Disease Management Update
Volume V, No. 23
October 2, 2008
Dear Healthcare Intelligence Network Client,
According to the National Institute of Mental Health (NIMH), nearly one in four American adults suffer from a diagnosable mental disorder each year. As the first week of October is Mental Health Awareness Week, this Disease Management Update looks at autistic children as well as mental health systems for American Indian and Alaskan children.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
- Study Examines the Prevalence and Impact of GI Problems in Autistic Children
- Disease Management Q&A: Integrating Utilization and Mental Health Responsibilities
- HealthSounds Podcast: Coordinating Maternity DM & Mental Health Needs
- SAMHSA Supports Childrenís Mental Health Systems in American Indian/Alaska Native Communities
- Survey of the Month: Healthcare Trends in 2009
- Truth or Consequences: Selecting HRAs
Study Examines the Prevalence and Impact of GI Problems in Autistic Children
A new study examines the characteristics of children with pervasive developmental disorders (PDD) who also have gastrointestinal (GI) problems. PDDs, such as autism and Aspergerís disorder, are marked by repetitive behavior and pervasive impairments in language and the ability to relate to others. Some studies have suggested a link between PDDs and GI problems such as reflux, stomach pain, bloating, food intolerance, constipation or diarrhea. But epidemiological studies have found no higher prevalence of GI problems among children with PDD compared to normally developing children.
Researchers at Yale University evaluated baseline data from the 172 children enrolled in the NIMH-funded Research Units on Pediatric Psychopharmacology (RUPP) Autism Network to examine the types and frequency of GI problems among the participants. The RUPP network conducted two major trials. In the first trial, children with autism accompanied by tantrums, aggression and self-injury were treated with the antipsychotic risperidone (Risperdal). In the second trial, children with PDD and hyperactivity were treated with the stimulant methylphenidate, which is commonly used to treat attention deficit hyperactivity disorder (ADHD).
Overall, 22.7 percent of the 172 children had GI problems. In the risperidone study, 29 percent had a history of GI problems compared to 14 percent in the methylphenidate study. The researchers found no demographic differences between the children with GI problems and those without GI problems, nor did the groups differ in communication, socialization, daily living skills, intellectual ability or on measures of autism severity. However, the group with GI problems had more severe anxiety, irritability and social withdrawal.
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2. Disease Management Q&A: Integrating Utilization and Mental Health Responsibilities
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Diane Flanders, director of coordinated care systems at MassHealth.
Question: In considering care transitions, how have you managed and integrated utilization review (UR) responsibilities, and how is mental health managed in both of those situations?
Response: (Diane Flanders) The UR responsibilities are within the organization itself. There are the classic mechanisms for sub-contracting, receiving and managing claims. They authorize those services, and they measure that with the claiming process. We made a big focus on mental health. Historically, this has been a real problem for seniors — them not accessing a mental health system — so we put a lot of work into this. For the non-elderly in Massachusetts we have a behavioral health contract, which serves people with mental illness and substance abuse in a variety of very creative ways. These can include partial hospitalization, day-care settings and community-based services that really arenít available in the traditional Medicare-Medicaid world. We just lifted those requirements and put them right into the package.
Now, all three of the senior care organizations have sub-contracted to varying extents with mental health companies so that they are purchasing that expertise. But we made a big point of saying that they needed to have their policies and procedures around that mental health fit in with a geriatric expertise, so that is part of the requirement, too. It is certainly a very important element, and it's something that weíre seeing an increase in utilization over what we see in fee for service. Thatís what we expected to see. Itís not very big at this point, but we think we should be seeing more services in that area.
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3. HealthSounds Podcast: Coordinating Maternity DM & Mental Health Needs
Dr. Joseph Stankaitis, chief medical officer at Monroe Plan for Medical Care, explains how incentives have improved physicians' completion of his organization's prenatal registration form and how Monroe improved coordination between its perinatal staff and behavioral health staff to address mental health and chemical dependency issues in the targeted population.
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SAMHSA Supports Childrenís Mental Health Systems in American Indian/Alaska Native Communities
SAMHSA has awarded eight grants totaling more than $6 million over three years to fund infrastructure development for childrenís mental health systems in American Indian/Alaska Native (AI/AN) communities. Known as the Circles of Care, the programís purpose is to provide tribal and urban Indian communities with tools and resources to plan and design a holistic, community-based system of care to support mental health and wellness for their children, youth and families. The eight awards are funded up to $305,875 per year in total costs for up to three years.
ďThese grants will increase the capacity and effectiveness of behavioral health systems serving American Indian/Alaska Native communities,Ē said Eric Broderick, D.D.S., M.P.H., acting administrator of SAMHSA. ďAs a result, Circles of Care grantees will be equipped to reduce the gap between the need for behavioral health services and the availability and coordination of services for children and families.Ē
The grant program supports the goals and mission of the Indian Health Service (IHS), another agency within the U.S. Department of Health and Human Services.
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5. Survey of the Month: Depression and DM in 2008
Depression affects over 20 million Americans and billions of dollars are spent on treatment, medication and other therapies. Most cases of depression are still unrecognized or treated inappropriately, which leads to immeasurable costs in employee absenteeism, lost productivity and spiraling healthcare costs. Complete HIN's survey of the month on depression in DM programs in 2008 by October 31 and get a FREE executive summary of the compiled results.
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6. Truth or Consequences: Selecting HRAs
Most people would agree that even the most innocuous assumptions about healthcare can have unintended consequences. The mistake of confusing one HRA with another can have ominous consequences. To that end, there are seven important characteristics of HRAs to keep in mind when partnering with a wellness firm to help implement/manage your corporate wellness program.
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