Access to mental health support services in Accountable Care Organizations: A national survey

Busch, Susan H.; Tomaino, Marisa; Newton, Helen; Meara, Ellen

doi:10.1016/j.hjdsi.2022.100613

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…As of 2023, 14 states have reported ACOs [ 65 ]. Further, ACO contracts may support access to EBPs for people with persistent mental illness in some arrangements as provider organizations are incentivized by the potential cost savings [ 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings

Wortham,

Rodwin,

Purtle

et al. 2023

Implementation Sci

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Background Over the past three decades, policy actors and actions have been highly influential in supporting the implementation of evidence-based practices (EBPs) in mental health settings. An early examination of these actions resulted in the Policy Ecology Framework (PEF), which was originally developed as a tactical primer for state and local mental health regulators in the field of child mental health. However, the policy landscape for implementation has evolved significantly since the original PEF was published. An interrogation of the strategies originally proposed in the PEF is necessary to provide an updated menu of strategies to improve our understanding of the mechanisms of policy action and promote system improvement. Objectives This paper builds upon the original PEF to address changes in the policy landscape for the implementation of mental health EBPs between 2009 and 2022. We review the current state of policy strategies that support the implementation of EBPs in mental health care and outline key areas for policy-oriented implementation research. Our review identifies policy strategies at federal, state, agency, and organizational levels, and highlights developments in the social context in which EBPs are implemented. Furthermore, our review is organized around some key changes that occurred across each PEF domain that span organizational, agency, political, and social contexts along with subdomains within each area. Discussion We present an updated menu of policy strategies to support the implementation of EBPs in mental health settings. This updated menu of strategies considers the broad range of conceptual developments and changes in the policy landscape. These developments have occurred across the organizational, agency, political, and social contexts and are important for policymakers to consider in the context of supporting the implementation of EBPs. Summary The updated PEF expands and enhances the specification of policy levers currently available, and identifies policy targets that are underdeveloped (e.g., de-implementation and sustainment) but are becoming visible opportunities for policy to support system improvement. The updated PEF clarifies current policy efforts within the field of implementation science in health to conceptualize and better operationalize the role of policy in the implementation of EBPs.

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Section: Discussionmentioning

confidence: 99%

Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings

Wortham,

Rodwin,

Purtle

et al. 2023

Implementation Sci

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“…Most ACOs report that their providers do not have the ability to refer patients to specialty support services, including many who even have a behavioral health facility participating in their ACO contract. 58 This suggests that to be successful, new payment models specifically focused on specialty mental health organizations may be needed, and that these may need to include a focus on team-based support services. Our work also suggests for-profit facilities may be less apt to offer these support services.…”

Section: Discussionmentioning

confidence: 99%

“…However, these models may fail to encourage providers to offer services with high start‐up costs that are used by the relatively narrow set of the population with serious mental illness. Most ACOs report that their providers do not have the ability to refer patients to specialty support services, including many who even have a behavioral health facility participating in their ACO contract 58 . This suggests that to be successful, new payment models specifically focused on specialty mental health organizations may be needed, and that these may need to include a focus on team‐based support services.…”

Section: Discussionmentioning

confidence: 99%

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

et al. 2022

Self Cite

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Community mental health facilities often do not offer the full range of evidence‐based clinical and support services for individuals with serious mental illness. Facilities were no more likely to offer six of seven services studied in 2019 compared with 2010 in both Medicaid expansion and nonexpansion states. For‐profit facilities generally experienced the largest declines in service availability, while public facilities experienced the smallest declines with small increases in availability of select services. New payment models that incentivize the offer of specialty support services may be needed to encourage adoption of clinical and support services by specialty mental health organizations. Context Community mental health facilities often do not offer the full range of evidence‐based clinical and support services for individuals with serious mental illness. This creates equity issues, particularly when low‐income and minority communities have access to fewer facilities. Medicaid expansion might encourage facilities to offer these services. However, this decision may also be affected by facility ownership type or mediated by service cost structure, particularly in the absence of innovative payment mechanisms. In this study, we determine whether and how Medicaid expansion and facility ownership are associated with changes in specialty mental health service availability in organized settings over time. Methods We estimated two‐way fixed effects models using six cross‐sections of the National Mental Health Services Survey and compared changes in facility‐reported offering of seven services from 2010 to 2019 (54,885 facility years): psychotropic medication, case management, family psychoeducation, psychiatric emergency walk‐in services, supported employment, assertive community treatment, illness management, and recovery services. We tested whether Medicaid expansion and facility ownership (private for‐profit, private not‐for‐profit, public) were associated with differential changes in service availability from 2010 to 2019. Findings Overall, facilities were no more likely to offer nearly all services in 2019 than 2010. We found smaller declines for psychotropic medication and psychiatric emergency walk‐in services among facilities in Medicaid expansion states compared to declines in non‐Medicaid expansion states (6.3 (95% CI 95% CI = 1.8‐10.7) and 5.5 (95% CI = 0.2‐10.8) percentage points respectively). For‐profit facilities experienced the largest declines in availability from 2010 to 2019, while public facilities experienced the smallest declines and some increases in availability of select services. Conclusions Specialty mental health services are still not widely offered in community outpatient settings despite significant investments in Medicaid, although Medicaid expansion was associated with slower declines in availability. New payment models that incentivize outpatient facilities to offer clinical and support services may be needed.

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“…The promotion of such physical health must be equalled with the existence of a conducive workplace (Lukan et al 2022 ). Thus, access to support services that support the development of well-being within organisations becomes crucial (Busch et al 2022 ). Most organisational behaviour studies have given scant focus to physical health issues within the workplace (Mathibe & Chinyamurindi 2021 ), rather than mental health.…”

Section: Introductionmentioning

confidence: 99%

Influence of organisational climate on public service employee physical health

Chigbu,

Chinyamurindi,

Marange

2024

Health SA Gesondheid

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Background: The working conditions in the South African public service, notably its challenging environment, pose significant threats to the physical health of employees. Calls exist in understanding how this can be addressed.Aim: The study investigated the predictors of physical health, accounting for the role of organisational climate and decent work.Setting: The study was conducted in Bisho in the Eastern Cape province of South Africa.Methods: An instrument was administered through a survey using a sample of 289 respondents. Descriptive and inferential statistics were used to test the hypothesised relationships.Results: No significant direct effect existed to show that the sounder an organisational climate, the better the physical health of employees will be (β = –0.014, t = –0.199, p = 0.843, 95% confidence interval [CI] [–0.153 to 0.125]). However, statistically significant evidence existed to show that the more focus on promoting decent work, the better the physical health of employees will be (β = 0.463, p = 0.001, 95% CI [0.258 to 0.668]). Finally, decent work has a full mediating effect on the relationship between organisational climate and employee physical health (β = 0.105, 95% CI [0.054 to 0.167]).Conclusion: Public service organisations need to pay attention to the role of its climate and decent working conditions in promoting employee physical health.Contribution: Interventions are needed centered on improving decent work and the organisational climate as identified predictors of employee physical health.

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Access to mental health support services in Accountable Care Organizations: A national survey

Cited by 4 publications

References 15 publications

Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings

Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

Influence of organisational climate on public service employee physical health

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