Journal of Mental Health Policy and Economics最新文献

{"title":"PERSPECTIVE: Implications of Recent Health Policies for Women's Reproductive Mental Health.","authors":"Kara Zivin, Anna Courant","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The economic cost of perinatal mood and anxiety disorders (PMADs) is high and includes the cost of reduced maternal economic productivity, more preterm births, and increases in other maternal mental health expenditures. PMADs also substantially contribute the cost of maternal morbidity. This paper offers a discussion of the quality-of-care cascade model of PMADs, which outlines care pathways that people typically face as well as gaps and unmet needs that frequently happen along the way. The model uses the US health system as an example. A discussion of international implications follows.</p><p><strong>Discussion: </strong>The quality-of-care cascade model outlines downward dips in quality of care along the perinatal mental health treatment continuum, including access (many Americans do not have access to affordable health insurance), enrollment (even when individuals are offered health insurance, some do not enroll), coverage (even if individuals have health insurance, some needed services or providers may not be covered), choice (even if services and providers are covered, patients may not be able to choose among plans, institutions, or clinicians), consistency (even if patients have a choice of plan or provider, a consistent source of care may not be accessible), referral (even if care is available and accessible, referral services may not be), quality (even if patients have access to both care and referral services, there may be gaps in the quality of care provided), adherence (even if patients receive high-quality care, they may not be adherent to treatment), barriers (societal forces that may influence people's choices and behaviors), and shocks (unanticipated events that could disrupt care pathways). In describing the quality-of-care cascade model, this paper uses the US healthcare system as the primary example. However, the model can extend to examine quality-of-care dips along the perinatal mental health treatment continuum within the international context. Although the US healthcare system may differ from other healthcare systems in many respects, shared commonalities lead to quality-of-care dips in countries with healthcare systems structured differently than in the US.</p><p><strong>Implications for health policies: </strong>The global cost of PMADs remains substantial, and addressing the costs of these conditions could have a significant impact on overall cost and quality of care internationally. The quality-of-care cascade model presented in this paper could help identify, understand, and address the complex contributing factors that lead to dips in quality-of-care for perinatal mental health conditions across the world.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 2","pages":"63-70"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: A Fireside Chat about Global Mental Health with Dr. Esther Duflo, Nobel Laureate in Economics.","authors":"Benjamin Lê Cook, Esther Duflo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dr. Esther Duflo, Nobel Laureate in Economics, and co-founder and co-director of the Abdul Latif Jameel Poverty Action Lab (J-PAL) sat down with Dr. Benjamin Cook for a \"fireside chat\" at the 12th National Institute of Mental Health Global Mental Health Research Without Borders Conference. Dr. Duflo discussed J-PAL's efforts to develop and test interventions for improving mental health and how cash transfer programs can be used to improve mental health. She also discussed the importance of using randomized control trials (RCTs) in shaping global mental health initiatives. Dr. Duflo shared insights from projects addressing loneliness among older individuals in India, secondary school scholarships in Ghana, and other studies that have informed social policies. Looking forward, she discusses climate change as a threat to the reductions in poverty realized in the last 30 years and encourages the expansion of networks of research and policy collaborations to improve global health.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 2","pages":"59-62"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Health Economic Interests at NIMH and NIDA to Improve Delivery of Behavioral Health Services.","authors":"Jennifer L Humensky, Sarah Q Duffy, Leonardo Cubillos, Michael C Freed, Agnes Rupp","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Effective financing mechanisms are essential to ensuring that people can access and utilize effective treatments and services. Financing mechanisms are needed not only to pay for the delivery of those treatments and services, but also ancillary costs, while also keeping care affordable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This article highlights key areas of the interest of the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) in supporting applied health economics and health care financing research. Specifically, this article discusses the long-range impact of NIH's earlier investments in applied health economics research, and NIH's ongoing efforts to communicate its interests in health economics research. We discuss the 2023 NIMH-NIDA-sponsored health economics conference, and the ideas presented there for developing and assessing innovative behavioral health care financing models; three of the presented papers were recently published in the Journal of