Mental Health Group IV

1) Public Policy Problem Problem: High cost medical conditions among Medicare beneficiaries with co- morbid mental health conditions are treated ineffectively because Medicare does not reimburse for evidence-based “collaborative care.”

2) Dimensions of the Problem About 1/3 of Medicare beneficiaries have a co- morbid mental health condition Fewer than half of Medicare beneficiaries with co-morbid mental health conditions are detected by PCPs 35 randomized clinical trials have found that evidence-based coordination of care with mental health providers doubles the effectiveness of treatment among beneficiaries with co-morbid mental health conditions

3) Rationale for Pursuing this Problem The effective treatment of Medicare beneficiaries with high-cost medical conditions requires the effective management of co-morbid mental disorders, particularly depression and anxiety. Medicare does not reimburse for evidence-based “collaborative care.”

4) Stakeholders: Supporters and Their Positions Primary mental health providers: neutral or supportive if this includes psychosocial therapy PCPs neutral or supportive if the case-rate is sufficient Nurses: supportive if generates additional jobs Pharmaceutical companies: supportive if they believe it will increase drug utilization Family caregivers (and the national association) will be supportive: will ease the care giving burden

5) Stakeholders: Opponents and Their Positions Anti-tax groups will argue that this is a new mandate and will raise taxes Some religious groups oppose because it conflicts with their values Some patient advocacy groups will be opposed because there are concerned about violations of privacy or the imposition of unwanted treatment

6) Action Plan Modify MMA to provide a 3 month case-rate reimbursement to primary care providers for evidence-based “care coordination” by a RN. This case-rate may be reauthorized up to 9 months Modify MMA to provide a fee-for-service reimbursement to Medicare licensed mental health providers for evidence-base “care coordination” Direct Secretary of HHS to report, every 2 years on the effectiveness of the program –Outcome measures should include: expenditures on Medicare beneficiaries with high-cost medical conditions and co-morbid mental health conditions; adherence rates; PHQ9 scores; and age-adjusted hospital discharge rates.