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Health Care Administration, Week 11 notes

by: Loretta Hellmann

Health Care Administration, Week 11 notes HCA 340 -002

Marketplace > Western Kentucky University > Nursing and Health Sciences > HCA 340 -002 > Health Care Administration Week 11 notes
Loretta Hellmann
GPA 3.75

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these notes are from week 11. next Thursday we have our second quiz and our research paper is due.
Steven W. Maddox
Class Notes
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This 10 page Class Notes was uploaded by Loretta Hellmann on Thursday April 14, 2016. The Class Notes belongs to HCA 340 -002 at Western Kentucky University taught by Steven W. Maddox in Spring 2016. Since its upload, it has received 27 views. For similar materials see HEALTH CARE ORG/MGT in Nursing and Health Sciences at Western Kentucky University.

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Date Created: 04/14/16
Week 11 notes Tuesday, April 12, 2016 9:35 AM Chapter 10 Mental Health Tuesday  Current background Mental health terminology changes:  "mental health care" often now called "behavioral health care" with psychiatric care, a medical subspecialty, one aspect of integrated services  "patient" replaced by "consumer" or "person/people" with a psychiatric or substance abuse disorder or "mental health issue"  "problem-based" diagnosis model replaced with "strength-based" model in "recovery Movement"  Historical Overview  Colonial era to 1800s: mentally ill confined to almshouses, jails, hospitals with no treatment, decrepit conditions 1800s: Quakers advocated "moral treatment" established 1814 Philadelphia "asylum"  WW1: "shell-shock" in returning military focused new attention on mental illness  Came back with PTSD or "shell shock" 1930s: First effective biological treatments: insulin coma, drug-induced convulsions, electroconvulsive therapy Post WWII, National Mental Health Act of 1946  National Institute of Mental Health (NIMH)  Dept. of Veterans' Affairs psychiatric hospitals and clinics By 1950s, still primarily inpatient- 1/2 M+ in state, county mental hospitals New drugs for schizophrenia, other psychotic disorder allowed ambulatory treatment  Partial hospitalization  After-care programs  Transitional residencies 1955: Joint Commission on Mental Illness and Health established by Congress, the first time a federal body considered resources for the mentally ill Attacked poor quality in county and state psychiatric hospitals 1960s  Mental health care reforms supported by president Kennedy  Additional, new pharmaceutical treatments  Federal Mental Retardation Facilities, Community Mental Health Centers Construction Acts  Medicare, Medicaid, Supplemental Security Income (SSI). Social Security Disability and housing subsidies accessible for mentally ill Until 1980s, payments on basic of units of service; no incentive for limiting treatments that went on for years. 1955-1980: treatment episodes quadrupled  Insurers balked with payment limits, discounted fee-for-service payments different from other medical care, "carve-out" outsourcing coverage to specialty managers, and capitation; "non-parity" for mental health services was established to plaque the mental health industry for decades. Deinstitutionalization (1970s-1980s)  Medicaid incentives to move patients from psychiatric hospitals to community boarding and nursing homes; community mental health centers inadequately staffed for severely mentally ill  Large numbers incarcerated, homeless  1950: 77% inpatient, 23% outpatient; 1990: 21% inpatient, 7% partial hospitalization, 67% outpatient Breakthrough developments- 1980s  NAMI (National Alliance on Mental Illness), HIMH clinical researchers' for advocacy re- defined mental illness from quantitative continuum to discontinuous in development; mental illness as biologically based, disorders more clearly defined requiring target treatments, not unfocused "talk therapies"  Carter's Presidential Commission on Mental Health sought applications of new research findings to benefit patients and reduce costs  Recommendations taken by Health and Human Services to expand psychosocial rehabilitation programs under Medicaid; Medicaid payment for outpatient services expanded; severely ill eligible for Supplemental Security Income  Expanded services severely curtailed in 1980s under Ronald Regan 1990-Present  Focus on sever mental illness with grants, federal support for research, training, not erroneous prevention strategies  Medicare Act of 2003 expanded drug coverage; CHIP (Child Health Insurance Program) increased coverage for low-income children; Wellstone-Domenici Parity Act of 2008 advanced equitable coverage for mentally ill  ACA of 2010 reinforced insurance parity  Recipients of Psychiatric and Behavioral Health Services Epidemiological Catchment Area and Co-morbidity Studies report  26.2% of Americans will have a mental disorder during any one year period, 57.7 M people  6%, subgroup classified as having "serious mental illness" with symptoms (excluding substance abuse) for at least 12 months  Neuropsychiatric disorders: the leading cause of disability in the US and Canada measured in units encompassing the total burden of disease as "disability-adjusted life years" (DALYs); contribute 2x DALYs of cardiovascular disease and cancers  DALYs- total number of years lost to illness, disability, or premature death in a given population Diagnosis and Treatments  As effective as physical health treatments; criteria provide predictability of natural history of illness and treatment  Classified in 17 categories; diagnostic criteria for over 450 conditions  Co-morbidity: the co-existence of two diagnoses; -1/2 of mentally ill have an additional disorder. Ex: substance abuse, 23- 80% with other disorders Mental Illness Costs  In addition to unquantifiable personal and family suffering, $300 B annually for disability payments, health care expenditures and lost earnings  Treatment Services Who does and does not get treatment?  