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From page 222... ... However, if these practices' mental health clinicians cannot receive reimbursement because they are not admitted to the insuring health plan's network, this prevents integrated care and decreases access to mental health services for the patient. The Moffitt Cancer Center in Florida, for example, reports that some managed behavioral health plans will not reimburse staff mental health clinicians because they are not part of the plan's network, but also will not allow them to become part of the network.15,16 Such problems with health plan networks are not explicitly addressed in leading accreditation standards for behavioral health plans.17 However, health plans need to consider expertise in the mental health treatment of patients with complex chronic diseases as an important competency of their provider panels. Read the entire page →
From page 223... ... , although this gap is narrowing. Performance measures for the delivery of a more comprehensive array of psychosocial health services in general and for patients with cancer in particular also are not very visible in major national performance measurement initiatives (see Table 6-4) Read the entire page →
From page 224... ... dependence • Mental health utilization: inpatient discharges and average length of stay (ALOS) , percentage of health plan members receiving inpatient and intermediate care and ambulatory services PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 225... ... , plus emergency care, geriatrics, disorder, bipolar disorder, alcohol and other drug treatment medication management, patient experience with • Other ambulatory care measures address tobacco cessation, physical care, screening, and preventive care (NQF, 2007b) activity, and cancer screening • Patient experience of care measures include CAHPS survey of adult specialty care and survey for children with chronic conditions PREPUBLICATION COPY: UNCORRECTED PROOFS Read the entire page →
From page 226... ... . A number of organizations could help develop and test measures of psychosocial health care (e.g., the National Quality Forum, the Agency for Healthcare Research and Quality's [AHRQ] Read the entire page →
From page 227... ... As the nation's leader in cancer care, NCI has a number of venues through which performance measures could be used to improve psychosocial health care. NCI's 61 designated cancer centers and comprehensive cancer centers together constitute the "centerpiece of the nation's effort to reduce morbidity and mortality from cancer" (NCI, 2004:2) Read the entire page →
From page 228... ... Group purchasers of health care coverage and health plans should fully support the evidence-based interventions necessary to deliver effective psychosocial health services: • Group purchasers should include provisions in their contracts and agreements with health plans that ensure coverage and reimbursement of mechanisms for identifying the psychosocial needs of cancer patients, linking patients with appropriate providers who can meet those needs, and coordinating psychosocial services with patients' biomedical care. • Group purchasers should review cost-sharing provisions that affect mental health services and revise those that impede cancer patients' access to such services. Read the entire page →
From page 229... ... . In recommending that group purchasers include in their contracts and agreements with health plans provisions to ensure the coverage and reimbursement of mechanisms to identify psychosocial needs, link patients to psychosocial health services, and coordinate these services with biomedical care, the committee is not necessarily calling for these interventions to be reimbursed separately by group purchasers and health plans. Read the entire page →
From page 230... ... and other standards-setting organizations (e.g., National Quality Forum, National Committee for Quality Assurance, URAC, Joint Commission) should: • Create oversight mechanisms that can be used to measure and report on the quality of ambulatory oncology care (including psychosocial health care) Read the entire page →
From page 232... ... 1999. Ensuring quality cancer care. Read the entire page →
From page 235... ... to meet the nation's need for psychosocial health services for people diagnosed with cancer, it is clear that there currently exists a large health care workforce that routinely encounters and cares for this population and can deliver these services. Institutions concerned with the preparation of this workforce address psychosocial issues in their standards for educational accreditation and licensure. Read the entire page →
From page 236... ... A wide variety of licensed providers deliver some psychosocial health services: allopathic physicians (such as those practicing oncology, internal medicine, family medicine, pediatric hematology-oncology, and pediatrics) , nurses, mental health professionals (such as psychiatrists, clinical psychologists, counselors, social workers, and pastoral counselors) Read the entire page →
From page 237... ... For these and other reasons discussed in Appendix B, the development of estimates of the overall workforce capacity required to meet psychosocial health needs through modeling or other methods was not a feasible activity for this study. Read the entire page →
From page 238... ... ; nAmerican Association of Pastoral Counselors (AAPC, 2006) Nonetheless, shortages and maldistribution of a variety of psychosocial health care providers, such as nurses and mental health providers is a long-recognized problem. Read the entire page →
From page 239... ... Although most professions have developed educational standards addressing psychosocial issues, it is unclear how these standards have been translated into educational curricula and more important, whether they create the competencies needed in the health care workforce to meet psychosocial health needs effectively. Professional education should prepare licensed clinicians to recognize and address psychosocial health needs just as they do biomedical needs. Read the entire page →
From page 240... ... The standards intentionally are broad in scope to afford schools flexibility in the way they meet them.4 BOX 7-1 LCME Undergraduate Medical Education Accreditation Standards That Address Psychosocial Health Services ED-7. It [the curriculum] Read the entire page →

From page 222...

... However, if these practices' mental health clinicians cannot receive reimbursement because they are not admitted to the insuring health plan's network, this prevents integrated care and decreases access to mental health services for the patient. The Moffitt Cancer Center in Florida, for example, reports that some managed behavioral health plans will not reimburse staff mental health clinicians because they are not part of the plan's network, but also will not allow them to become part of the network.15,16 Such problems with health plan networks are not explicitly addressed in leading accreditation standards for behavioral health plans.17 However, health plans need to consider expertise in the mental health treatment of patients with complex chronic diseases as an important competency of their provider panels.