Establishing a Vision for Health Workforce Development in Virginia

This blog site has been created to obtain input on the final draft set of recommendations regarding Code language for establishing an Authority structure to facilitate the development of the health workforce in Virginia.  This consolidated set of recommendations is the result of a series of meetings with stakeholders over the course of the past six months:

http://healthcareworkforceinva.blogspot.com/

The legislation to develop an Authority structure in Virginia stems partially from the processes and recommendations regarding the health workforce from Virginia's State Rural Health Plan.  Recommendations for Code language will be going to the General Assembly in a study report at the end of November, so this is the final opportunity for public comment before the completion of the study report.  Please take the time to read through the recommendations and provide your input on/before noon on Friday November 13, 2009. Your contributions are important in shaping this proposed legislation.

Integrating Primary Care and Behavioral/Mental Health

The Virginia State Office of Rural Health began an effort to promote an integrative model of primary and behavioral/mental health care last year by making available small planning grants, funding research to explore existing models if integrated care in Virginia, and by providing training at the March 2009 Rural Health Summit (presentations from the trainings can be found here). Further exploration of this model of care was also one of the recommendations of the Virginia State Rural Health Plan.

The following announcement was issued last month by the American Academy of Physicians:

The AAFP's National Research Network, or NRN, is recruiting practices for its new subnetwork, the Collaborative Care Research Network, or CCRN. The new network is designed to investigate and evaluate the integration of mental health services in primary care settings.

A study published online in Health Affairs in April found that two-thirds of primary care physicians don't have access to mental health specialists because of numerous barriers, including lack of mental health professionals and insurance restrictions.

According to Rodger Kessler, Ph.D., a research assistant professor in the department of family medicine at the University of Vermont College of Medicine, Burlington, mental health is the most difficult specialty for family physicians to access.

"When a physician refers a patient out to mental health providers, only 20 percent to 40 percent (of those visits) result in care being initiated," said Kessler, who also is the research director of the CCRN. "It just doesn't happen." The CCRN, however, is studying a new treatment model for mental health services.

The new model, said Kessler, would involve in-house medical teams who would work together to plan treatments and execute a patient's care. The expectation is that combining mental health, substance abuse and physical health services in this kind of team structure will produce better outcomes than the old referral system.

Benjamin Miller, Psy.D., assistant professor in the department of family medicine at the University of Colorado School of Medicine, Denver, said that although this type of collaborative care seems like a good concept, the CCRN needs practice-based evidence to support that theory.

The purpose of the CCRN, "isn't just to get another research paper out there," said Miller, who also is the administrative director of the CCRN. "It's to shape and change the landscape of health care."

Integrating mental health into primary care is a relatively new idea, said Kessler, but it is a vital part of the patient-centered medical home because primary care physicians provide the greatest portion of care for mental health and substance abuse.

In addition, Kessler noted that a number of other common medical issues dealt with by primary care physicians, including chronic pain, insomnia and gastrointestinal disorders, would benefit from a collaborative care approach.

Issues such as hypertension, smoking cessation and weight loss also are behavior-related and could benefit from collaborative care, said Miller.

"(The CCRN) is a response to the fragmentation we see in the health care system," Miller said. "If you're going to be sent across the street or down the hall, most people just don't go for that."

The CCRN has recruited about 30 practices to date and hopes to add 50 practices a year during the next two years, according to Kessler. The eventual goal is to have 150 to 200 practices nationwide working together to make collaborative care more effective.

In addition to having a mental health professional on staff, primary care practices participating in the CCRN need to have an interest in practice-based research, a willingness to share data and an interest in addressing important research questions, said Kessler.

The CCRN has received funding from the Agency for Healthcare Research and Quality to convene an invitation-only meeting Oct. 8-9 in Denver to create a research agenda for behavioral health in primary care. Kessler said he expects to have representation from the primary care and mental health fields, as well as government agencies, including the Department of Defense and the Department of Veterans Affairs.

Kessler and Miller also plan to take their message directly to health care professionals with sessions during the Collaborative Family Healthcare Association's conference Oct. 22-24 in San Diego and during the AAFP's Conference on Practice Improvement Nov. 5-8 in Kansas City, Mo.

Practices interested in obtaining an enrollment packet should contact Mindy Spano with the AAFP's National Research Network at (800) 267-2237, Ext. 3178.

Source: http://www.aafp.org/online/en/home/publications/news/news-now/clinical-care-research/20090805ccrnlaunch.html

Right here in rural Virginia, the Southwest Virginia Community Health Systems Inc. has been testing this integrative care model and will soon have available outcomes research using two years of clinical data.

Adopt a Rural Health Plan Recommendation

Who?

Anyone, individual or organization/agency! If you are already working on some aspect of one or more of these recommendations, or are considering doing so in any capacity, we NEED you to sign up!

Why? What am I Committing to Do?

By signing up to adopt a recommendation, you are committing to:

• Let us and others know what you are doing!
• Provide us with periodic updates about your efforts and give us permission to let others know.

That’s all! Simple, right?

Please sign up to adopt one or more of these recommendations.