Mental Health Policy and Economics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We describe the history and impact of NIMH- and NIDA-sponsored economic research and identify current research interests as identified in the NIMH and NIDA Strategic Plans and recent funding announcements. We examine themes presented at the NIMH-NIDA Health Economics conference. The conference included over 300 participants from 20 countries, from six continents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The topics highlighted at the conference highlight the ways in which NIH-funded research has promoted the development of innovative health care financing methods, both from the supply side (e.g., providers and payers) and demand side (e.g., service users and families). Invited speakers discussed the findings from NIH-supported research in the topic areas of payment and financing, behavioral economics and social determinants of health. Keynote speakers highlighted emerging topics in the field, including the economics of health equity, biases in mental health models in health care, and value-based insurance design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;We demonstrate a resurgence of and explicit interest in health economics and policy research at NIMH and NIDA. However, more work is needed in order to design funding mechanisms that fully provide access to and facilitate use of effective evidence-based practices to improve mental health outcomes. For example, it is important that policy and health economic research projects include decision makers who will be the end users of data and study results, to ensure that results can be meaningfully put into practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care: &lt;/strong&gt;Designing effective and efficient funding mechanisms can help ensure that service users have access to effective treatments and that clinicians and provider organizations are adequately compensated for their work.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;Fe","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 1","pages":"33-39"},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: A Path to Value-Based Insurance Design for Mental Health Services.","authors":"Michael C Freed, Jennifer L Humensky, Patricia A Arean","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Aligning cost of mental health care with expected clinical and functional benefits of that care would incentivize the delivery of high value treatments and services. In turn, ineffective or untested care could still be offered but at costs high enough to offset the delivery of high value care.</p><p><strong>Aims: </strong>The authors comment on Benson and Fendrick's paper on Value-Based Insurance Design (VBID) for mental health in the September 2023 special issue of this journal. The authors also present a preliminary framework of key ingredients needed to consider VBID for mental health treatments and services.</p><p><strong>Methods: </strong>The authors briefly review current and past efforts to contain costs and improve quality of mental health care, which include (for example) use of carve-out and carve-in programs, evaluation of cost sharing models, impact of accountable care organizations, and studying other benefit designs and impact of federal and state policies.</p><p><strong>Results: </strong>Using PTSD as an example, key ingredients of VBID for mental health services were identified and include the following: tools for case identification and monitoring progress over time at the population level; specific treatments and services with evidence of clinical effectiveness, cost-effectiveness, and health equity; and an approach to document the specific treatment or service was delivered (versus another treatment or service that may lack evidence).</p><p><strong>Discussion: </strong>The inability to afford mental health care is a top barrier to treatment seeking. People who do elect to spend time and money on mental health care are further disadvantaged by accessing care that is not well regulated and the quality at best is questionable. VBID could be an important lever for increasing access to and use of high value mental health care. Partnerships among the research, practice, and policy communities can help ensure research solutions meet needs of these two communities.</p><p><strong>Implications for health care: </strong>VBID holds promise to make high value mental health care more affordable while discouraging low value treatments and services.</p><p><strong>Implications for health policies: </strong>While evidence gaps remain, these gaps can be filled concurrently with pursuit of VBID for mental health services.</p><p><strong>Implications for future research: </strong>This paper identifies important research opportunities to help make VBID a reality for mental health care.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 1","pages":"23-31"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Antidepressants in Combination with Psychotherapy.","authors":"Farrokh Alemi, Tulay G Soylu, Mary Cannon, Conor McCandless","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Consensus-guidelines for prescribing antidepressants recommend that clinicians should be vigilant to match antidepressants to patient's medical history but provide no specific advice on which antidepressant is best for a given medical history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;For patients with major depression who are in psychotherapy, this study provides an empirically derived guideline for prescribing antidepressant medications that fit patients' medical history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, observational, cohort study analyzed a large insurance database of 3,678,082 patients. Data was obtained from healthcare providers in the U.S. between January 1, 2001, and December 31, 2018. These patients had 10,221,145 episodes of antidepressant treatments. This study reports the remission rates for the 14 most commonly prescribed single antidepressants (amitriptyline, bupropion, citalopram, desvenlafaxine, doxepin, duloxetine, escitalopram, fluoxetine, mirtazapine, nortriptyline, paroxetine, sertraline, trazodone, and venlafaxine) and a category named \"Other\" (other antidepressants/combination of antidepressants). The study used robust LASSO regressions to identify factors that affected remission rate and clinicians' selection of antidepressants. The selection bias in observational data was removed through stratification. We organized the data into 16,770 subgroups, of at least 100 cases, using the combination of the largest factors that affected remission and selection bias. This paper reports on 2,467 subgroups of patients who had received psychotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We found large, and statistically significant, differences in remission rates within subgroups of patients. Remission rates for sertraline ranged from 4.5% to 77.86%, for fluoxetine from 2.86% to 77.78%, for venlafaxine from 5.07% to 76.44%, for bupropion from 0.5% to 64.63%, for desvenlafaxine from 1.59% to 75%, for duloxetine from 3.77% to 75%, for paroxetine from 6.48% to 68.79%, for escitalopram from 1.85% to 65%, and for citalopram from 4.67% to 76.23%. Clearly these medications are ideal for patients in some subgroups but not others. If patients are matched to the subgroups, clinicians can prescribe the medication that works best in the subgroup. Some medications (amitriptyline, doxepin, nortriptyline, and trazodone) always had remission rates below 11% and therefore were not suitable as single antidepressant therapy for any of the subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussions: &lt;/strong&gt;This study provides an opportunity for clinicians to identify an optimal antidepressant for their patients, before they engage in repeated trials of antidepressants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;To facilitate the matching of patients to the most effective antidepressants, this study provides access to a free, non-commercial, decision aid at http://MeAgainMeds.com.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implicati","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 1","pages":"3-12"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economic Burden of Chronic Psychotic Disorders: An Incidence-based Cost-of-Illness Approach.","authors":"Claire de Oliveira, Bryan Tanner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The economic burden of chronic psychotic disorders is substantial. However, few studies have employed an incidence based approach to estimate the economic burden of chronic psychotic disorders. Furthermore, the existing work has mainly used models populated with data obtained from published literature, making several assumptions to estimate incidence-based costs.</p><p><strong>Aims of the study: </strong>The objective of this study was to estimate the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system.</p><p><strong>Methods: </strong>Using health records from Ontario, Canada, all individuals with a valid health card number, residing in the province, and diagnosed with a chronic psychotic disorder between the ages of 16 and 45 from April 1st, 2006, to March 31st, 2021, were included in the analysis. Using a mix of bottom-up and top-down methodologies and a robust cost estimator, cumulative mean health care costs were estimated from diagnosis to death or the end of observation period. Cumulative mean health care costs, and respective 95% confidence intervals (CIs), were estimated for the 1-year period (i.e., first year post-diagnosis), overall, by sex, age groups and health service, and for the 5-, 10- and 15-periods, overall and by sex.</p><p><strong>Results: </strong>One-, 5-, 10- and 15-year total discounted cumulative mean health care costs were estimated at USD 24,441.16, 95% CI (USD 24,166.13, USD 24,716.19), USD 70,754.69, 95% CI (USD 69,827.48-USD 71,681.89), USD 117,136.88, 95% CI (USD 115,370.40-USD 118,903.35), and USD 157,829.01 95% CI (USD 155,599.32.-USD 160,058.70), respectively. Total mean 1-year costs post-diagnosis were higher for younger individuals. Although females had higher 1-year costs, males had higher 5-, 10- and 15-year costs. Psychiatric hospitalisations made up the largest component of total costs across all cost estimates.</p><p><strong>Discussion: </strong>These results suggest that the costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. Compared to previous work, the cost estimates from the present study suggest that the use of real-world data produces lower estimates of cumulative costs, albeit likely more accurate ones. However, these estimates do not account for costs of care provided in community-based agencies.</p><p><strong>Implications for health policies: </strong>These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation.</p><p><strong>Implications for future research: </strong>Future research should seek to follow incident cases in administrative data over a longer time period to obtain cumulative costs of longer duration.