Mental Health Matters: Importance, Integration, and Intervention Opportunities

(Note: this guest piece was written by Elizabeth Archer-Nanda, DNP, APRN, PMHCNS-BC. Elizabeth is the manager of the Behavioral Oncology Program at Norton Healthcare, which cares for the emotional and mental health needs of oncology patients and their families. In this piece, she shares her reflections from the KHC 2019 Annual Conference, which she attended.)

Last month, the Kentuckiana Health Collaborative hosted their fifth annual conference focusing on opportunities to create high value behavioral healthcare across the region. The room was full of community and national partners and offered comprehensive discussions around closing the gap on how to approach the treatment of mental health and substance use disorders. Speakers gave personal reflections on the impact mental illness has on individuals close to them as well as prospects for how purchasers and stakeholders may address foundational barriers to quality mental health care.

Paul Gionfriddo, President and CEO of Mental Health America, Inc. provided an overview of mental health services in the U.S. from 1970 to current day by poignantly comparing and contrasting his family’s experiences navigating mental health services for his son, Tim, versus medical care for his daughter, Larissa.

Although Larissa ultimately died due to breast cancer at age 34, her health journey was met with opportunity for personal growth throughout her four-year illness. Tim’s health journey, however, which began at age five and now spans close to three decades, has been riddled with years of pending diagnoses, deteriorating mental health, homelessness, and – on more than one occasion – imprisonment.

Following Gionfriddo’s talk, Mike Thompson highlighted that for mental health care to be truly accessible, barriers must be removed, including:

  • eliminating obstacles to provider credentialing,
  • improving, vastly, the mental health provider reimbursement models, and
  • Increasing incentives to attract psychiatrically trained providers to work within health systems where the majority of patients are receiving care.

The impetus for these recommendations is solid. The prevalence of mental health conditions far exceeds the number of available psychiatric providers trained to treat these conditions. The healthcare system must begin to think creatively regarding how to care for individuals with mental health conditions. Only 20 percent of individuals with co-occurring mental health conditions will receive specialty mental health and/or substance use care intervention. Meanwhile, approximately 21 percent receive care through routine primary care; this leaves the remaining 59 percent of individuals not to receive care at all (Robinson & Reiter, 2016). The ability to weave the care of mental health conditions throughout routine care provides an enhanced opportunity to promote earlier intervention and adequate treatment for co-occurring mental health and substance use conditions.

Both presenters reinforced the 2017 position statement by the American Psychiatric Nurses Association that “whole health begins with mental health.” Specifically, the negative impacts of mental health and substance use on our productivity and wellness as a nation are widely known, yet movement toward early intervention for mental health conditions remains scarce in most communities.

This is reflected in the research.

Approximately 56 million American adults experience mental health or substance use conditions each year, with three-quarters of all chronic mental health conditions beginning by age 24 and the first intervention occurring almost 10 years later. Among individuals affiliated, 68 percent have co-occurring medical conditions, as was discussed by Intermountain Healthcare’s Brenda Reiss-Brennan at last year’s KHC Annual Conference. Further, worldwide depression is the leading cause of disability and by 2020 it is estimated that there will be one death by suicide every 20 seconds. Lastly, the cost of (untreated) mental health and substance use conditions in the U.S. is equally staggering at $201 billion annually – exceeding all other conditions.

A shift must occur in which we build systems capable of caring for a whole person’s health needs at the onset of symptom distress across their healthcare journey, rather than providing reactive crisis related care intervention. An individual’s health relies on their mental health to fully embrace the challenges presented in life. The ability to access care that embraces mental health as part of personhood is needed in order to truly promote health and wellness.

Gionfriddo’s honest account of two of his children’s journeys highlighted the disparity experienced among those with mental illness. He urged attendees to consider what might be if mental health conditions were met with the same resource allocation as other illnesses. What might happen if instead of attempting to “rescue” individuals from already debilitating symptoms of mental illness, earlier intervention strategies were employed to treat individuals before advanced stages of mental illness?  

As a psychiatric advanced practice nurse embedded within an oncology setting, we widely recognize the disadvantage of a later stage cancer diagnosis. The campaign launched by Mental Health America to treat mental illness before stage IV should not be a goal that is considered unattainable; rather, it is a call to action for each of us to begin movement toward reducing barriers to care and enhancing lives.

“High Value Behavioral Healthcare” Speakers Answer Your Questions

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

We packed a ton of great content into a small amount of time, so we didn’t get to all of the questions submitted by participants on our web application.

Let’s remedy that.

The KHC has spent the last couple of weeks following up with speakers on these questions, and we’ve compiled them below. Note that some answers have been edited for space.


“For Mental Health, Let’s Act Before Stage 4”

Paul Gionfriddo | President and CEO | Mental Health America

In other countries they have programs to integrate mental health treatment and the community. What do you think the barriers are to doing that in the US?

We tend to favor the system with which we have the most experience. In the United States, that has been characterized by separate and unequal care, first in state hospitals, now in jails and prisons, for people with mental illnesses. Our challenge is to change the way we think about mental health conditions, because thinking about them as public safety concerns (i.e. dangerous to self or others) makes it hard to fully integrate the services and treatment for them into the community.

How do we get people to seek treatment without the fear of retribution or ostracization?

First, we should screen everyone for mental health conditions as ubiquitously as we screen for blood pressure in adults, and hearing and vision in children. That’s what’s recommended for everyone over the age of 11 by the U.S. Preventive Services Task Force, but it’s just not done. By screening, we normalize mental health and mental health care and make this a part of overall health and health care. And then we can treat right away when it’s warranted, instead of letting up to ten years pass between the emergence of symptoms and getting the right diagnosis and treatment.


“Roadmap for Employers to Achieve High Value Behavioral Healthcare”

Mike Thompson | President and CEO | National Alliance of Healthcare Purchaser Coalitions

The National Alliance recommends ensuring health plans have network adequacy for behavioral health services. How is this best measured?

Most health plans have directory of network psychiatrists. However, few know whether those psychiatrists are taking new patients – ask them, by specialty if possible (eg child psychiatrists), what percentage of network behavioral health specialists are taking new patients.

Most health plans measure access to network providers by driving distance but few know or monitor how long it takes to schedule an appointment – ask them, by specialty if possible, what is the average wait time for an appointment for a new patient?

Most health plans will indicate that it is difficult to get behavioral health specialists to join networks but few have taken a positive step toward change this trend – ask them, by specialty if possible, how do network reimbursement rates for behavioral health specialists compare to non-behavioral health specialists? How do network reimbursement rates compare to out-of-network charges for behavioral health specialists? What is you plan to improve network participation rates of behavioral health specialist?

What do you think has shifted within our world society to now have this be recognized as a top 5 issues when it’s always been perceived as a personal and economic issue?

Three things that have contributed to Mental Health rising to be among the top issues facing companies and organizations globally:

1) growing recognition of the huge and disproportionate economic impact of the issue to companies and societies, well beyond the costs of treatment (e.g. impact on co-morbidity, impact on productivity. Impact on caregivers).

2) growing understanding of the physical and environment underpinning of behavioral health issues (genetics, social determinants and trauma, brain science) as well as how to prevent and treat it.

3) cultural change giving a growing voice to its wide prevalence and new acceptance as a human condition rather than a character flaw. This has been led by advocates, celebrities, businesses and policy makers.


“Unaddressed Drivers of Poor Mental Health (PANEL)”

Aja Barber | Community Health Administrator, Center for Health Equity | Louisville Metro Dept of Public Health

When is the next Health Equity Report slated to be released?

In keeping with the timeline so far, we’re anticipating releasing a 2020 or 2021 Health Equity Report.

From the CHE perspective, what can be done on a policy level to help close mental health disparities throughout our community?

We’re currently in process of building the legislative agenda for Public Health & Wellness so I don’t have a specific answer to this yet. But I do believe policies ensuring physical and mental healthcare as a guaranteed right for every individual are critical first steps.

Danesh Mazloomdoost, MD | Founder | Wellward Regenerative Medicine

What can we do as community members, professionals, and advocates for change to get the appropriate word out about the model that Wellward works off of?

Wellward looks for opportunities to work with the community and educating both patients and clinicians on this paradigm shift in addressing painful conditions. Any opportunity to speak or inform the public about Fifty Shades of Pain would be welcomed. While the book became an international bestseller, any purchase or review helps boost its visibility to the public, even a $0.99 Kindle purchase does a lot. Our goal is to simply create greater awareness about sustainable ways to think about pain in improved the health of our community such that pain problems become less prevalent. Your assistance in spreading that message in any capacity is helpful.


“Incenting Recovery Rather than Relapse through Bundled Payments (PANEL)”

Kelly Clark, MD | Founder, Addiction Crisis Solutions | President, American Society of Addiction Medicine

David Smith | Founder| Third Horizon Strategies

In a bundled payment model for medications treatment for Opioid Use Disorder, what non medicine therapies should be included?

Clark: In the PCOAT payment model, medications themselves are not core services/products being delivered.  The core elements to be covered are those consistent with the ASAM Guidelines for Use of Medications in the Treatment of Addiction Involving Opioids: Medical services for diagnosis, treatment planning and medication management; core psychosocial interventions including the levels of counselling which can be done by the prescriber with sufficient time and expertise; and care coordination activities.  There are different approaches in this bundle, depending on the capacity and capabilities of the provider/provider group.  More information can be found here.

