-So good morning.
Apologize for the technical difficulties.
And I will try to be a little quicker to save some time.
This is Arlene Bierman.
I'm the director of the Center for Evidence
and Practice Improvement at AHRQ,
and the agency is really thrilled to be
a part of this very important webinar.
Next slide.
So today's presentation is going to be myself,
Dr. Unuetzer and Dr. Moran,
and together, we will cover a number of key questions.
We're going to let you know a little bit about AHRQ,
who we are and what we do,
what is integrated behavioral health and primary care,
why we need to integrate these
two important types of medical services,
and what are some prominent models for this integration,
and what does the research tell us
about integrated care models,
and what resources does the AHRQ Academy
offer to support developing
behavioral health and primary-care integration?
So you will learn about some very valuable resources
that will be able to help you.
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So AHRQ, for those of you who are not familiar with AHRQ,
has a guiding principle to improve the safety
and quality of America's health-care-delivery system.
Its mission is to produce evidence
to make health care safer,
higher quality, more accessible, equitable and affordable
and to work within HHS
and with our other partners to make sure the evidence
is understood and used.
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So how do we do this?
AHRQ invests in research and evidence to understand
how to make health care safer and improve quality.
We create materials to teach and train health-care systems
and professionals to catalyze improvements in care,
and most importantly,
we generate measures of data
used to track and improve performance
and evaluate progress in the U.S. health system.
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So you're going to hear from a number of HHS agencies today,
and we all have distinct roles.
NIH does the clinical research
to develop effective new treatment.
CDC does population health and community-based
interventions to improve health.
CMS does the payments and incentives for delivery
of effective treatment,
and AHRQ does the research to help health-care systems
deliver safe and effective treatments.
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AHRQ is also the home for the lead federal agency
for primary-care research.
This is the National Center for Excellence
in Primary Care Research,
and AHRQ is the main point of contact
with the primary-care community,
communicating the evidence
from AHRQ's research and how this evidence
can be used to improve health
and primary health care to researchers,
primary-care professionals,
health-care decision makers, patients and families.
And integrating behavioral health and primary care
has been a big focus of our work for many years.
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So back in 2008,
AHRQ published a comprehensive review
of the literature called
"Integration of Mental Health/Substance Abuse
and Primary Care"
on the evidence to that point
on integrated models of behavioral health
and primary care,
and that was followed by a report in 2011,
which was A National Agenda
for Research in Collaborative Care.
You're going to hear from Dr. Moran from the AHRQ
Academy for Integrating Behavioral
Health and Primary Care, which was funded in 2010,
and he's going to tell you a lot more
about the multiple resources it hosts,
including a playbook to help practices develop
the interventions needed to integrate care
in their practices,
a lexicon which has definitions of key words
so we're all speaking on the same page
and a measures atlas to be able to improve quality.
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So just as an example of the type of research we do,
which is very exciting because what we hope to do
is provide the evidence
for different models of care
and learn how to implement and scale them
so our other sister agencies like HRSA
and SAMHSA can take them to scale.
And we did, several years ago now, a technical brief,
which reviewed the literature
on medication-assisted treatment models of care
for opioid use disorder in primary-care settings
and learned that there was quite a bit of evidence
that this does work
and then sponsored a series of R18 grants
to be able to learn,
how do we increase the capacity
of rural primary-care providers
often who don't have the resources
and expertise to manage opioid use?
And so we have four states involved, one in rural Oklahoma,
Pennsylvania's Medicaid program.
North Carolina is another state involved as well as Colorado,
and we're looking forward to the results of these studies.
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So we all know that behavioral disorders
are very prevalent among the most costly
and consistently costly patients,
but a Rutgers study
of New Jersey Medicaid patients found
that 86% of individuals in the top 1% spending group
had a mental-health or substance-abuse diagnosis.
And CMS reports that behavioral-health conditions,
including mental illness and substance-use disorders,
are very common among those patients
whose costs remain high over multiple years.
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At some time in their lives,
about half of Americans meet criteria
for a mental-health or substance-abuse problem,
and no family goes untouched.
In a given year, one in four Americans
will have a diagnosable disorder.
Anxiety and depression are most common.
And where AHRQ. Yes.
Where AHRQ focuses is in primary care
where most of these conditions are either missed
and not diagnosed or treated,
and sometimes when they're treated,
they're treated suboptimally
so really to maximize the quality of care
delivered for these services
and integrate them with their other physical-health problems.
Mental disorders are the fourth most costly
health conditions in the U.S.
Mental-health disorders are major contributors
to disability worldwide,
and for governments, high health-care costs,
unemployment, homelessness
and criminal-justice involvement all add
to the cost of managing mental
and substance-abuse disorders.
And for employers, mental health and substance-use problems
are major drivers of health-care costs,
suicide, absenteeism and presenteeism.
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So mental health and primary care are inseparable,
and any attempts to separate
the two leads to inferior care.
And this was back
from an Institute of Medicine report in 1996.
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So what is behavioral-health integration?
The source is the AHRQ Academy Lexicon,
and it says that behavioral-health integration
refers to the care from a practice team
of primary care and behavioral-health clinicians
working together with patients and families,
using a systematic and cost-effective approach
to provide patient-centered care for a defined population.
And this care can address mental health
and substance-abuse conditions,
health behaviors, including their contribution
to chronic medical illnesses,
life stressors and crises,
stress-related physical symptoms
and ineffective patterns of health-care utilization.
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So Dr. Unuetzer is going to go into much more detail
about models of primary-care integration,
but I'm just going to quickly highlight.
We know a lot now about, what are the common elements
needed to accomplish this?
And some similar elements across models
that have been summarized extensively
in the policy literature include screening for depression,
anxiety and other behavioral disorders
using validated screening tools.
AHRQ also hosts the U.S. Preventive Services Task Force,
which makes recommendations for screening
for these disorders,
team-based care with nonphysician staff
to support primary care.
AHRQ also has developed the TeamSTEPS to help teams
work better together to comanage treatment --
shared-information systems that facilitate coordination
and communication across providers,
standardized use of evidence-based guidelines,
systematic review and measurement
of patient outcomes using registries
and patient tracking tools.
And just so you know, AHRQ hosts
the National Guideline Clearinghouse
as well as the Registry of Registries,
engagement with broader community services,
individualized, person-centered care
that incorporates family members
and caregivers into the treatment plan.
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So this is my last slide,
and I'm going to hand it off to Dr. Unuetzer.
And this is the screenshot of the academy portal
where you can find lots of resources,
so I'll make it to support your efforts
to integrate behavioral health and primary care.
And Dr. Moran will be going into a lot more detail
about this valuable resource.
Okay. Thank you very much.