45.6 M people over 18 years met criteria for one psychiatric disorder in the past 12 months… 19.6% of adult population; only 38.2% able to access treatment  Access to treatment worst among underserved groups: minorities, low income, uninsured, rural  Barrier to Care Barriers: provider availability; financial, lack of health insurance; stigma; misunderstanding about treatability; personal and provider attitudes; cultural issues; poorly organized system of care  Substance abuse and adductions: providers view as "moral," not chronic disease issues; removal from treatment often follows relapse Children and Adolescents  Service use date available first in 1999 from NIMH survey: only 9% able to access some services: half of those with diagnosed mental illness; school system is largest provider  2009 study: prevalence in 4-17 year olds increased 40% through diagnosis by primary doctors  Clinical research for children and adolescents lags far behind adults, inadequate number of trained professions for size of population at risk Older adults- 25% with significant psychiatric disorders  Diagnosis and treatment difficult due to other conditions  Complications from drugs to treat medical conditions  Fear of stigma  Stereotypes about aging  The Organization of Psychiatric and behavioral Health Services Four major delivery system sectors 1. Psychiatric and behavioral health 2. Primary care 3. Human services 4. Voluntary support network Psychiatric and Behavioral Health Sector 1. Behavioral health professionals, e.g. psychiatrists, psychologists, psychiatric nurses, psychiatric social workers, behavior health clinicians; also "peer specialists"  Provide majority of outpatient care in private or public clinics; acute care in designated in-patient hospital beds in community and public hospitals; residential treatment centers for children and adolescents 2. Multi-service facility provide or coordinate a range of outpatient, intensive case management, partial hospitalization, or inpatient services 3. Increased focus on independent living accommodations in apartments with case managers to assist with daily living skills Primary Care Sector 1. Health care professionals, e.g. private practice internal medicine, family practice doctors, nurse practitioners, pediatricians, clinics, hospitals, nursing homes  Often the initial and only point of contact for mental health services  Rates of mental illness diagnosis in primary care in past decade: double for children and increased almost 30% for adults Human Services Sector 1. Staff of social services agencies, school-based counseling services, residential rehab services, vocational rehab services, criminal justice/prison-based services, religious professional counselors  2008 recession reduced state funding and increased barriers to care from this sector with loss of support for housing, medical care and medications 2. Increased homelessness; lost medication support led to recurrence of symptoms among those previously stable 3. Increased petty crimes and incarcerations in prison system ill-equipped for treatment, with very high costs  Volunteer Support Network Sector 1. Self-help groups, family advocacy groups  Powerful In shifting public attention to people with persistent and severe mental illness  Major impacts on Congress and funding appropriations for research on mental illness and substance abuse through NIMH (national institution for mental health)  State3 legislature lobbying against cuts in service programs and general assistance for mentally ill  Paradigm Shifts  Since 2008, shifts toward turning the mental health system into a more integrate effective care system  Recovery oriented systems of Care (ROSC)  Initiated by Bush's "Freedom Commission on Mental Health." 2004 National Consensus Conference cited "recovery" as most important goal for transforming mental illness in America  Focus on choice, consumer strength-based empowerment, establishing hope for a better life to guide treatment planning; goal to empower with choices and vision for hopeful future; link consumers; strengths with family, community resources Patient Protection and Affordable Care Act  Provide psychiatric benefits with parity  ACO's care continuum will benefit mental health service recipients with coordination of services through primary care and with multiple providers Integration of Primary Care and Behavioral Health Services  ACA provisions on parity support service integration, diffusing prior issues with behavioral health professional reimbursement for primary care services  PCMH puts behavioral health practitioners on the "team" of providers eligible for reimbursement  Financing Psychiatric and Behavioral Health Services Funding sources: private health insurance, Medicaid, Medicare, state and county funding, contracts and grants  "Non-parity" existed for many years, denying the chronic nature of mental illness compared with medical conditions, dates to 1950s  Parity: requirements that insurers cover mental health at the same levels as general medical care Mental Health Parity Act., 1996:  Equated aggregate lifetime limits, annual limits with general medical care  Allowed cost-shifting loopholes: e.g. limits on psychiatric inpatient days, prescription drugs, raising co-insurance and deductibles; did not require employers to offer mental health coverage or coverage for substance abuse disorders Mental Health Parity and Addiction Equity act, 2008:  End health insurance benefit inequity between mental health/substance abuse plans and medical/surgical plans  Equal coverage applicable to all deductibles, copayments, coinsurance and out-of-pocket expenses an all treatment limitations  Parity for annual and lifetime dollar limits  Broad definition of mental health and substance abuse benefits  MH coverage not mandated to employers, but if offered must be equal with medical coverage  Out-of-network coverage must be equal  Preserves existing state parity laws Public Funding of Mental Health Care  Recession effects on State budgets: unemployment, financial markets impact  Kaiser 50-state study  Sharp Medicaid outlay increases due to recession, decline in employment  American Recovery and Reinvestment Act assistance insufficient to stem state crisis The ACA is a "game-changer"  $100 b appropriation over 10 years and $100 B discretionary funds will extend insured health services to millions of mentally ill persons  ACA health insurance exchanges and Medicaid expansion will open care access to many mentally ill adult, child and adolescent persons  Use of "non-quantitative treatment limitations" by insurers to curtail benefits must be monitored and addressed Cost Containment Mechanisms  Managed care systems (public and private) tightly control and monitor services for mentally ill; use subcontractors, "managed behavioral healthcare organizations" (MBHOs) to manage behavioral health patients through carve outs; research indicated that MBHOs successfully facilitate service access and coordinate care for patients in need  The future of Psychiatric and Behavioral Health Services  Shift to a "recovery Model" provides for strength based system with client-directed goals paramount  Move toward psychiatric care more integrated with primary care  ACA will assure Americans of access to services and bring disenfranchised mentally ill persons into the "system


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