Smith: We would be deferential to the professionals empaneled to provide care for the patient. The entire ARMH-APM turns on the axis of a treatment and recovery plan that addresses a range of mental and social considerations (in addition to clinical) that support a patient’s recovery. The clinical professionals and support teams that work with the patients are required to work with the patient in identifying specific therapies, in addition to addressing exogenous determinants that would interfere with the recovery plan and facilitate resources accordingly. The concept APM does set general guidelines regarding the need for evidence-based approaches to therapies holistically, but we also believe that the payment mechanism and the associated risk will play a role in motivating the underlying delivery system to provide non-medical services and therapies in a way that will sustain impact.

How do we move to a model that values quality care and implements metrics around performance?

Clark: We start by defining quality and performance. We can use the Triple Aim concept of Value = Quality/Cost, but quality of care in medical systems is an ever-expanding construct…Beginning by ensuring baseline process measures are used to ensure standards of care are being met – we don’t want to incent performance of cost savings by allowing care considered not to meet baseline standard of care quality metrics…Next, we need to consider the goals of managing chronic diseases: Decreased disease related morbidity, early mortality, total cost of care, and increased functioning/quality of life…To be operationalized, “Quality” is a very granular concept, and we must move boldly ahead to save lives.

Smith: It’s a collaborative enterprise and requires a payer to lean into a payment model that provides adequate resources for care that has a long-term orientation and supports the delivery system in its integration for the purpose of a more seamless patient experience. Our approach is to facilitate this through a risk-bearing provider entity capable of centrally managing a care team and the associated care transitions through a network of providers that engage the patient based on need and subsequently (or initially, depending on the patient) supports the patient’s assimilation back into their environment (or a new environment depending on the underlying circumstances).

Why don’t all clinics require counseling along with the administration of these medications? How is a patient supposed to differentiate between these clinics?

Clark: In an ideal world, people with any disease would have access to whatever interventions they need to help them manage their chronic disease at the time they need it, and also have access to things which would possibly benefit them. In the case of addiction, an individual at one point in time may require 24-hour care in addition to ongoing medication management, or require intensive outpatient care at another point in time, or require no further outpatient services than meetings with their prescriber. There is no one size fits all… 

We do not expect people with brain or other diseases to “talk their way out of their illness.” The currently available data we have for opioid addiction does not show improved outcomes by adding 60-minute formal counselling sessions to the regular physician medication management visits (which include supportive counselling and other techniques)…And forcing people into higher than needed levels of care does not improve outcomes – I have seen it simply discourage them from receiving the care they do need. Finally, there are structural and payment barriers to providing psychotherapy (done by licensed masters level professionals) in the same offices as prescribers which include licensing and payment issues as well as a shortage of either psychotherapists or counselors of lower educational requirements.

Patients and their families currently have few ways to determine the quality of care being provided by any provider or program. The ASAM/CARF certification, as well as the proposed Shatterproof rating system, are looking to make information about programs more transparent by means of independent site surveys (ASAM/CARF) or provider/patient/payer data collection (Shatterproof).

Patients with opioid addiction and their families can look here for information:

http://eguideline.guidelinecentral.com/i/706017-asam-opioid-patient-piece/0?

https://store.samhsa.gov/product/Finding-Quality-Treatment-for-Substance-Use-Disorders/PEP18-TREATMENT-LOC

The Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Where are these programs being piloted?

Clark: The P-COAT model does not currently have formal piloting occurring, but it does delineate the types of bundled payment approaches which are already being provided in some communities by forward thinking health plans working with engaged providers. 

Smith: Like everything in health care, we are living under our potential. We don’t get the results we pay for and have developed a delivery system that receives enormous financial benefit when patients have a recovery disruption or cycle through recovery. Our perverse incentives prevent us from driving the type of alignment across this diffuse ecosystem of resources that does a tremendous disservice to patients and their families.

Are recovery models serving people equally across socio-economic levels, including the homeless?

Smith: Today, no, not generally (in my opinion). This is where we need to go. Most Americans can access some form of coverage (non-expansion states notwithstanding). Even for those Americans unable to access coverage, the financial burden of addiction on our entire emergency infrastructure creates an economic rationale for society to provide these services. If we build a delivery model that supports this and link patients under the auspices of their coverage/non-coverage considerations, an underlying economic calculus that isolates value for parties (government, society, payer, etc.) should be a catalyst for establishing the right access to services for patients.

KHC Continues Conversation Around Behavioral Health with Successful Annual Conference

At the KHC 2018 Annual Conference, “Connecting Mental and Physical Health,” our organization pledged to continue to focus on the what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. In addition to the many projects and grants related to behavioral health that we’ve had in the last year, our KHC 2019 Annual Conference continued the conversation started in 2018, titled “High Value Behavioral Healthcare.”

