The Robert Wood Johnson Foundation (RWJF) released a report examining the national health care reform law’s impact on individuals with comorbid mental and physical health disorders.  The report notes that individuals with mental illnesses are more likely than those without mental illness to be uninsured and have physical health ailments.  The authors posit that health reform’s expanded coverage will benefit this population, particularly through broader Medicaid eligibility.  The brief suggests that health reform offers policymakers an opportunity to address mental and physical illness comorbidities in a manner that improves care, reduces care fragmentation, and disseminates evidence-based practices for treating comorbid illnesses in routine care settings.

From the report:

In the wake of the passage of national health reform, the nation is focusing its efforts on how to improve quality and efficiency within the health care system. However, expenditures and gaps in care delivery are not evenly distributed throughout the population; only 5 percent of the population account for half of all health care spending (138) and there is considerable variation in quality of care across different conditions and settings (106). Therefore, achieving the goals of improved quality and efficiency will require focusing specifically on subgroups most at risk for high costs and poor quality of care (113).

Full Report: Mental disorders and medical comorbidity (PDF | 543 KB) 

Robert Wood Johnson Foundation. (2011). Mental disorders and medical comorbidity. Druss, B. and Reisinger Walker, E.

The Journal of the American Academy of Child and Adolescent Psychiatry published a study examining the barriers to behavioral health treatment for adolescents, especially those with co-occurring disorders.  The authors analyze the implications of health reform on access to behavioral health, and conclude that health reform will improve access to behavioral health for adolescents.

Sterling, S., Weisner, C., Hinman, A. and Parthasarathy, S.  (2010).  Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities.  The Journal of the American Academy of Child and Adolescent Psychiatry,  49(7): 637-646.  http://www.ncbi.nlm.nih.gov/pubmed/20610133

Authors: S. Sterling, C. Weisner, A. Hinman and S. Parthasarathy 

The Kaiser Family Foundation (KFF) released a brief examining provisions in the national health care reform law aimed at improving the delivery and coordination of services for dual eligibles.  The brief uses linked Medicare and Medicaid data to examine the chronic conditions and co-morbidities that lead to substantial service needs for dual eligibles, and outlines how both programs contribute financially to ensure that dual eligibles receive the care that they need.  KFF suggests that dual eligibles will be a focus of state and federal policy for the foreseeable future.

From the report: With the passage of health reform, new provisions are directed at improving the delivery and coordination of services for persons enrolled in both Medicaid and Medicare, otherwise known as dual eligibles. Dual eligibles constitute a costly segment of beneficiaries for both programs and include individuals with some of the most severely disabling chronic conditions. While the higher costs associated with services to dual eligibles is well‐known, information on how spending distributes across these programs is less understood. This analysis uses linked Medicare and Medicaid data to provide a clearer picture of the chronic physical and mental conditions and multiple co‐morbidities that create substantial needs for medical and long‐term services among dual eligibles, and provides information about the financial contribution of both Medicare and Medicaid in meeting these needs.

Full report: Chronic Disease and Co-Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending (PDF | 505.5 KB)

Kaiser Family Foundation.  (2010).  Chronic disease and co-morbidity among dual eligibles: implications for patterns of medicaid and medicare service use and spending.

A report by the National Academy for State Health Policy (NASHP) examines the initiatives in the Patient Protection and Affordable Care Act that enhance long term services and supports (LTSS) and improve coordination of primary and chronic care for the elderly and adults with disabilities.  The report finds that the Act’s provisions establish delivery systems demonstrations and Medicaid options that the states can adopt to implement state reform.  The report analyzes the provisions regarding: national voluntary long-term care insurance; Medicaid options and incentives for financing LTSS expansions; other LTSS provisions; the coordination of primary and chronic care; and nursing home reform.

From the report:

The Patient Protection and Affordable Care Act (PPACA) signed into law on March 23, 2010 includes provisions that affect practically every aspect of the country’s health care system. This report focuses on policy changes related to the continuum of care for older people—specifically long term services and supports (LTSS) and chronic care coordination. For this analysis, the Act’s major provisions in these areas are organized into five categories: 1) national insurance for long term services and supports; 2) Medicaid options and incentives to expand LTSS; 3) other LTSS provisions; 4) chronic care coordination; and 5) nursing home reforms.

Full report:  Long Term Services and Supports and Chronic Care Coordination under Health Care Reform and States Options (PDF | 152.81 KB)

National Academy for State Health Policy. (2010). Long term services and supports and chronic care coordination: policy advances enacted by the Patient Protection and Affordable Care Act. Justice, D.

The Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS), released its two annual studies on health care quality and disparities for 2009; the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR).  Both reports examine effectiveness in health care, patient safety, timeliness, patient-orientation, and efficiency of care.  The NHQR found that the median level of receipt of needed services nationally was 58 percent, and noted that the uninsured are less likely to obtain preventative care or chronic disease management than the insured.  The NHDR found that minorities and the poor are significantly more likely to receive a lower quality of care, and that their access to care is also worse.

National Healthcare Quality Report (PDF | 3.14 MB)

National Healthcare Disparity Report (PDF | 7.89 MB)

Agency for Healthcare Research and Quality. (2010). National Healthcare Quality and Disparities Reports.

On April 20, the Kaiser Family Foundation (KFF) released a brief offering answers to general questions about the temporary national high-risk pool that will be implemented in June and last until insurance exchanges become operational in January 2014.

From the report: