Category Mental Health Reform

How Peer Specialists Enhance Shared Decision Making

Tom Lane, Certified Recovery Support Specialist

Much has been written about patient-centered care. Proof that this model is gaining acceptance is the evolution to shared decision making (SDM). The National Learning Consortium defines SDM as a “process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.”

In a recent CFYM post John Williams, M.D., writes that there are several tools that clinicians can use to step through the shared decision making process. Dr. Williams opines that when there are many different treatment options, SDM takes on added importance. As a result, a major step in the SDM process must be for clinicians to understand the desired outcomes of their patients.

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Use Shared Decision Making to Maximize Health Insurance Benefits

Depression and Bipolar Support Alliance for Care for Your Mind

It’s no secret that out-of-pocket healthcare costs—the amount you pay—have risen significantly. These expenses have been trending upward for over a decade and there is no indication that this trend will end anytime soon. In 2013, according to the HealthAffairs Blog, nearly one-third of participants in an employer-sponsored plan had a high deductible. Plans purchased through the federal marketplace have similar out-of-pocket costs, especially at the Bronze level.

The rationale behind Health Savings Accounts (tax-free accounts where money is set aside for medical expenses) is that, when people have a financial investment in their healthcare, they are more likely to make better decisions about how they consume or use this commodity. It’s fair to say that this idea can also support the trend towards higher copays or co-insurance.

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Why You Deserve Shared Decision Making

Editor’s note: Care for Your Mind—in partnership with the National Network of Depression Centers and other organizations—has been seeking answers to the question: what’s keeping people from getting the mental health care they need? Shared decision making (SDM) is one piece of the puzzle, through which healthcare providers work with patients to understand their individual needs, preferences, and values. Then, patients and providers discuss different options and make care decisions together. It’s a common sense, personalized approach to care. Dr. John Williams introduces our series on SDM. Join the conversation!

John W. Williams Jr., MD Professor of Medicine and Psychiatry at Duke University

As a patient, would you want your physician making healthcare decisions on your behalf without any regard for your personal preferences, values, or needs? If you’re like most people, you’d prefer to be involved in choosing the care that’s right for you. After all, it’s your body, your mind, your financial resources, and your life.

Shared decision making, or SDM, is a process through which you and your doctor make decisions together, as partners. It’s a common sense concept: you discuss the things that matter to you, your doctor provides information, and then works with you to choose the best treatment for you.

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What Role Do Patients Play in Improving Quality of Care? A Big One.

Editor’s note: Please enjoy this article from the CFYM archive, first published March 24, 2014. Look for the upcoming series which will focus on the collaboration between the patient and the clinical team around shared-decision making.

David Katzelnick, M.D.
Chair, Division of Integrated Behavioral Health, Mayo Clinic
We acknowledge the collaboration of 
National Network of Depression Centers in developing this series.

With a world of health information literally at our fingertips, patients are more informed and engaged than ever. Research indicates that patients who are actively involved in their own healthcare receive higher quality care and achieve better health outcomes.

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Is the “Helping Families in Mental Health Crisis Act” Ready for Prime Time?

Things can move very quickly in DC when the right people are motivated. Case in point: Speaker of the House Paul Ryan (R-WI) signaled that he wanted mental health legislation to reach a floor vote this year. So while H.R. 2646, sometimes known as the Murphy bill, seemed to be languishing, the leadership of the Energy and Commerce Committee worked to bring the bill to mark-up last Wednesday, June 15.

Some people opine that our democracy intends for citizens to advocate hard for their principles while accepting that competing points of views must also be acknowledged when moving legislation. Others believe that people should hold tight to their principles, never relenting.

Depending on your own philosophy, last week’s committee mark-up outcome is cause for celebration, acceptance of the inevitable, or reason to keep up the fight. Following is an overview of the bill that was voted out of committee. Insiders are saying that Speaker Ryan wants a full chamber vote later this summer.

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BCBS North Carolina Isn’t Paying Claims. People Are Suffering. What to Do?

Rhonda Karg, Ph.D.
New Leaf Psychotherapy, Asheville, NC

Imagine being a small business owner. You’re passionate about what you do, you serve your community, and your main purpose is to help people in need. But suddenly your biggest client withholds payment for six months or more. Would you find this unacceptable, illegal, infuriating? How would you keep your doors open or pay your car insurance, phone bill, or mortgage?

For many behavioral health providers who’ve contracted with Blue Cross Blue Shield of North Carolina (BCBSNC), that’s the situation they’ve faced since January.

Citing a software problem, the insurance giant is now months behind on paying 9-15% of its claims from providers. In addition to the outrageous financial toll this is taking on clinicians—some of whom rely on BCBSNC for 90% of their income— thousands of patients statewide have lost their access to care.

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How Communities Can Fund Mental Health Services

Funding local mental health and substance use disorder programs and services is an ongoing challenge. Although the federal government allocates money to support mental health care in the states, federal spending on public health has been eroded through funding cuts and budget caps. State governments haven’t done any better. However, over the past couple of decades, state legislatures have been empowering counties and municipalities to create their own revenue, whether through a local sales tax or property tax.

Sales tax in Washington State
Like many other counties in Washington State, Snohomish County adopted a 1/10th of 1% sales tax to support mental health and substance use disorders services. Since 2010, these funds have been used to support a range of direct and wrap-around services for six target populations: youth, families with children, veterans and their families, the aging population, the most vulnerable, and the most costly (i.e., high utilizers).

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A Success Story from Snohomish County

Families for Depression Awareness

In the post above, we used the example of Snohomish County, Washington, of using a designated sales tax to fund mental health services. Here is an example of how funds are used and how they made the difference in one case.

Among many programs, the Snohomish County sales tax funds the Student Support Advocate Program, which provides “intensive case management services to at-risk middle and high school students to connect and engage students and their families with needed resources (mental health and substance use disorder treatment, housing resources and homeless prevention services, food and other basic needs, etc.).” In 2015, the results included the following:

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