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Details about the conference agenda and speakers can be found here, but some of the highlights included:

  • A motivating opening speech by Mental Health America President and CEO Paul Gionfriddo, which got a standing ovation – a first ever for the KHC Annual Conference. If you are unfamiliar with Gionfriddo’s story or work, take few minutes to read his essay for “Health Affairs.”
  • An employer roadmap for achieving high value behavioral healthcare, developed by the National Alliance of Healthcare Purchaser Coalitions, to ensure that organizations’ health plans drive high value care.
  • Panels on the unaddressed drivers and contributors of behavioral health and new bundled payments to incent addiction recovery. Stay tuned for follow-ups with more discussion from these panelists on our blog!
  • A story of successful implementation of behavioral telehealth medical services by the Kentucky Employees’ Health Plan, presented by Commissioner Jenny Goins.

New Strategies Improve Interaction, Engagement

A record 212 individuals attended this year’s conference, and 75 of those individuals attended the pre-conference reception the evening before the conference, where they were able to meet with other attendees, conference speakers, sponsors, and exhibitors. Although always a challenging endeavor because of people’s demanding schedules, there was an increase of more the 40% in attendance and more food had to be ordered to accommodate. A fantastic problem to have!

KHC 2019 Annual Conference attendees listen to a panel.

The KHC also implemented a new system of commenting and asking questions, through Slido.com, which allowed more questions to be asked more efficiently. Compared to the previous app that we had used, this got a lot more engagement. We were able to archive additional questions that weren’t addressed and followed up with our speakers on them – stay tuned for those answers, coming soon!

The comments received from participants were overall very positive and educational. We are reviewing the feedback now and will use it to guide our future conference planning.

KHC conference achieved directive and financial objectives

The KHC staff, Executive Committee, and members appreciate our community coming together for another outstanding conference examining how to create a high value behavioral healthcare system. The conference met attendee’s expectations and provided finances to further the work of the KHC. The success of the conference would not have been possible without the support of our sponsors and exhibitors. A huge thank you to our Gold sponsors Pacira Pharmaceutical and Artemis Health, who each presented a showcase. An immense thank you to our partner Norton Healthcare, who has been a Silver sponsor for the fifth year. We also want to thank our partners Kentucky Primary Care Association and LG&E-KU for being Bronze sponsors. This year many of our partners and community organizations sponsored tables, allowing many of their employees and associates to attend the conference. A big thank you to table sponsors Norton Healthcare, Baptist Health, CHI Saint Joseph Health Partners/Our Lady of Peace, Anthem, Novo Nordisk, Department of Behavioral Health, Developmental, and Intellectual Disabilities, Trager Institute, Blue and Co. CPA, Commonwealth of Kentucky Personnel Cabinet, and Louisville Society of Human Resource Management. A pre-conference reception allowed attendees, exhibitors, and speakers to network. Thank you to Humana for sponsoring the reception. Finally, we want to say thank you to all of the exhibitors and attendees who participated in this year’s conference.

There is no rest when it comes to the KHC Annual Conference, so we’ve already begun planning the KHC 2020 Annual Conference, our sixth. Save the date for March 11, 2020, and stay tuned for the conference title!

KHC Fifth Annual Conference to Focus on High Value Behavioral Healthcare

On March 5, the KHC’s annual conference will move from a broad based view of value-based healthcare innovation to a deep dive into what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. This conference will examine how employers, payers, and providers can ensure individuals have access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Mental health and substance use disorder continues to rise to the top of many healthcare purchasers’ costliest and most prevalent conditions. Yet, these conditions are not treated by plans and providers the same way as physical health conditions. In fact, mental health is the only chronic disease in America that is not treated until Stage IV. And individuals facing substance use disorder continue to receive treatment that does not comply with current medical recommendations. Research consistently demonstrates smaller payments to behavioral health providers and higher out-of-network use for patients with mental health and substance use disorders, despite parity being law. All of these barriers create a system that often does not meet individuals’ behavioral healthcare needs.

The night before the conference a networking reception will be held, during which a short role-playing exercise by local high school students and a psychologist will demonstrate to attendees how adults and students can have positive mental health dialogue. Appetizers and drinks will be served, and exhibitors will be available.

The morning of the annual conference will kick off with Paul Gionfriddo, President and CEO of Mental Health America. Gionfriddo will provide an overview of mental health status and access in the United States, with a personal reflection on how, through policy decisions, he helped create a flawed mental health system that has failed millions, including his son.

Dr. Stephen O’Connor, University of Louisville Department of Psychiatry and Behavioral Sciences, will moderate four panelists, who will discuss several drivers and contributors to poor mental health often overlooked:

  • Dr. Joseph Bargione, a school psychologist, will discuss how healthcare networks can address adverse childhood experiences (ACEs) in patients
  • Dr. Danesh Mazloomost, anesthesiologist and pain management specialist, will discuss a new framework for treating pain that avoids addiction and has better outcomes
  • Aja Barber from Louisville Metro’s Center for Health Equity will explain how the relationship between mental health, social determinants of health, and institutionalized systems of power/oppression keep us from experiencing the kind of world we all deserve
  • Allison Tu, StAMINA and student at duPont Manual High School, will share youth insights into the factors influencing mental health from a series of focus groups conducted with high schoolers across Kentucky

Mike Thompson, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, will discuss the roadmap and checklist his organization developed for employers to use in designing high value behavioral healthcare. All attendees will receive a copy of the roadmap, which includes an assessment of current performance of health plans and behavioral health organizations across key areas. The KHC is a member of the National Alliance, which represents more than 50 business coalitions in the U.S., supporting more than 12,000 healthcare purchasers and 45 million Americans.

A light continues to shine on the fact that many patients do not get appropriate treatment for substance use disorder. As a result, two new payment models have been designed to help incent effective treatment and recovery. Dr. Kelly Clark, an addiction psychiatrist and the President of the American Society of Addiction Medicine, will present the new Patient-Centered Opioid Addiction Treatment (P-COAT). The model is designed to increase the utilization of office-based treatment of opioid use disorder by providing adequate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological, and social support services. David Smith from Third Horizon Strategies will then discuss the new Addiction Recovery Medical Home (ARMH) receiving significant national attention. The model establishes a continuum of care from the time a patient enters an acute-care setting and is diagnosed with a substance use disorder through their recovery process. ARMH incorporates quality payments and bonuses for achieving certain outcomes and cost savings.

Telehealth has quickly gained the attention of employers and payers working to increase network adequacy of medical and behavioral health providers. Commissioner Jenny Goins will present examples of how Kentucky’s Department of Employee Insurance has implemented telehealth behavioral health along with the data related to utilization and financial savings.

Dr. Diana Han, Global Medical Director for Louisville-based GE Appliances, a Haier company will explore the reactions of local health plans to the day’s presentations. She will discuss with plans how their organizations are innovating to help individuals gain access to timely, effective, and affordable behavioral healthcare. Eric Bailly from Anthem and Dr. Stephen Houghland from Passport Health Plan will discuss their latest strategies to address network adequacy of high quality behavioral health services to their members.

Several other behavioral health innovations will be highlighted at the conference as well. Attendees will learn about a new non-opioid alternative for reducing opioid exposure post-surgery. A new MOMS Partnership that makes mental health within reach of over-burdened, under-resourced mothers will be presented. The KHC will will share the six priority behavioral healthcare measures selected to align Kentucky’s primary care providers and will provide a sneak peek into the soon-to-be released toolkit for employers on benefit design and workplace policies for supporting prevention, treatment, and recovery.

The conference will provide excellent networking opportunities for all types of healthcare stakeholders. Over 20 exhibitors will be available to discuss their latest products and services. If you have any questions about the conference, be sure to call the KHC office at 502-238-3603 or email info@khcollaborative.org. We hope to see you there next month!

Photo Gallery: 2018 KHC Conference

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KHC Annual Conference Meets Organization Goals, Starts Conversation Around Mental Health

Mike Veny demonstrates how drumming has helped him cope with mental illness.

Despite the second nor’easter in two years to interfere with our annual conference speakers’ flights, the Kentuckiana Health Collaborative was able to pull off 16 live speakers for this year’s conference, and they did not disappoint.

Day started with big picture ideas, moved into more narrowed focus presentations

Keynote speaker and advocate Mike Veny kicked off the conference by illustrating the challenges and triumphs he had experienced as a child and adult living with depression, anxiety, and obsessive-compulsive disorder. He explained how stigma starts with shame and how we can transform shame by breaking the silence about mental health issues and self-care. Brenda Reiss-Brennan, PhD, APRN, discussed how Utah-based Intermountain Healthcare created a Mental Health Integration program for patients that made mental health evaluation and service part of the routine care. Their 10-year study including more than 100,000 patients demonstrated improved outcomes, enhanced patient experience, and improved value. Similar to mental health integration, Kristin Kroeger from the American Psychiatric Association and Dr. Anna Ratzliff from University of Washington’s Department of Psychiatry discussed how the Collaborative Care Model can also expand access to mental health and substance use disorder (SUD) services and treatment in primary care.

Samantha Arsenault kicked off the more-focused talks and panels on addiction and SUD by outlining Shatterproof’s core components of good care in the National Principles of Care. A panel followed with Dr. Kelly Clark, American Society of Addiction Medicine, Scott Hesseltine, Centerstone Kentucky, and Matt La Rocco, Louisville Metro Department of Public Health and Wellness, to discuss the latest scientific advancements around opioid addiction treatment. While the panelists agreed on many points, there was lively debate, as Dr. Stephen Houghland of Passport Health Plan moderated the discussion. Gaye Fortner of the HealthCare 21 Business Coalition in Knoxville, Tenn., shared several strategies employers must take to deal with the many workforce and benefit challenges of addiction.

