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Addressing Behavioral Health Integration With Payment Reform

By Deborah Cohen, PhD

(Note: This article originally appeared in Health Affairs Blog on April 20, 2015. An edited version is being reposted here as part of the research effort investigating the impact of Alternative Payment Methodology (APM) on the delivery of primary care in safety-net populations. Through this website, Frontiers of Health Care, we are sharing lessons learned and perspectives from key stakeholders on the frontlines of reform.)

Primary care practices in Oregon and elsewhere have been moving toward the Patient Centered Primary Care Home (PCPCH) model. As they emphasize whole-person primary care that is accessible, high in quality, and safe, Oregon’s Alternative Payment Methodology (APM) pilot is an important step to align payment with these core principles. The APM pilot has been described as a bridge to value-based care. It isn’t the solution to the fee-for-service treadmill, but some think it’s a step in the right direction.

The APM pilot is testing the idea that a per-member-per-month (PMPM) fee to care for a population can support comprehensive care. Integration of physical and behavioral health care is a great case for examining alternative payment methodologies, and it gives us a peek into what Oregon’s APM is (and isn’t) achieving.

Integration of behavioral health and primary care by health care systems is one of the most robust examples of patient-centered, comprehensive care that I have observed in this model. We know that emotional and behavioral issues commonly compound physical health risks and lead to worsening health outcomes. We also know that primary care is where most people struggling with these commonly co-occurring conditions are seen by health care professionals. Continue reading Addressing Behavioral Health Integration With Payment Reform

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When’s the Last Time Your Doctor Inspired You to be Healthy?

 By Jen Coury

“Patient engagement” is a buzz word that, in some ways, reveals how far away much of the health care system has strayed from truly serving patients. Most doctors are used to thinking about things like “compliance” and “adherence.” For example, are patients taking their medication as prescribed? But think of how much more powerful this question is: What would motivate my patient to take this prescription?

Patients are not used to being asked what they want to accomplish for their own health. Yet, a new movement is changing things. Health care systems large and small are trying to get patients involved, not only in their own self-care, but also in the way health care systems, clinics, and doctors provide care. For individuals seeing a doctor, a partnership looks something like the doctor and patient determining the best treatment together. Health systems and clinics could involve patients as advisers, or even have them co-leading quality improvement efforts with staff members. Continue reading When’s the Last Time Your Doctor Inspired You to be Healthy?