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"27 1","pages":"13-21"},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19, Mental Health, and Mental Health Treatment among Adults.","authors":"Samuel H Zuvekas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has been widely reported to have increased symptoms of anxiety, depression, and other mental health issues. It may also have significantly disrupted continuity of treatment for existing patients and made access for those newly seeking care more difficult at a time when treatment needs are higher.</p><p><strong>Aims of the study: </strong>This study seeks to examine the impact of the COVID-19 pandemic on mental health status and mental health treatment among adults residing in the U.S. civilian, non-institutionalized population.</p><p><strong>Methods: </strong>The data are drawn from the 2019-2020 Medical Expenditure Panel Survey (MEPS), a nationally representative household survey of the U.S. civilian non-institutionalized population conducted annually since 1996 and used extensively to study mental health treatment in the U.S. I examine unadjusted and regression-adjusted differences between 2019 and 2020 in perceived mental health status (excellent, very good, good, fair, poor) and in the K6 general psychological distress, the PHQ-2 depression screener, and the VR-12 mental component summary score. Similarly, using the detailed MEPS data on health care encounters and prescription drug fills, I examine differences in mental health use treatment between 2019 and 2020. I focus specifically on changes in continuity of treatment among those already in treatment in January and February, before the pandemic fully struck, as well differences in the initiation of new episodes of treatment after the pandemic began.</p><p><strong>Results: </strong>All four mental health scales included in the MEPS show statistically significant declines in mental health between 2019 and 2020, particularly among younger adults. On balance, the percentage of US adults receiving mental health treatment did not change significantly. Continuity of treatment increased slightly in 2020, with 87.1% of adults in treatment January or February still receiving care in the second quarter, an increase of 2.5 percentage points (p=.025). However, there were significant declines in the initiation of new episodes of treatment, especially in the second quarter of 2020.</p><p><strong>Discussion: </strong>While the continuity of treatment among adults already in care when the COVID pandemic first led to nationwide disruptions is welcome news, the decline in new episodes of mental health treatment among those not previously treated is of great concern. In a time of heightened need, the gap between need and treatment likely grew larger. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE, AND IMPLICATIONS FOR HEALTH POLICIES: Continued long-term monitoring of the mental health needs and treatment gaps will be important, especially as many emergency measures designed to mitigate the effects of the pandemic on access to mental health treatment expire.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 4","pages":"159-183"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employer-Provided and Self-Initiated Job Accommodations for Workers with Serious Mental Illness.","authors":"Marjorie L Baldwin, Rebecca M B White, Steven C Marcus","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many individuals with serious mental illness (SMI) are capable of employment in regular jobs (i.e. jobs paying at least minimum wage, not set aside for persons with disabilities, and not obtained with assistance from mental health services), but they may need job accommodations to be successful. The extant literature focuses almost exclusively on accommodations for workers with SMI who are receiving employment support, so we know almost nothing about the nature or frequency of accommodations needed by workers who are independently employed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;Drawing on survey data from a sample of workers with diagnoses of SMI who are capable of regular, mainstream employment, we aim to: (i) describe the nature and frequency of job accommodations workers requested from their employer or initiated on their own; and (ii) identify individual- and work-related factors associated with the probabilities of requesting or initiating accommodations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The analysis sample includes 731 workers with diagnoses of schizophrenia, bipolar disorder, or major depressive disorder, who were employed in regular jobs post-onset of SMI. Workers identified any job accommodations requested from their employer, or initiated on their own. Summary statistics describe the nature and frequency of accommodations in four categories: scheduling, workspace, supervision, job modification. Logistic regression models estimate the relationship between workers' health- and job-related characteristics and the probabilities of requesting or self-initiating accommodations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Whereas 84% of workers in our sample self-initiated accommodations, only 25% requested accommodations from their employer. The most frequent accommodations of either type involved flexibility in scheduling (63% self-initiated, 24% requested), or modifications to the workspace (58%, 19%). Factors significantly correlated with the probability of requesting accommodations include: supportive workplace culture, longer job tenure, more severe