Barbra Cave, APRN, University of Louisville Physicians’ Gastroenterology Hepatology, kept a room full of 200 people during lunch engaged in a presentation about Hepatitis C through her sheer energy, passion, and clear commitment to helping every single person with Hepatitis C reach a cure.

Anyone following the news today has seen the rise of student activism, and Louisville has its own star student activist, Allison Tu, a Junior at Manual High School and Founder of the Student Alliance for Mental Health Innovation and Action (StAMINA). Allison presented why students need to be solution partners to help address Kentucky’s youth mental health issues, what her student-led group has planned, and unveiled the launch of their new website, www.staminaky.com.

Conference wrapped up with KHC mental health activities

Stephanie Clouser of the KHC began the closing stretch of the conference by highlighting the KHC’s work around mental health and SUD:

  1. Served on National Quality Forum’s team to develop the National Quality Partners Playbook™: Opioid Stewardship
  2. Developing a provider tool for Screening, Brief Intervention, and Referral to Treatment (SBIRT) through the Kentucky Opioid Response Effort (KORE) grant
  3. Planned development of an employer toolkit around mental health and SUD through a KORE grant
  4. Convening of a new mental health workgroup
  5. Serving on Louisville Metro Department of Public Health’s Opioid Action Team, which developed a two-year action plan for addressing substance abuse in Louisville

Dr. Katie Marks from KORE reiterated KORE and KHC’s partnership and also highlighted KORE’s overall efforts to expand access to high quality, evidence-based opioid prevention, treatment, recovery, and harm reduction services and supports. Dr. Diana Han, KHC Co-Chair, closed the conference by discussing GE Appliances, a Haier Company’s commitment to helping address the mental health and substance use issues of our community through both sweat and financial equity. She gave a passionate plea for the need for an all hands on deck approach to dealing with the mental health and SUD crisis of our community and invited interested participants to join the KHC and others’ efforts.

Event met KHC quality and financial goals

The KHC team was proud of this year’s conference and was thrilled to meet both event satisfaction and financial goals. The KHC staff, Executive Committee, and members put in a lot of hard work each year to make the conference possible. Our sponsors deserve a lot of credit, and we want to thank our gold sponsor, Artemis Health, who co-presented their data analytics work with GE Appliances to demonstrate how they had identified and prioritized improvements needed for SUD care using health plan data. Another big thank you goes to our partners at Norton Healthcare and Kentucky Primary Care Association for being our silver sponsors and leading the best stretch breaks ever held at the KHC’s annual conference. We also want to thank Alkermes for their bronze sponsorship this year. Our friends from Anthem, Family Health Centers, Kentucky One Health, and Novo Nordisk also deserve a big thank you for being table sponsors and bringing several team members from their organizations to attend the conference. We want to also thank all of the exhibitors and attendees who participated in this year’s conference.

We know that to improve the mental health of our community, key healthcare stakeholders will need to collaborate to make systemic cultural and organizational changes. We hope the conference served as a catalyst to spark innovative approaches, strategies, and partnerships to drive improvements our community so desperately needs. While a conference like this is important to bring together conversation in this area, it is imperative to not let it end there.

The Complete Guide to Workplace Mental Health

(Note: This column was written by Mike Veny, CEO for Mike Veny, Inc. and one of America’s leading mental health speakers. Veny will speak at the KHC Annual Conference on March 13-14 in Louisville. This column was originally published on Veny’s “Transforming Stigma” website.)

Mike Veny

Jobs and careers are supposed to be a good thing, right? Your job should provide a place where you can use your gifts, talents, and education to make a difference in this world, big or small. It should be a place where you can build confidence and excel. However, that isn’t what it is for many people. Reports show that when it comes to workplace mental health, most people find their job mentally unhealthy. That means that for many people, work is just another place that is pulling them down and adding to the weight they are already carrying.

Why is Mental Health Important in the Workplace?

Take a look at these statistics:

I could list pages and pages of statistics like this for you, but I think you get the point. Mental health is a big deal in the workplace. There are hundreds of millions of people that are already dealing with mental health challenges on a regular basis, and they don’t need to add to these challenges while at work. Creating an environment for good workplace mental health benefits the economy as a whole and each individual employee.

To read the rest of this article, with information about what depression in the workplace looks like, creating the optimal environment to tackle the issue, and creating a plan to improve workplace mental health, click here.

Moving Past the Stigma of Addiction: Implementing National Principles of Care

(Note: this column was written by Samantha Arsenault, Director of National Treatment Quality Initiatives at Shatterproof, a national nonprofit organization dedicated to ending the devastation addiction causes families. Samantha will speak at the 2018 KHC Annual Conference.)

