USPSTF Ruling, Medicare Policy Change Signal Shift In Recognizing Link Between Chronic Disease, Behavioral Health

Two recent policy announcements, one from Medicare and another from the US Preventive Services Task Force, signal a shift toward understanding that America's battle with obesity and diabetes is not only a medical but also a behavioral health problem, and must be treated as such.

Two recent policy announcements, one from Medicare and another from the US Preventive Services Task Force, signal a shift toward understanding that America’s battle with obesity and diabetes is not only a medical but also a behavioral health problem, and must be treated as such.

First, the Centers for Medicare and Medicaid Services (CMS) announced last month that it would start paying primary care physicians $42 a month per patient next year to coordinate the care those with chronic diseases that include diabetes, heart disease, and depression. According to the Advisory Board, the fee is contingent upon practices addressing patients’ psychological and social needs.

Then, last week, the USPSTF followed up with a recommendation that obese or overweight patients with cardiovascular disease receive intensive behavioral counseling. The recommendations, published in the Annals of Internal Medicine, apply to adults age 18 or older and carry a “B” recommendation, which means that it is a moderate benefit that should be offered to most patients.

The two policy announcements support the findings of a study published just last week by The American Journal of Managed Care, which studied practices that spent extra time with Medicare patients upfront in an effort to avoid medical costs later. The practices capped patient loads and featured many elements that will be required under the new CMS reimbursement model — such as 24-hour access and coordinated care. The study showed the model produced better health outcomes and cost savings for Medicare Advantage.

The Affordable Care Act (ACA) requires that all preventive services rated B or higher be covered, and obesity screening and counseling coverage is already included for all but a few grandfathered plans. However, such counseling typically ends a preset number of sessions.

Reimbursing primary care doctors is likely to make bigger difference. Many PCPs often act as care coordinators without compensation, at a financial loss. The inability to be compensated for such coordination tasks is seen as a contributing factor to the shortage of PCPs nationwide, and to overcrowding in practices. Not only is the situation unpleasant for doctors and patients, but it is viewed as a contributor to the spiraling cost of healthcare.

As reported in Evidence-Based Diabetes Management in July, the concept of coordinating care between PCPs who treat diabetes and obesity and behavioral health specialists received high-profile attention at recent meetings of both the American Diabetes Association and the American Psychiatric Association. TEAMCare of the University of Washington pioneered the concept and published its results in the New England Journal of Medicine, demonstrating savings per patient of $594 a year.

Around the Web

Personalized Preventive Care Reduces Healthcare Expenditures Among Medicare Advantage Beneficiaries

Integrated Treatment for Diabetes, Depression Gains Notice With Help from ACA

Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients

Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors