Nomination of Natalie Levkovich for the 2019 CFHA Don Bloch Award.

Don Bloch's legacy is expansive and deep, epitomized by his vision, systemic orientation, innovative work, and a paragon of connecting people. Natalie Levkovich has continued this tradition as past president of the Collaborative Family Healthcare Association (CFHA), Chief Executive Officer of the Health Federation of Philadelphia, and contributor to numerous boards and projects. She is a fervent champion for improving population health by increasing access to high quality care for all, especially the most marginalized. The nomination highlights four central themes to her innovative and remarkable leadership. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Preparing for a value-driven future.

At this month's staff meeting of your integrated primary care practice, the medical director makes an announcement: Your health system just signed a contract that includes a value-based payment (VBP) arrangement with a local managed care organization (MCO). The medical director suggests that this will lead to big changes in your practice because you will now focus on producing patient outcomes rather than on volume of care delivered. You wonder: What is a VBP arrangement? What kinds of patient outcomes? What does this mean for integrated care? and How do I help our organization succeed? Value-based care is the future, and it will impact the way that all of us practice. In value-based arrangements, the delivery of care fundamentally changes because payment for care shifts from our current fee-for-service model, in which provider productivity is key to financial survival, to payment for positive clinical outcomes where quality of care rules. And this change is happening now. In 2015, the U.S. Department of Health and Human Services announced aggressive national VBP targets, with a goal of tying 50% of all Medicare payments to alternative payment models by the end of 2018 (New York State Department of Health, 2015). Since then, many states have adopted similar targets for their Medicaid programs in light of ongoing state budget challenges and unsustainable cost growth trends. As these changes take hold, health care providers are increasingly expected to make fundamental changes to service delivery, financial, and organizational operations. As health care providers, VBP will require us and our health centers to develop new skills, capacities, and systems for managing clinical, financial, and operational performance and risk. We must all make sure we understand and are ready to play our part in the transition to VBP. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The State and Future of the Primary Care Behavioral Health Model of Service Delivery Workforce.

The growth of the Primary Care Behavioral Health model (PCBH) nationally has highlighted and created a workforce development challenge given that most mental health professionals are not trained for primary care specialization. This work provides a review of the current efforts to retrain mental health professionals to fulfill roles as Behavioral Health Consultants (BHCs) including certificate programs, technical assistance programs, literature and on-the-job training, as well as detail the future needs of the workforce if the model is to sustainably proliferate. Eight recommendations are offered including: (1) the development of an interprofessional certification body for PCBH training criteria, (2) integration of PCBH model specific curricula in graduate studies, (3) integration of program development skill building in curricula, (4) efforts to develop faculty for PCBH model awareness, (5) intentional efforts to draw students to graduate programs for PCBH model training, (6) a national employment clearinghouse, (7) efforts to coalesce current knowledge around the provision of technical assistance to sites, and (8) workforce specific research efforts.

Using standardized patients as a means of training and evaluating behavioral health consultants in primary care.

INTRODUCTION: The Health Federation of Philadelphia, which hosts a network of Behavioral Health Consultants (BHC) operating within the Primary Care Behavioral Health model (PCBH), identified a need to systematically evaluate PCBH model fidelity and to rigorously evaluate the competency assessment process to further their workforce development. A simulated patient exercise was developed for evaluating BHC PCBH specific competencies. METHOD: A simulated BHC encounter was held at a clinical learning center using standardized patients, repeated twice over 2 years. A competency based rating scale was developed by the network for the simulation (BHC-ORS), patient feedback was captured using the Working Alliance Inventory (WAI), and BHC feedback was collected using a questionnaire. Dedicated consultants were hired to develop the internal process, as well as conduct the evaluation in a way that might make a contribution to research. RESULTS: Targeted PCBH competencies generally improved after being identified as training needs in Year 1 of the simulation. Patient feedback showed average ratings for the majority of the BHCs. BHCs identified the experience as valid and useful. Important changes in methodology between Years 1 and 2 of the pilot limited a more complete analysis. DISCUSSION: The use of simulated patients to evaluate BHC adherence to the PCBH model was helpful for training and adds to the workforce development literature. The authors suggest that doing practice based research will always entail unanticipated needs that interfere with quantitative research but that there are ways in which researchers can attempt to anticipate these changes. Review of possible applications to community PCBH practice is included. (PsycINFO Database Record

Payer-provider patient registry utilized in a behavioral health home.

OBJECTIVES: As defined by the Affordable Care Act, health homes seek to improve healthcare coordination through data exchange and health information technologies; however, few examples of how to use such technology are available. The present effort describes a payer-provider patient registry for behavioral health home service. STUDY DESIGN: An observational study design was used to describe characteristics of individuals identified by the payer-provider patient registry. METHODS: In Pennsylvania, behavioral health agencies serve as health homes, with support by a behavioral health managed care organization (BHMCO) in the absence of a state waiver for health homes. The BHMCO initiates a priority patient registry monthly based on diagnoses for serious mental illness (SMI) and at least 1 chronic physical health condition. Providers contribute health data through a secure Web-based portal that become part of the registry and identify new participants. RESULTS: We identified 3759 individuals in the priority patient registry; 91% were identified by the payer. Most commonly, individuals with SMI were identified with hypertension (39%), asthma/chronic obstructive pulmonary disease (27%), hyperlipidemia (20%), and diabetes (18%). Annual behavioral health Medicaid expenditures for individuals in the 12 months prior to appearing on the registry averaged $14,685 per individual. Twelve percent of registry participants had annual behavioral health care expenditures over $25,000. CONCLUSIONS: The use of claims data and health assessment information can identify individuals presenting with complex healthcare needs that may benefit from behavioral health home service.

Turning toward treating the seriously mentally ill in primary care.

Discusses the problem of people with serious mental illness not feeling welcome in primary care. The issue may be that health care providers are simply uncomfortable with the symptoms of serious mental illness, and this results in avoidance, both individually and as a system. This health disparity can only be addressed if the affected population is part of the conversation. Community-based primary care has a responsibility to address the physical health needs of the seriously mentally ill. To do this, we need to start by acknowledging our discomfort, listening deeply to the voices of people with severe mental illness, and learning how to intervene effectively to improve their health.

Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.