Families, Systems, & Health 2014, Vol. 32, No. 2, 151–152
© 2014 American Psychological Association 1091-7527/14/$12.00 DOI: 10.1037/fsh0000038
COMMENTARY
Commentary by the American College of Physicians on the “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home”
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Nitin S. Damle, MD, MS, FACP American College of Physicians, Washington, DC
On behalf of the American College of Physicians (ACP), I appreciate this opportunity to provide commentary on the “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home.” ACP has long recognized the importance of collaboration with specialty and subspecialty practices, including those providing behavioral health care, to achieve the goal of improved care integration and coordination within the Patient-Centered Medical Home (PCMH) care delivery model. ACP was involved in providing comments on earlier drafts of the “Joint Principles: Integrating Behavioral Health Care Into the PatientCentered Medical Home,” when the document was initially circulated by the authors in 2011. At that time, ACP sought feedback from our major policy committees and provided that input to the authors. The final version of the principles distributed for endorsement included language not previously reviewed by our committees. ACP decided it could not endorse the document given the deadlines imposed by the authors; however, ACP does support the intent of these “Joint Principles” for behavioral health care and agrees that the incorporation of behavioral health care within the PCMH model is incomplete. The following feedback is offered in the spirit of being constructive, with the hope that we can ultimately move toward integrating behavioral health care into the PCMH.
First, ACP believes that these principles should be labeled as guidelines, rather than Joint Principles. While the authors note that these principles are not intended to replace the original “Joint Principles of the PCMH,” which were released in March, 2007 by AAFP, AAP, ACP, and AOA (2007), using the same terminology in the title can lead to unnecessary confusion that could detract from the ultimate mission of the document. To those familiar with delivery and payment reform efforts across the country, the original “Joint Principles of the PCMH” are largely seen as a guidepost to provide direction to PCMH projects. There have been additional “joint” documents created and endorsed by those that drafted the original joint principles (AAFP, AAP, ACP, & AOA, 20091; AAFP, AAP, ACP, & AOA, 20102)—and all have been careful with their terminology so as to prevent any potential confusion. Therefore, ACP strongly believes that the terminology used in this document should be revised along the same lines. Second, ACP is concerned with the use of overgeneralizations within the document that do not include a cited evidence base. For example, stating that the “PCMH will be incomplete and ineffective without the full incorporation of this element [that is, behavioral health care],” is
Nitin S. Damle, MD, MS, FACP, Chair, ACP Medical Practice and Quality Committee, American College of Physicians. Correspondence concerning this article should be addressed to Shari M. Erickson, Vice President of Governmental and Regulatory Affairs, American College of Physicians, 25 Massachusetts Avenue, Northwest, Suite 700, Washington, DC 20001. E-mail: [email protected]
1 The Guidelines for PCMH Demonstration Projects have also been endorsed by the Patient-Centered Primary Collaborative (PCPCC), a multi-stakeholder organization that is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the PCMH. 2 While the term principles was used for the Joint Principles of Accountable Care Organizations, it was focused at the delivery system model level (rather than elements within a delivery system model)—and on a different model than the PCMH.
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This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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problematic in that PCMH practices have demonstrated that they can be very effective for many patients across the country (PCPCC, 2014), even though behavioral health care has not yet been fully integrated into the model. The College strongly agrees with the authors that integration of behavioral health care, particularly for those patients with a mental or behavioral diagnosis or symptoms, as well as the integration of the broader PCMH-neighborhood model (ACP, 2010) into the PCMH model is critical and should be incorporated into early design of projects to the extent possible, rather than retrofitted. However, statements such as the one noted above may undermine the document’s credibility and could have an effect on its ability to influence change. In 2010, ACP co-convened a Health Education Summit with The Carter Center’s Mental Health Program and produced a white paper entitled, “Five Prescriptions for Ensuring the Future of Primary Care” (The Carter Center & ACP, 2010). The vision expressed in that document emphasizes that the future of patient-centered care is built on, “. . . a foundation of team-based primary care that is fully integrated with behavioral and mental health care, focused on overall wellness and prevention.” We continue to support that vision and sincerely hope that the new “Joint Principles” document can evolve to become a shared approach to the integration of behavioral health care into the PCMH and provide benefits to all stakeholders.
