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The American Journal of Managed Care December 2016
Getting From Here to There: Health IT Needs for Population Health
Joshua R. Vest, PhD, MPH; Christopher A. Harle, PhD; Titus Schleyer, DMD, PhD; Brian E. Dixon, MPA, PhD, FHIMSS; Shaun J. Grannis, MD, MS, FAAFP, FACMI; Paul K. Halverson, DrPH, FACHE; and Nir Menache
The Health Information Technology Special Issue: Current Trends and Future Directions
Joshua R. Vest, PhD, MPH
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How Health Plans Promote Health IT to Improve Behavioral Health Care
Amity E. Quinn, PhD; Sharon Reif, PhD; Brooke Evans, MA, MSW; Timothy B. Creedon, MA; Maureen T. Stewart, PhD; Deborah W. Garnick, ScD; and Constance M. Horgan, ScD
Accountable Care Organization Hospitals Differ in Health IT Capabilities
Daniel M. Walker, PhD, MPH; Arthur M. Mora, PhD, MHA; and Ann Scheck McAlearney, ScD, MS
Building Health IT Capacity to Improve HIV Infection Health Outcomes
Hannah Rettler, MPH; R. Monina Klevens, DDS, MPH; Gillian Haney, MPH; Liisa Randall, PhD; Alfred DeMaria, MD; and Johanna Goderre, MPH
Telemedicine and the Sharing Economy: The "Uber" for Healthcare
Brian J. Miller, MD, MBA, MPH; Derek W. Moore, JD; and Chester W. Schmidt, Jr, MD
Assessing Electronic Health Record Implementation Challenges Using Item Response Theory
Kitty S. Chan, PhD; Hadi Kharrazi, MD, PhD; Megha A. Parikh, MS; and Eric W. Ford, PhD, MPH
Payer—Provider Patient Registry Utilized in a Behavioral Health Home
Michele Mesiano, MSW; Meghna Parthasarathy, MS; Shari L. Hutchison, MS, PMP; David Salai, BS; Suzanne Daub, LCSW; Mary Doyle, MHIS; and James M. Schuster, MD, MBA
US Hospital Engagement in Core Domains of Interoperability
A. Jay Holmgren, BA; Vaishali Patel, PhD; Dustin Charles, MPH; and Julia Adler-Milstein, PhD

How Health Plans Promote Health IT to Improve Behavioral Health Care

Amity E. Quinn, PhD; Sharon Reif, PhD; Brooke Evans, MA, MSW; Timothy B. Creedon, MA; Maureen T. Stewart, PhD; Deborah W. Garnick, ScD; and Constance M. Horgan, ScD
Commercial health plans promote the use of health IT to support behavioral health care access and delivery.
Overall, a majority of products were engaged in strategies to improve assessment and treatment services using health IT. Nearly all products offered enrollees an online self-assessment tool (94.9%). Fewer offered online personalized responses to questions or problems (70%). Online counseling was offered by 60% of products. Products with hybrid-internal contracts were significantly more likely to offer online personalized responses and online counseling (over 80%) than products with specialty external and internal contracts; fewer than 10% of specialty external and internal products offered online counseling. However, specialty external (19.4%) and internal products (58.7%) offered online personalized responses more frequently than online counseling.

DISCUSSION

This study provides a baseline of health plans’ promotion of health IT strategies at a pivotal point for US health and behavioral health care policy, and fills a gap in the literature around how health IT was utilized in behavioral health care early in the post-HITECH era. Although a limited amount of literature specific to behavioral health and health IT is available, research in general medical settings suggests that health IT has a positive effect on quality, efficiency, and provider satisfaction.26 This research has implications for behavioral health. A 2011 review identified the importance of strong leadership and staff buy-in for successful health IT implementation, and that smaller providers—not only those in large integrated care organizations—can benefit from health IT.26 More leadership for health IT in behavioral health, which has been slower to adopt health IT, could improve behavioral health care quality, efficiency, and coordination between behavioral health and general medical care.

Our findings illustrate that health plans are promoting health IT for behavioral health. However, health plans are limited in how much they can spur adoption of health IT for behavioral health more broadly, because health IT overall still has many limitations (eg, standardization of data, interoperability within healthcare systems, operability outside healthcare environments, lack of or insufficient inclusion of behavioral health data elements) that prevent adequate incorporation and clinical use of behavioral health information.7,20,27 Addressing the limits of health IT to meaningfully incorporate behavioral health information is likely to be a key ingredient in order to successfully integrate medical and behavioral care.7 For example, 2 large payers—Kaiser Permanente of Northern California and the Veteran’s Health Administration—have been leaders in using EHRs to address risky alcohol use in primary care, primarily by using a standardized EHR that includes recommended alcohol screening questions, tracking performance, using clinical alerts/decision support software, and providing positive leadership.28-33 In 2010, commercial health plans were engaging in health IT in all 3 areas that we examined to support providers, facilitate access to care, and improve care delivery. Among provider support strategies, financial strategies were more common than technical assistance strategies. Across the 3 domains, health IT approaches that facilitated access, assessment, and treatment were generally used more often than provider support strategies.