cognitive/social limitations. Factors significantly correlated with the probability of self-initiating accommodations include: younger age, more severe social limitations, greater job autonomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This is the first study of job accommodations among a cohort of persons with SMI independently employed in regular jobs. We identify a type of accommodation, self-initiated by the worker, that has not been studied before. These self-initiated accommodations are far more prevalent than employer-provided accommodations in our sample. Key factors associated with the probabilities of requesting/initiating accommodations reflect need (e.g. compromised health) and feasibility of implementation in a particular job. Limitations of the study include the cross-sectional design which limits our ability to identify causal relationships.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for he","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 4","pages":"137-147"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Sustainability of Novel Delivery Models in Behavioral Health Treatment.","authors":"Dominic Hodgkin, Constance M Horgan, Stephanie Jordan Brown, Gavin Bart, Maureen T Stewart","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through grants to develop and test the new interventions. The original grant funding is typically time-limited. This implies that eventually communities, clinicians, and others must find resources to replace the grant funding -otherwise the innovation will not be adopted. Diffusion is challenged by the continued dominance in the US of fee-for-service reimbursement, especially for behavioral health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To understand the financial challenges to disseminating innovative behavioral health delivery models posed by fee-for-service reimbursement, and to explore alternative payment models that promise to accelerate adoption by better addressing need for flexibility and sustainability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We review US experience with three specific novel delivery models that emerged in recent years. The models are: collaborative care model for depression (CoCM), outpatient based opioid treatment (OBOT), and the certified community behavioral health clinic (CCBHC) model. These examples were selected as illustrating some common themes and some different issues affecting diffusion. For each model, we discuss its core components; evidence on its effectiveness and cost-effectiveness; how its dissemination was funded; how providers are paid; and what has been the uptake so far.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The collaborative care model has existed for longest, but has been slow to disseminate, due in part to a lack of billing codes for key components until recently. The OBOT model faced that problem, and also (until recently) a regulatory requirement requiring physicians to obtain federal waivers in order to prescribe buprenorphine. Similarly, the CCBHC model includes previously nonbillable services, but it appears to be diffusing more successfully than some other innovations, due in part to the approach taken by funders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policy: &lt;/strong&gt;For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 4","pages":"149-158"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value-Based Insurance Design: Clinically Nuanced Consumer Cost-Sharing for Mental Health Services.","authors":"Nicole M Benson,&nbsp;A Mark Fendrick","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>While consumer cost-sharing is a widely used strategy to mitigate health care spending, numerous studies have demonstrated that even modest levels of out-of-pocket cost are associated with lower use of medical care, including clinically necessary, high-value services. Within mental health care, increases in cost-sharing are associated with reductions in use of mental health care and psychotropic medication use. Further, these reductions in mental health services and treatments can lead to downstream consequences including worsening of psychiatric illness and increased need for acute care and psychiatric hospitalization. Thus, there is a need for clinically informed solutions that explicitly balance the need for appropriate access to essential mental health services and treatments with growing fiscal pressures faced by public and private payers. Value-Based Insurance Design (VBID) describes a model where consumer cost-sharing is based on the potential clinical benefit rather than the price of a specific health care service or treatment.</p><p><strong>Aims of the study: </strong>Describe value-based insurance design and applications in mental health care.</p><p><strong>Results, discussion and implications for health policies: </strong>For over two decades, clinically nuanced VBID programs have been implemented in an effort to optimize the use of high-value health services and enhance equity through reduced consumer cost-sharing. Overall, the evidence suggests that VBID has demonstrated success in reducing consumer out-of-pocket costs associated with specific, high value services. By reducing financial barriers to essential clinical services and medications, VBID has potential to enhance equity. However, the impact of VBID on overall mental health care spending and clinical outcomes remains uncertain.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 3","pages":"101-108"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}