Samantha Arsenhault

In the past year, 20.1 million Americans had a substance use disorder (SUD), of which more than 2 million were addicted to opioids. Approximately 90,000 Americans die every year related to the misuse of alcohol, and in 2016, 63,600 people died of a drug overdose. Of those, approximately two-thirds were related to prescription or illicit opioids. In addition to rising mortality and morbidity, the cost of the opioid crisis to our society in lost productivity, healthcare, and criminal justice costs exceeds $500 billion per year.

Many of us are all too familiar with these statistics. In fact, addiction affects 1 in 3 people in the US. Yet, many people are not aware that addiction is a chronic relapsing disease, or that decades of scientific evidence has shown that it can be treated with the same effectiveness as other chronic illnesses, such as diabetes or hypertension. Evidence-based SUD treatment can reduce the risk of overdose while improving outcomes and reducing costs.

What is “good” addiction treatment?

Unfortunately, there is no one-size-fits-all model. There is no standard programmatic combination or duration of medications, behavioral therapies, or social supports that will reliably bring about recovery for all those affected with SUD. Individuals with SUDs vary substantially in the nature, complexity and severity of their health problems as such, treatment should include an individualized combination of FDA-approved medications, behavioral therapies, and social supports to reduce or eliminate the substance use and to improve general health and function. The National Principles of Care for SUD Treatment are core components of addiction treatment that are shown to improve patient outcomes. These include:

  1. Universal screening for substance use disorders (SUDs) across medical care settings
  2. Rapid access to appropriate SUD care
  3. Personalized diagnosis, assessment, and treatment planning
  4. Engagement in continuing long-term outpatient care with monitoring and adjustments to treatment
  5. Concurrent, coordinated care for physical and mental illness
  6. Access to fully trained and accredited behavioral health professionals
  7. Access to FDA-approved medications
  8. Access to non-medical recovery support services

Implementing the National Principles of Care

There is a deadly stigma around addiction – a misconception that it is a moral failing rather than a manageable disease. Stigma causes individuals to suffer in silence rather than seek life-saving help and has resulted in a fragmented treatment system separate from mainstream healthcare. Currently, only one in ten people with an SUD receives any form of treatment, and many of those receive care that is absent of the evidence-based best practices highlighted above. This can result in poor outcomes and significant costs for patients and families seeking help, as well as a blemished reputation for the field.

While legislative and regulatory mechanisms, including the Mental Health Parity and Addiction Equity Act and Affordable Care Act require insurance coverage of addiction treatment at par with other medical conditions, and the passage of the Comprehensive Addiction Recovery Act (CARA) and Twenty-First Century Cures Act seek to expand prevention, education, and treatment around this disease, there has been slow adoption of life-saving treatment modalities.

Shatterproof is a national nonprofit organization dedicated to ending the devastation that addiction causes families and the lead convener of the Substance Use Disorder Treatment Task Force. This coalition of key stakeholders and experts in addiction treatment is working to close the gap between the tragic outcomes of those suffering from SUDs and the promise of effective treatment. Currently, this work is focused in four key areas: payer-based strategies, provider practices, consumer education, and legislative and regulatory policies.

In addition to the responsibility to cover mental health and addiction treatment at parity with physical health conditions, payers can influence access, availability, and delivery of evidence-based treatment modalities. The first deliverable of the Task Force was a publicly signed agreement by sixteen large insurers, representing more than 248 million lives, to recognize and adopt the National Principles of Care. The agreement among payers included a commitment to identify, promote, and reward addiction treatment practices consonant with the Principles. The Task Force is now working with payers to adopt strategies which reduce barriers and incentivize high quality care.

Groups across the country, big and small, are working to reverse stigma and improv access to life-saving addiction treatment. Join us at the Fourth Annual KHC Conference to learn more about 1) the core components of evidence-based addiction treatment, and 2) understand current systemic barriers and opportunities to changing this system.

Achieving Population Health through Mental Health Integration & Team-Based Care

KHC 4th Annual Conference Preview and Guest Blog: Scott Hammer, Project Manager – Strategy & Operations, Mental Health Integration (MHI), Intermountain Healthcare

One in five adults in the U.S, and nearly 43 million people, experience mental illness during a given year. The cost associated to lost productivity in America for mental illness is $193 billion annually, according to the National Alliance on Mental Illness. The majority of Americans suffering from mental illness and substance abuse disorders seek treatment in primary care facilities.

Integrating mental and physical health care is imperative to delivering whole-person care and helping patients live the healthiest lives possible. Properly diagnosing and treating mental disorders in primary care through an effective integrated care team is vital to the delivery of high quality care and achieving population health.
Intermountain Healthcare aims to deliver the highest quality of care at the lowest possible cost to patients through the delivery of Mental Health Integration (MHI) and Team-Based Care (TBC). The TBC model provides a standardized clinical and operational care process that engages patients and families in primary care, and incorporates mental health resources and supports. In 2000, Intermountain embedded mental health screening and treatment within its primary care physician offices, investing in mental health integration. Today, it continues to utilize this approach to help patients with mental illness and to properly manage and treat their conditions.

