Managed Care - March 2008 - (Page M25) PANEL DISCUSSION Integrating Physical and Behavioral Health Care MICHAEL GOLINKOFF, PHD, MBA: At Aetna, we have a FACULTY ELISABETH J. BUCHMAN, MA, LMHC, Director of Behavioral Health & Wellness, Regence MICHAEL GOLINKOFF, PHD, MBA, National Clinical Director, Aetna Behavioral Health ANTHONY M. KOTIN, MD, Chief Clinical Officer, Magellan Health Services; Chair, Association for Behavioral Health and Wellness DAVID WHITEHOUSE, MD, PHD, MBA, Chief Medical Officer, Strategy and Innovation, United Behavioral Health Colloquy attendees were given the opportunity to pose questions to an expert panel. A selection of questions and answers is presented below. QUESTION: Where are we with mental health parity? ANTHONY M. KOTIN, MD: Speaking as chair of the As- sociation for Behavioral Health and Wellness, I can say that this industry trade association supports parity at the federal level — we think it is essential. We favor the Senate version of the bill. Opening up the behavioral health benefit to be equal to the medical benefit will enhance our ability to manage patients properly across comorbid states. There should be no differentiation between physical and behavioral health benefits. ELISABETH J. BUCHMAN, MA, LMHC: At the state level, about 40 states now have some form of mental health parity, but no two states are alike. Some have biological models and some have DSM-IV–driven models, so the lack of a uniform definition makes it challenging to manage care across those states. Federal parity legislation may assist with this complexity, depending on when federal law supersedes state law. QUESTION: What has spurred interest in integrating behavioral health and medical management? KOTIN: Through the literature and millions of claims, we have found that patients suffering from a behavioral health disorder and a comorbid condition have at least 2 times greater total medical costs. Sleep disorders, for example, strongly affect physical health. The causative relationships aren’t clear, but improved management of behavioral health would dramatic improve management of comorbid medical conditions. program for those persons with chronic medical conditions that screen positive for depression and standard depression management programs. For many years, Aetna subcontracted behavioral care management. The initial motivation to bring it back in-house was the recognition of comorbid conditions and the need to have better integrated behavioral health care services for persons with chronic medical problems. Recently, this decision has been reinforced by the growing awareness that medical outcomes ultimately are driven by the behavioral health decisions that patients and providers make every day. It has nothing to do with comorbidity. Rather, it’s how we choose to act, our attitudes and values, that drives outcomes. We need to leverage the knowledge behavioral health specialists bring to our organizations to influence those behaviors and attitudes in the most effective way. BUCHMAN: Regence is an affiliation of BlueCross and BlueShield health plans operating in the Pacific Northwest and Intermountain West regions. We serve approximately 3 million covered lives. In late 2001, we began insourcing behavioral health. At the same time, our senior executive leadership set forth a new vision for Regence to transform the health care system. This vision addresses three main targets, seeking to reduce waste, confusion, and tyranny in the system for our members and their families. When members are shuffled back and forth between primary care and mental health care, there can be confusion regarding where they should go for the best care. Insourcing behavioral health was a key initial step on the path to integrating medical and behavioral health services and promoting a collaborative care model. DAVID WHITEHOUSE, MD, PHD, MBA: At United Behavioral Health, we realized that if we asked our people to try to solve problems in terms of medical behavior and health psychology integration — engaging and activating people — they would use the whole realm of their psychological expertise and would feel more satisfied about their job, and we would, in turn, provide greater value to our clients. KOTIN: Our pharmacy data show that 75 to 80 percent of psychotropic medications are not prescribed by people who are formally trained in behavioral health illnesses, and 30 percent of patients are prescribed SUPPLEMENT / 2007 MEDICAL DIRECTOR COLLOQUY 25
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