How does the ACO model improve care coordination?
The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of p …
Can integrated care help people with alcohol and other drug problems?
There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience.
Does integration of AOD and medical care increase abstinence from drug use?
Similarly, randomised trials evaluating the effectiveness of the integration of AOD and medical care have found higher rates of abstinence from AOD without adding significant additional costs amongst clients receiving integrated care [ 21, 22, 23 ].
Does outpatient treatment improve outcomes in substance abuse recovery?
Although consistent participation in outpatient treatment has been found to be important for psychosocial functioning and staying in recovery from substance abuse, participation in mutual support programs has also been found to independently improve these outcomes (Moos, Schaefer, Andrassy, & Moos, 2001).
What are the benefits of integrated treatment?
Benefits of integrated treatment may include the following: Help patients into recovery by providing more holistic support services, such as employment assistance. Assists patients in identifying individualized recovery goals and learning how recovery from each illness will work.
What is the most effective intervention for substance abuse?
CBT is often rated as the most effective approach to treatment with a drug and alcohol population.
How does motivational interviewing help with the treatment of substance use disorders?
Motivational Interviewing For Addiction Treatment. Motivational Interviewing (MI) is a therapeutic technique used to address addiction and substance use disorders (SUD) in patients by strengthening one's motivation and commitment to a particular goal, such as sobriety.
What is integrated treatment approach?
Integrated treatment simply means that one provider (or one team of providers) delivers both mental health and substance use services at the same time. Integrated Treatment. is Most Effective Approach.
What are the most successful methods for intervention?
Some of the most effective ones include:The Systemic Family Model of Intervention. ... The Love First Approach to Intervention. ... The Confrontational Model of Intervention. ... Tough Love. ... Crisis Intervention. ... The Johnson Model of Intervention. ... ARISE Intervention. ... CRAFT Intervention.
What are the priority nursing interventions for substance abuse?
Nursing interventions for a client with substance abuse include:Providing health teaching for client and family. Clients and family members need facts about the substance, its effects, and recovery.Addressing family issues. ... Promoting coping skills.
What are the benefits of motivational interviewing?
The Benefits of Motivational Interviewing Benefits of motivational interviewing include: Helping clients to take responsibility for themselves and their actions. Encouraging clients to envision a future free of substance abuse or mental health struggles. Preparing clients to become more receptive to treatment.
Why is motivational interviewing more effective?
Motivational Interviewing aims to explore and resolve ambivalence that people might have about health behaviour in favour of change. It encourages people to say why and how they might change and pertains both to a style of relating to others and a set of skills to facilitate that process.
Why is motivational interviewing effective?
MI can help high-risk clients build motivation for their treatment. A review of studies by Lundahl and Burke (2009) found that MI was 10% to 20% more effective at reducing risky behaviors and increasing engagement than no treatment at all.
What are the elements of an integrated treatment plan?
In this article we define integrated treatment for clients with co-occurring disorders, and identify the core components of effective integrated programs, including: assertive outreach, comprehensiveness, shared decision-making, harm-reduction, long-term commitment, and stage-wise (motivation-based) treatment.
What does an integrated treatment plan contain?
In Integrated Treatment programs, the same practitioners or treatment team, working in one setting, provide mental health and substance abuse interventions in a coordinated fashion. Consumers receive one consistent message about treatment and recovery.
What is the most effective approach for the treatment of co-occurring disorders?
Integrated Treatment for Co-Occurring Disorders, an evidence-based practice, is one of the most effective service strategies available, demonstrating consistent, positive outcomes for this vulnerable population.
What is integrated treatment?
Integrated treatment refers to the focus of treatment on two or more conditions and to the use of multiple treatments such as the combination of psychotherapy and pharmacotherapy.
Does alcohol deplete serotonin?
Badawy’s (2003)review indicates that alcohol can de plete serotonin to the point of inducing aggression, even in people who are non-alcohol-dependent. Urban et al. (2012)conclude that even moderate use of ecstasy affects serotonin to the point of negatively affect mood, cognition, and impulse control.
What are the key approaches to improving integrated care at a clinical level?
Studies mentioned screening, routine informed consent practices, joint care planning and supervision as key approaches to improving integrated care at a clinical level. Many of these were found to be facilitated by service delivery and organisational level factors.
Why is it impossible to isolate a single strategy and study its effectiveness?
It is almost impossible to isolate a single strategy and study its effectiveness, because of the embedded nature of partnership and integration. This is perhaps why we did not find any randomised control trials of strategies to improve integrated care to people with AOD problems.
What is case management?
Case-management was the most common model of service delivery identified as a useful approach to integrated care [ 33, 36 ]. Case-management has been found to be a particularly appropriate for clients with multiple and complex needs that cannot be met by a single provider [ 36 ]. In these cases, having a provider (e.g., case-manager) who can plan and arrange care can facilitate access and ensure needs are met [ 36 ]. In evaluating intensive case-management in Belgium, Vanderplaschen et al. [ 36] found that case-management also improved participation and retention in AOD treatment, and helped to avert crisis situations.
What are the problems with AOD?
These can include mental health, medical, housing, unemployment, education and training needs, as well as issues with criminal justice and social services [ 2, 3, 4] and potentially intimate partner violence [ 5 ]. Unmet psychosocial needs can result in treatment drop out, highlighting the need for a holistic approach to treatment [ 6 ].
What are the key strategies at the service delivery level?
Staff training, information sharing, case-management, referral and the development of staff inter-professional networks emerged as key strategies at the service delivery level. Most of these were found to be underpinned by strong inter-agency relationships.
Study Data and Methods
- Survey Data And Analysis
We conducted the National Survey of Accountable Care Organizations (NSACO), a comprehensive survey of ACOs that were in existence as of August 2013. These ACOs included participants in Medicare’s Shared Savings Program, Pioneer ACOs, Medicaid ACOs, and commercial-payer ACO…
Study Results
- Total Cost Of Care Inclusion
We began by examining whether mental health and substance abuse treatment costs were included in the total cost of care for which providers are responsible. The total cost is the full set of charges upon which an ACO’s spending performance is measured to determine potential shar… - Providers And Services
We next examined the extent to which ACOs had behavioral health care providers associated with them. According to our survey data, 37 percent of ACOs reported that they had no formal relationship with behavioral health care provider groups, and 21 percent reported that they contr…
Implications
- Our findings have several implications. First, low levels of behavioral health care incorporation in ACOs indicate that there is much opportunity to advance the integration of behavioral health care into ACOs. Most ACOs have at least one contract with responsibility for behavioral health in their total cost of care measures. This inclusion represents an important shift away from historical fi…
Conclusion
- The ability of ACOs to meet the mental health and substance abuse treatment needs of their patients may influence the organizations’ long-term success. Unmet behavioral health needs can compound patients’ difficulties in accessing care and adhering to treatment recommendations. Lack of access to these services may contribute to chronic or ongoing health problems and to in…
Acknowledgments
- This research was supported by a grant from the Commonwealth Fund. The authors thank Steve Bartels, Bob Drake, Anusha Raja, Pamela Riley, Aleen Saunders, Karen Schoenherr, Stephen Shortell, and Hal Sox for valuable research support and comments on earlier versions of this article.
Notes
- 1 Berwick DM . Making good on ACOs’ promise—the final rule for the Medicare shared savings program . N Engl J Med . 2011 ; 365 ( 19 ): 1753 – 6 . Crossref, Medline, Google Scholar
- 2 Fisher ES , Shortell SM , Kreindler SA , Van Citters AD , Larson BK . A framework for evaluating the formation, implementation, and performance of accountable care organizations . Health Aff (Mil...
- 1 Berwick DM . Making good on ACOs’ promise—the final rule for the Medicare shared savings program . N Engl J Med . 2011 ; 365 ( 19 ): 1753 – 6 . Crossref, Medline, Google Scholar
- 2 Fisher ES , Shortell SM , Kreindler SA , Van Citters AD , Larson BK . A framework for evaluating the formation, implementation, and performance of accountable care organizations . Health Aff (Mil...
- 3 Maust DT , Oslin DW , Marcus SC . Mental health care in the accountable care organization . Psychiatr Serv . 2013 ; 64 ( 9 ): 908 – 10 . Crossref, Medline, Google Scholar
- 4 O’Donnell AN , Williams BC , Eisenberg D , Kilbourne AM . Mental health in ACOs: missed opportunities and low hanging fruit . Am J Manag Care . 2013 ; 19 ( 3 ): 180 – 4 . Medline, Google Scholar
