The majority of Medicaid beneficiaries feel that the medical care they receive is patient-centered, accessible and well-coordinated between primary care providers and specialists, according to a Virginia Commonwealth University-led study.

In an article published this month in the journal Health Affairs, Peter Cunningham, professor in the Department of Healthcare Policy and Research at the VCU School of Medicine, examined the prevalence of five aspects of the patient-centered medical home model among the Medicaid population from the perspective of Medicaid patients. Most Medicaid beneficiaries with no other coverage and a continuing source of primary care described the care they receive as consistent with at least three of five key attributes of the patient-centered medical home model.

“Patient-centered medical homes are a way of delivering primary care that stresses the patient experience,” Cunningham said. “The patient-centered medical home model is one of the primary delivery system innovations in the health care system to try to improve quality of care and lower costs.”

Using nationally representative data from the U.S. Department of Health and Human Services’ Medical Expenditure Panel Survey, Cunningham focused on five key patient-centered medical home attributes — serving multiple health needs, accessibility of phone contact, extended office hours, coordination of prescriptions, and shared decision-making — to get an understanding of the number of Medicaid patients nationally who are in primary care practices that have some attributes of patient-centered medical homes.

He found that younger, healthier and higher-income Medicaid beneficiaries tended to report care sources with multiple attributes, compared with the older, sicker and lower-income beneficiaries, who may be more likely to benefit from access to such care.

“Those who have a primary care provider with a lot of patient-centered medical home characteristics tend to be young and healthy rather than older and sick,” Cunningham said. “However, the benefits of a patient-centered medical home will accrue more for patients who are older and sicker and have more complex health needs because they are the ones generating most of the costs and concerns regarding quality of care.”

Framework for Pyschosocial Treatment Standards to Treat Behavioral Health

A considerable gap exists in mental health and substance abuse treatments known as psychosocial interventions between what is known to be effective and those interventions that are commonly delivered, says a new report from the National Academies of Sciences, Engineering and Medicine. 

Mental health and substance use affect approximately 20 percent of the U.S. population, and often occur together.  Psychosocial interventions — such as psychotherapies, community-based treatments, vocational rehabilitation, peer support services, and integrated care interventions — aim to improve the health and well-being of those diagnosed with these disorders and are provided in a variety of settings and formats, including individual, family or group.  The new report presents a framework for implementing evidence-based psychosocial interventions.    

“A wide variety of psychosocial interventions play a major role in the treatment of mental health and substance use disorders, but most consumers of mental health care find it difficult to know whether they are receiving high-quality care,” said Mary Jane England, chair of the committee that carried out the study and wrote the report, and a clinical professor at the school of public health at Boston University. “The efficacy of a broad range of psychosocial interventions has been established through hundreds of randomized controlled clinical trials and numerous meta-analyses.  However, for many patients, the quality of care that is actually delivered is less than ideal.”

Psychosocial interventions that have been demonstrated to be effective in research settings are not used routinely in clinical practice or taught in educational programs that train mental health professionals, the committee found.   This gap between what is known to be effective and the care actually delivered is due to problems of access, insurance coverage, and fragmentation of care — which include different systems of providers, separation of primary and specialty care, and different entities sponsoring and paying for care.

The committee recommended that psychosocial interventions be elevated to equal regard as physical health care, measurement and improvement strategies used in mental health care be equated with those used in physical health care, and greater emphasis be given to context and infrastructure for high-quality psychosocial interventions.

Furthermore, it said, the U.S. Department of Health and Human Services should adopt the committee’s framework to support policy, research, and implementation strategies designed to promote the use of evidence-based psychosocial interventions. Steps in this iterative process framework are: strengthen the evidence base for interventions, identify key elements of effective interventions, conduct systematic reviews to inform clinical guidelines, develop quality measures to track the outcomes and effectiveness of interventions, and implement quality.