Meeting Psychosocial Health Needs - The Academies

Role of Advocac

• Strengthen the patien
provider partnership

• Utilize tools that have
effective

• Strengthen the patien
relationship through p
and services

cy Organizations

nt side of the patient-
e been found to be
nt side of the
provision of new tools

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27



28

Recommendation 3
educa

Patient education and advoc

• educate patients with can
caregivers to expect, and
cancer care that meets th
psychosocial care.

• continue strengthening th
patient–provider partners
tools and training in obtai
decisions, solving problem
communicating with their

3: Patient and family
ation.

cacy organizations should:

ncer and their family
request when necessary,

he standard for

he patient side of the
ship . . . . . by providing
ining information, making
ms, and better
r health care providers.

29

Implications fo
Purch

Sherry Glie

Department of H
Management, Mailm

Health, Colum

or Health Care
hasers

ed PhD, Chair

Health Policy and
man School of Public
mbia University

30

Much is low co
reimbu

Element of Care
1. Pt-Provider

communication
2. ID needs
3. Link with providers
4. Support illness self

management
5. Coordinate care
6. Follow-up

ost or already
ursable

Cost / Reimbursement
Provided for in E&M

billing codes
Performed by patient/

family
Standard office practice;

e.g., referrals
New billing codes; e.g.

Health and Behavior
Assessment codes

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Health and Behav

Intervention

Health and behavior assessment procedures a
behavioral, emotional, cognitive, and social
or management of physical health problems

The focus of the assessment is … on the biops
problems and treatments. The focus of the inte
being utilizing cognitive, behavioral, social, and
ameliorate specific disease-related problems.

Codes 96150-96155 describe services offered
illnesses, diagnoses, or symptoms and may be
focus on the biopsychosocial factors related to

• 96150 health and behavior assessment (e.g., h
observations, psychophysiological monitoring,
face-to-face with the patient, initial assessment

• 96151 re-assessment
• 96152 health and behavior intervention, each 1
• 96153 group (2 or more patients)
• 96154 family (with the patient present)
• 96155 family (without the patient present).

vior Assessment /
billing codes

are used to identify the psychological,
l factors important to the prevention, treatment,
s.

sychosocial factors important to physical health
ervention is to improve the patient’s health and well-
d/or psychophysiological procedures designed to

to patients who present with primary physical
enefit from assessments and interventions that

the patient’s health status...

health-focused clinical interview, behavioral
health-oriented questionnaires), each 15 minutes
t

15 minutes, face-to-face; individual

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Psychologist Claims Paid by Medica
Intervention, and Comparison 2005
T ypes

Code Description 2003
Psychologist Claims
96150
96151 H/B Assessment 50,660
96152 51,888
96153 H/B Reassessment 136,904

96154 H/B Intervention—face-to- 9,252
face, individual
96155
H/B Intervention—group
Total (two or more patients)

H/B Intervention—family 6,129
(with patient present)

H/B Intervention—family Medicare does not re
(without patient present)

254,833

are, 2003–2005, by Type of
5 Claims Paid for All Provider

2004 Psychologist 2005 Psychologist 2005
Claims Claims All Provider Claims

74,371 78,008 90,016
47,599 18,421 21,913
245,088 291,103 300,463

16,431 17,873 34,052

7,003 7,508 7,942

eimburse for this type of intervention

390,492 412,913 454,386

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Recommendation: S

1. Group purchasers sh
in their contracts and
plans that ensure co
reimbursement of me
identifying the psych
patients, linking patie
providers who can m
coordinating psycho
patients’ biomedical

Support from payers.

hould include provisions
d agreements with health
overage and
echanisms for
hosocial needs of cancer
ents with appropriate
meet those needs, and
osocial services with
care.

34

Recommendation: S

1. Group purchasers should include p
agreements with health plans that e
mechanisms for identifying the psyc
linking patients with appropriate pro
coordinating psychosocial services

2. Group purchasers sh
sharing provisions th
services and revise t
cancer patients’ acce

Support from payers.

provisions in their contracts and
ensure coverage and reimbursement of
chosocial needs of cancer patients,
oviders who can meet those needs, and
s with patients’ biomedical care.

hould review cost-
hat affect mental health
those that impede
ess to such services.

35

Recommendation: S

1. Group purchasers should include provisions in their con
coverage and reimbursement of mechanisms for identif
patients with appropriate providers who can meet those
patients’ biomedical care.

2. Group purchasers should review cost-sharing provisions
impede cancer patients’ access to such services.

3. Group purchasers and health p

access to providers with exper
health conditions in individuals
regimens such as those used t

Health plans whose networks l
reimburse for mental health se
network practitioners with this
quality and other standards (at
within the plan’s network).

Support from payers.

ntracts and agreements with health plans that ensure
fying the psychosocial needs of cancer patients, linking
e needs, and coordinating psychosocial services with

s that affect mental health services and revise those that

plans should ensure …

rtise in the treatment of mental
s undergoing complex medical
to treat cancer.

lack this expertise should
ervices provided by out-of-

expertise who meet the plan’s
t rates paid to similar providers

36

Recommendation: S

1. Group purchasers should include provisio
health plans that ensure coverage and re
the psychosocial needs of cancer patient
who can meet those needs, and coordina
biomedical care.

2. Group purchasers should review cost-sha
services and revise those that impede ca

3. Group purchasers and health plans shou
cancer patients’ access to providers with
conditions in individuals undergoing comp
to treat cancer. Health plans whose netw
mental health services provided by out-of
who meet the plan’s quality and other sta
within the plan’s network).

4. Group purchasers and he
incentives for the effectiv
care in payment reform pr
performance, pay-for-repo
they participate.

