Wednesday, September 23, 2009

"Medical Homes" Included in Healthcare Reform Proposals

This morning I attended a Campaign for Mental Health Reform congressional briefing, “The Integration of Mental Health and Health: Evidence from the Medical Home.” CHADD is a Campaign member. All five congressional committee draft healthcare reform legislative proposals contain financial incentives for creating and expanding “medical” or “healthcare” homes.

CHADD endorses the concept and experience of a “medical home” (clinical home/healthcare home) for children with special healthcare needs as defined, implemented, and advocated over the past decade by the American Academy of Pediatrics. Medical homes as defined by AAP are about a single medical practice taking ownership/responsibility to coordinate interventions for children with special needs, whether those children have either complex needs or a variety of needs.

The essential elements of a medical home for children with special healthcare needs are:
• Personal physician in a culturally and linguistically competent physician-directed medical
practice who provides continuous and comprehensive care;
• A focus on the “whole” child, youth, and family with coordinated care/services/supports;
• A family-driven partnership that ensures a coordinated network of community-based services where both physicians and families share accountability for quality improvement through a performance measurement system;
• A focus on transitions to ensure no disruptions of services as children and youth
progress through normal stages of growth and development;
• Privacy-protected, family-driven electronic medical records for communication with youth and families, and consultation between treating professionals.

One of the briefing speakers was Ted Epperly, MD, the president of the American Academy of Family Physicians. I asked the other speakers (a psychiatrist with the Carter Center Mental Health Program, a psychiatrist with the Missouri Department of Mental Health, and a PhD health and disease management director of prevention programs) if they agreed with Dr. Epperly’s policy and practice objective that every American have a “trusted relationship with a personal physician”? They did. All emphasized the need for a full interdisciplinary team. All agreed that the practice should be fully integrated and “patient-centered.” All agreed that the physician should be the “quarterback” of the team and have the ultimate accountability. All agreed that physician assistants, nurse practitioners, and various mental health professionals were essential to the team. All agreed that this was the goal. All agreed that this is not practice today, but we are moving toward it. All agreed that the electronic medical record was a methodology to help achieve this objective.

There are many different models of “medical homes,” involving different types of professionals based on the age and health situation of the consumer. CHADD supports adapting the AAP model for children with special needs to other populations, including adults.


You can read this blog and others like it at the HealthCentral website.

Wednesday, September 2, 2009

AD/HD and the Role of Government

Following receipt of our August 13, 2009 e-mail blast to our 68,000 constituents titled Get Involved—Health Care Reform and Congress—13 Principles to Consider, a gentleman asked to be removed from our mailing list. He was in his fifties and has lived with AD/HD his entire adult life. He commented that to deal with AD/HD, CHADD did not need to promote “government dependence.” So, I wanted to share with you some CHADD philosophy, as articulated through our public policy platform on adults with AD/HD and children with AD/HD, as developed and approved by our volunteer leadership.

Many people with AD/HD face policy obstacles to fulfilling their life expectations. These can be government policies and these can be business policies. For example, health insurance is regulated by government but mostly implemented by insurance businesses. In health care reform, we are just trying to eliminate discrimination and policy obstacles.

For example, CHADD’s 13 principles include the following three:

1) Health care plans should require “parity” for mental health assessment and treatment. This includes non-discrimination between health conditions.
2) Health care plans must not discriminate on the basis of pre-existing conditions or health status.
3) Health care plans must not terminate coverage when people become seriously ill or are being treated for long-term chronic conditions and must not have lifetime caps.

People with AD/HD frequently have less generous coverage and pay more out-of-pocket costs because of discrimination. People with “pre-existing” AD/HD are frequently denied health insurance. And people with AD/HD frequently face limits on the treatment of AD/HD over time. CHADD’s objective is not to make people with AD/HD become “dependent” on the government. Our objective is to eliminate discriminatory coverage policies so citizens with AD/HD can receive the same health benefits as other citizens.

Likewise, our objective that a health care initiative must provide health care coverage for all Americans is not intended to make Americans “dependent” on government, but to ensure that all Americans have the health insurance coverage that they need.

The last two principles I will address here are: a health care initiative that allows young adults to stay covered on their parents’ plan until the age of 26, and a health care initiative that specifically covers young adults, with a particular focus on young adults with special health care needs. As the father of a soon-to-be 19-year-old son with substantial co-occurring disorders, I am supportive of CHADD’s advocacy of these principles in order to avoid “government dependence.” The education system and the vocational rehabilitation system have encouraged our son to apply for Supplemental Security Income (SSI), as his vocational future is uncertain. The major reason for this encouragement is lack of health insurance—depending on student status, at ages 18 and 22 he is on his own to locate his own health insurance. Our son and his parents reject the notion of needing SSI at age 18. He has lots of years left to develop his vocational skills and enhance his education. But we are worried about health insurance. The Ross family opposes the economic incentive to apply for government financial assistance because of the fear and possibility of no health insurance. Parents throughout the nation and in our family and social circles have this same philosophy.

So, asking the government to provide adequate non-discriminatory health insurance for all citizens, particularly those with a history of special needs is not promoting “government dependence,” but encouraging independence to pursue life choices. As CHADD CEO, I regret that we lost a constituent. But as the father of a young adult with special needs, I am glad that I work for an organization whose volunteer leadership sees the validity of these objectives.


You can read this blog and others like it at the HealthCentral website.