In 2016, a 10-year Intermountain Healthcare study in JAMA called “Association of Integrated Team-Based Care with Health Care Quality, Utilization, and Cost” identified the effectiveness of integrating mental and physical health. This landmark study demonstrated that integrating mental health in primary care by utilizing the Team-Based Care model produced dramatically better patient outcomes, more appropriate utilization of health care services, and lower costs.

The study results showed:

  • A higher rate of patients screened for depression — A 22 percent increase.
  • A lower rate of emergency room visits – A reduction of 23 percent.
  • A lower rate of hospital admissions – A reduction of 10.6 percent.
  • Better patient care through improved care management – Primary care physician encounters reduced by 7.0 percent.
  • Lower payments to providers – $3,400 for patients in team-based practices versus $3,515 for patients in traditional practices for a savings of 3.3 percent.

For patients, the bottom line is that getting care in a Team-Based Care setting where medical providers work hand-in-hand with mental health providers, results in higher screening rates, more proactive treatment, and better clinical outcomes for complex chronic disease.

TBC has shown to be successful with MHI, and shows potential to be scaled and extended to many disease states, conditions, and patient demographics. Within Intermountain, this team structure has provided the foundation for Personalized Primary Care (PPC) and has standardized the TBC strategy for population health management. While this approach requires sustained investment in leadership, clinical and analytic workforce, robust information systems, and quality incentives, the savings towards health care providers exceeds the cost, and is sustainable.
In a value-based world, TBC and MHI will be critical components of population health. The elements of Team-Based Care will allow for organizations to realize the benefits of population health, increasing savings, and providing whole-person, high quality of care for patients.

If you want to learn more about Intermountain’s mental health integration work, be sure to REGISTER for the KHC’s annual conference on March 13-14, 2018 to hear from Brenda Reiss-Brennan, PhD, Mental Health Integration Director, Intermountain Healthcare.

Mental Health Integration: the Focus of 2018 Annual KHC Conference

In planning our 2018 annual conference, the KHC Executive Committee quickly identified mental and physical health integration as the focus, a clear indication that mental health has become the priority for many our key healthcare stakeholders.

We know that our community is facing alarming rates of mental health issues, including substance use disorders. Kentucky has three times as many deaths to suicide as homicide, and overdose deaths are rising at unprecedented rates. Nearly a third of Kentucky high school students report they feel sad or hopeless, according to the U.S. Department of Health and Human Services. Kentucky leads the nation in many of the risk factors linked to poor mental health such as poor physical health, sedentary lifestyle, poor diet, smoking, and poverty. Stress, trauma, and negative coping skills are also significant risk factors for developing depression, anxiety, and substance use disorders.

Despite these statistics, persons with mental illness are under-identified and under-treated. Primary care providers are the backbone of the healthcare delivery system and are seeing a greater volume of patients with mental health issues than even mental health providers. They “prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States,” according to researchers. Patients dying by suicide see primary care more than twice as often as mental health providers and 45 percent saw a primary care clinician in the month before their death (see research).

The World Health Organization has called integrating mental health services into primary care as the most viable way of closing the treatment gap for untreated mental illnesses. Integrated models of care are seeing success in communities across the country, including the Collaborative Care Model developed jointly by the American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM). The Collaborative Care Model and other integrated care models work to better meet the whole health needs of people with mental health conditions.

The barriers individuals face in getting mental health services are many and go well beyond the healthcare delivery system. One of the biggest barriers to individuals seeking treatment is the stigma associated with mental illness. The KHC conference will feature keynote speaker Mike Veny, who will discuss his personal journey and how mental health stigma can be transformed (see keynote highlights here).

The KHC annual conference will be held on March 14, 2018. Registration will open in October. The conference will feature evidenced-based approaches, best practices, and successful models of addressing mental health and integrating care. Topics for the day include:

  • Mental Health Stigma
  • StAMINA – Student Alliance for Mental Health Innovation and Action
  • Collaborative Care Model
  • Integrated Care Models
  • Addiction Treatment Models
  • Mental Health Co-Morbidities, Hepatitis C
  • Mental Health Innovation and Technology
  • Successful Employer Models of Improving Mental Health

Having a mentally healthy community means that each of us are better able to function during stressful situations, form good interpersonal relationships, set and achieve realistic goals, seek help during difficult times, and enjoy life to the fullest.  To improve the mental health of our community, key healthcare stakeholders will need to collaborate to make systemic cultural and organizational changes. The KHC is currently investigating how to best support efforts to increase effective mental health prevention and treatment services for Kentuckiana youth and adults and will be announcing its plans at the 2018 KHC conference.