Support from payers.

ons in their contracts and agreements with
eimbursement of mechanisms for identifying
ts, linking patients with appropriate providers
ating psychosocial services with patients’

aring provisions that affect mental health
ancer patients’ access to such services.

uld ensure coverage policies do not impede
expertise in the treatment of mental health
plex medical regimens such as those used

works lack this expertise should reimburse for
f-network practitioners with this expertise
andards (at rates paid to similar providers

ealth plans should include
ve delivery of psychosocial
rograms; e.g., pay-for-
orting initiatives —in which

37

Implications
Setting Org

Jimmie Ho
Wayne E. Chapman

Onco
Memorial Sloan-Kett

for Standard
ganizations

olland MD,
n Chair in Psychiatric
ology
tering Cancer Center

Two commo
quality im

• Performance meas

• Using performance
leverage change

on pathways to
mprovement

surement
e measures to

39

Obstacles to Q
psychosocial heal

patie

• less well-developed
delivery of psychoso
and

• a less well-develope
ensure the applicati
standards.

QI initiatives on
lth care for cancer
ents

d measures of the
ocial health services,

ed mechanism to
ion of measures and

40

Recommendation 6

Organizations setting standards fo
ASCO, ACS’ Commission on C
standards-setting organization
NCQA, URAC, Joint Commissio

– Create oversight mechanisms
quality of ambulatory oncology
health care).

– Incorporate requirements for id
psychosocial health care need
standards.

6: Quality oversight.

or cancer care (e.g., NCCN,
Cancer, ONS, APOS) and other
ns (e.g., National Quality Forum,
on) should:

for measuring and reporting on the
y care (including psychosocial

dentifying and responding to
ds into their protocols, policies, and

41

Recommendation 6

Organizations setting standards for c
Commission on Cancer, ONS, APO
organizations (e.g., National Qualit
Commission) should:

– Create oversight mechanisms for
ambulatory oncology care (includi

– Incorporate requirements for ident
health care needs into their protoc

– Develop and use perfor
psychosocial health ca
activities.

NCI, CMS, and AHRQ should fund
development of performance meas

6: Quality oversight.

cancer care (e.g., NCCN, ASCO, ACS’
OS) and other standards-setting
ty Forum, NCQA, URAC, Joint

measuring and reporting on the quality of
ing psychosocial health care).

tifying and responding to psychosocial
cols, policies, and standards.

rmance measures for
are in their quality oversight

research focused on the
sures for psychosocial cancer care.

42

Implications f
Fund

Sherrie Ka
Associate Dean f

and Health Serv
University of Ca

School of

for Research
ders

aplan PhD,
for Clinical Policy
vices Research,
alifornia at Irvine
Medicine

Limitations in
Nome

n Taxonomy and
enclature

44

Recommendatio
nomenc

To facilitate research on and
psychosocial interventions,
create and lead an initiative
transdisciplinary taxonomy
psychosocial health service

This initiative should aim to
and nomenclature into such
Medical Subject Headings (M
and EMBASE.

on: Standardized
clature.

d quality measurement of
, NIH and AHRQ should
to develop a standardized,
and nomenclature for
es.

o incorporate this taxonomy
h databases as the NLM’s
MeSH), PsycINFO, CINAHL,

45

Recommendation 4:
Upta

NCI, CMS, AHRQ should
collectively, conduct a
demonstration and ev
approaches to the effi
psychosocial health c
the standard.

This program should de
standard can be imple
settings and populatio
personnel and organiz

: Dissemination and
ake.

d, individually or
a large-scale
valuation of various
icient provision of
care in accordance with

emonstrate how the
emented in different
ons, and with varying
zational arrangements.

46

Recommendation 9:

• Clinical tools and strategies for:

– Improving patient-provider commu
– More comprehensive screening in

psychosocial health needs.
– Needs assessment.
– Illness and wellness management.
– Effectively linking patients with se

• Services to treat mental problems
healthy behaviors, such as smokin

• Standard outcome measures for a

• Reimbursement arrangements to p
health care.

• Delivery of services to vulnerable
adults, socially isolated, and cultu

: Research priorities

unication and patient decision-support.
nstruments to identify individuals with

.
ervices and coordinating care.

and assist patients to practice
ng cessation, exercise, and diet
assessing effectiveness.
promote and reward psychosocial

populations; e.g., low literacy, older
ural minorities.

47

Implications fo
Chronic C

Ed Wagn
Director, Group He
W.A. McColl Institu
Innovation Center

or Care of Other
Conditions

ner, MD
ealth Cooperative
ute for Healthcare
r for Health Studies

48

Comorbidities of C

• 42% have other chro

– 28% cardiovascular
– 9 % diabetes
– 5 % asthma
– 5 % emphysema
– 5 % ulcer disease

• Nearly half over age
• 11% with limits in AD

Cancer Survivors

onic conditions

65
DLs

Source: NHIS (Hewitt, et al. 2003)

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Effective Delivery
Health

• RWJ Building Health Systems for
People with Chronic Illnesses
(Palmer and Somers, 2005)

• Chronic Care Model (ICIC, 2007)

• Clinical Practice Guidelines for
Distress Management (NCCN,
2007)

• Clinical Practice Guidelines for
the Psychosocial Care of Adults
with Cancer (Australia, 2003)

• Improving Supportive and
Palliative Care for Adults with
Cancer (NICE, 2004)

y of Psychosocial
h Care

• Collaborative Care of Depression
in Primary Care (Katon, 2003)

• Three Component Model
(3CM™)

• Project IMPACT Collaborative
Care Model (Unutzer et al., 2002)

• Partners in Care (Wells et al., 2004)

• Promoting Excellence in End-of-
Life Care Program (Byock et al.,

2006)

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