E-mailing providers and online appointment scheduling were infrequent among this survey of health plans. However, both of these approaches are more likely to be activities that provider systems, rather than health plans, operate and encourage; thus, this finding is unsurprising. With increased uptake of patient portals,34 the role of commercial health plans in encouraging access to care and care delivery through portals may grow over time. In the changing healthcare marketplace, health plans are not only payers, but can also play an important role in helping patients to manage their health and healthcare.

Approaches varied by behavioral health contracting arrangement, which points to the influence of health plan organizational characteristics on their health IT strategies. Products with hybrid-internal arrangements were more likely to support health IT for behavioral health than specialty external and internal products. This may result from their unique organizational structure that offers both specialization in behavioral health and a closer relationship between behavioral health and medical care management because of common ownership of the behavioral health organization and the health plan. It may also reflect the challenges that interoperability requires when multiple organizations are involved, as for plans with other behavioral health contracting arrangements.

Compared with a similar study in 2003,35 there has been a large increase in health plans’ health IT strategies in the domains of access and assessment and treatment. In 2003, two-thirds of health plan products offered self-assessment tools, half provided online referrals, one-third provided personalized responses to problems, and only 2% offered online counseling. Most strikingly, in 2010, 60% of products offered online counseling. As health IT moves toward new innovations, like smartphone applications,36 it will be interesting to observe how health plans’ assessment and treatment health IT strategies evolve.

Limitations

Data were self-reported by health plan executives and may not fully reflect what was happening in practice. Provider support strategies had high rates of missing data and were not all specific to behavioral health. Further, it is possible that online appointment scheduling and e-mailing between patients and providers is available to patients at the provider organization level. Additional research is needed to assess what inroads have been made by health plans to promote health IT for behavioral health care since 2010 and in the new MACRA era, including implementation studies to assess which strategies and settings are effective.

CONCLUSIONS

These results suggest important implications for health IT implementation and improvement in the behavioral health sector. Given the current focus on integrating physical and behavioral health care, health IT strategies and EHR interoperability are likely to be important facilitators.37 The success of PCMH and ACO delivery system transformation efforts rests, in large part, on health IT infrastructure development,37 and to what extent behavioral health is included. Moreover, given the low rates of EHR uptake and implementation among providers who were excluded under HITECH12,38,39—which includes many behavioral health providers—it will be important to support behavioral health providers in EHR development and use in the MACRA environment.

Health plans are likely to be key stakeholders in encouraging health IT-oriented activities for behavioral health, and in the shift toward integrated care. Our results indicate that health plans specifically support the use of health IT in integrated care delivery by allowing primary care providers to bill for e-mailing patients about behavioral health issues. As these findings suggest, health plans played an important health IT role in 2010 to facilitate behavioral health care delivery. Health plans may also have a pivotal role moving forward to improve how health IT strategies incorporate behavioral health information and improve the quality of behavioral health care. 

Acknowledgments

The authors wish to acknowledge the contributions of Pat Nemeth, Frank Potter and staff at Mathematica Policy Research, Inc. (survey design, statistical consultation and data collection), Grant Ritter (statistical consultation), and Galina Zolutusky (statistical programming).

Author Affiliations: Heller School for Social Policy and Management, Brandeis University (AEQ, SR, BE, TBC, MTS, DWG, CMH), Waltham, MA.

Source of Funding: This work was funded by the National Institute on Alcohol Abuse and Alcoholism (R01AA010869) and the National Institute on Drug Abuse (R01DA029316). The funding agencies did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (AEQ, SR, BE, TBC, MTS, DWG, CMH); acquisition of data (AEQ, SR, TBC, MTS, DWG, CMH); analysis and interpretation of data (AEQ, SR, BE, TBC, MTS, CMH); drafting of the manuscript (AEQ, SR, BE, TBC, MTS, CMH); critical revision of the manuscript for important intellectual content (AEQ, SR, BE, TBC, MTS, DWG); statistical analysis (TBC, CMH); obtaining funding (SR, CMH); administrative, technical, or logistic support (AEQ, BE); and supervision (SR, CMH).

Address Correspondence to: Amity E. Quinn, PhD, Brandeis University, 415 South St, MS035, Waltham, MA 02453. E-mail: amity@brandeis.edu.
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