Informed Physicians Key to Integrating Patient Care, Says Speaker

KANSAS CITY, Mo. — Behavioral health professionals must educate the medical community on the best approaches to diagnosing and treating mental health problems, an expert on patient-centered care said Wednesday at a meeting of the Metropolitan Mental Health Stakeholders of Greater Kansas City.

“I think that is part of the responsibility that the mental health community has — to make sure that in our relationship between mental health and primary care that we are doing as much as we can, so you can do as much as you can,” Dr. Bruce Bagley told a group of about 25 representatives from area mental health providers.

This week’s meeting of the mental health stakeholders group — part of the Regional Health Care Initiative — was the third in a series the group is holding on the integration of medical care and behavioral health services.

Bagley — a former practicing physician — is chief executive of TransforMED, a non-profit subsidiary of the American Academy of Family Physicians, which is based in Leawood.

Established in 2005, TransforMED helps physicians and hospitals become patient-centered medical homes.

Bagley also said there must be better communication between primary care offices and mental health providers.

“Let’s have a conversation of what part should I do, what part should you do,” he said.

“What do you want me to have before I send them over to your place? What can I expect in terms of a timely appointment? What can I expect in terms of a report? What can I expect in terms of quality, outcomes, timing, medication management team — that kind of stuff.”

It’s in everybody’s best interest to have those conversations, Bagley said, particularly as health care moves away from procedure-based payments to paying for outcomes, including for patients with anxiety and depression.

“I see that as a collective responsibility,” Bagley said.

Medical home initiatives

The REACH Healthcare Foundation in Merriam is leading an initiative to help area safety-net providers earn recognition as patient-centered medical homes by the National Committee for Quality Assurance.

In a similar initiative, the Centers for Medicare and Medicaid Services (CMS) also provides enhanced payments to providers that serve as medical homes for high-cost Medicaid patients.

Also speaking at the stakeholders meeting was Jill Watson, chief executive of a local accountable care organization, or ACO, organized through the Kansas City Metropolitan Physicians Association (KCMPA).

Established in January, the ACO is part of a Medicare initiative.

Through the program, provider groups come together to provide better coordination of care. The participants share in the cost savings they achieve for Medicare fee-for-service patients.

Watson’s organization has 12 primary care practices located around the metropolitan area. She said the number of patients covered through the ACO is about 12,000.

KCMPA is one of about three dozen participants nationally accepted by CMS to operate under an advance payment model.

That model is for smaller, physician-based operations that qualify for early payment on the shared savings they expect to earn. The funding goes for staff and infrastructure to facilitate care coordination.

The metropolitan physicians ACO is eligible for $2.3 million over 18 months, according to Watson.

Depression screening is one of the 33 quality measures upon which Medicare evaluates the ACO.

Watson said the organization’s care coordinators have met with officials at the community mental health centers to better coordinate care.

“I can’t say that we have it figured out, but I can tell you that we are working towards much better communication with anybody who is prescribing psychiatric meds of any kind, because that is a big pain point for our physicians,” she said.

Physicians don’t feel qualified managing those medications, Watson said, and at times they don’t get any information as to what was prescribed or why or who should take the lead on monitoring the medications.

“We definitely need to talk about how to make that better,” she said.

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