References AAFP, AAP, ACP, & AOA. (2007). Joint principles of the PCMH. Retrieved from http:// www.acponline.org/acp_policy/policies/joint_ principles_pcmh_2007.pdf AAFP, AAP, ACP, & AOA. (2009). Guidelines for PCMH demonstration projects. Retrieved from http://www.acponline.org/running_practice/ delivery_and_payment_models/pcmh/demonstrations/ guidedemo.pdf AAFP, AAP, ACP, & AOA. (2010). Joint principles of accountable care organizations. Retrieved from http://www.acponline.org/advocacy/where_we_ stand/assets/aco-principles-2010.pdf ACP. (2010). The patient-centered medical home neighbor: The interface of the patient-centered medical home with specialty/subspecialty practices. Retrieved from http://www.acponline.org/ acp_policy/policies/pcmh_interface_subspecialty_ practices_2010.pdf PCPCC. (2014). The medical home’s impact on cost and quality: An annual update of the evidence, 20122013. Retrieved from http://www.pcpcc.org/resource/ medical-homes-impact-cost-quality The Carter Center & ACP. (2010). Five prescriptions for ensuring the future of primary care. Retrieved from http://www.acponline.org/advocacy/ current_policy_papers/five_prescriptions_future_pc .pdf Received February 28, 2014 Accepted March 5, 2014 䡲
© 2014 American Psychological Association 1091-7527/14/$12.00 DOI: 10.1037/fsh0000038
COMMENTARY
Commentary by the American College of Physicians on the “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home”
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Nitin S. Damle, MD, MS, FACP American College of Physicians, Washington, DC
On behalf of the American College of Physicians (ACP), I appreciate this opportunity to provide commentary on the “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home.” ACP has long recognized the importance of collaboration with specialty and subspecialty practices, including those providing behavioral health care, to achieve the goal of improved care integration and coordination within the Patient-Centered Medical Home (PCMH) care delivery model. ACP was involved in providing comments on earlier drafts of the “Joint Principles: Integrating Behavioral Health Care Into the PatientCentered Medical Home,” when the document was initially circulated by the authors in 2011. At that time, ACP sought feedback from our major policy committees and provided that input to the authors. The final version of the principles distributed for endorsement included language not previously reviewed by our committees. ACP decided it could not endorse the document given the deadlines imposed by the authors; however, ACP does support the intent of these “Joint Principles” for behavioral health care and agrees that the incorporation of behavioral health care within the PCMH model is incomplete. The following feedback is offered in the spirit of being constructive, with the hope that we can ultimately move toward integrating behavioral health care into the PCMH.
First, ACP believes that these principles should be labeled as guidelines, rather than Joint Principles. While the authors note that these principles are not intended to replace the original “Joint Principles of the PCMH,” which were released in March, 2007 by AAFP, AAP, ACP, and AOA (2007), using the same terminology in the title can lead to unnecessary confusion that could detract from the ultimate mission of the document. To those familiar with delivery and payment reform efforts across the country, the original “Joint Principles of the PCMH” are largely seen as a guidepost to provide direction to PCMH projects. There have been additional “joint” documents created and endorsed by those that drafted the original joint principles (AAFP, AAP, ACP, & AOA, 20091; AAFP, AAP, ACP, & AOA, 20102)—and all have been careful with their terminology so as to prevent any potential confusion. Therefore, ACP strongly believes that the terminology used in this document should be revised along the same lines. Second, ACP is concerned with the use of overgeneralizations within the document that do not include a cited evidence base. For example, stating that the “PCMH will be incomplete and ineffective without the full incorporation of this element [that is, behavioral health care],” is
Nitin S. Damle, MD, MS, FACP, Chair, ACP Medical Practice and Quality Committee, American College of Physicians. Correspondence concerning this article should be addressed to Shari M. Erickson, Vice President of Governmental and Regulatory Affairs, American College of Physicians, 25 Massachusetts Avenue, Northwest, Suite 700, Washington, DC 20001. E-mail: [email protected]
1 The Guidelines for PCMH Demonstration Projects have also been endorsed by the Patient-Centered Primary Collaborative (PCPCC), a multi-stakeholder organization that is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the PCMH. 2 While the term principles was used for the Joint Principles of Accountable Care Organizations, it was focused at the delivery system model level (rather than elements within a delivery system model)—and on a different model than the PCMH.
151
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
152
DAMLE
problematic in that PCMH practices have demonstrated that they can be very effective for many patients across the country (PCPCC, 2014), even though behavioral health care has not yet been fully integrated into the model. The College strongly agrees with the authors that integration of behavioral health care, particularly for those patients with a mental or behavioral diagnosis or symptoms, as well as the integration of the broader PCMH-neighborhood model (ACP, 2010) into the PCMH model is critical and should be incorporated into early design of projects to the extent possible, rather than retrofitted. However, statements such as the one noted above may undermine the document’s credibility and could have an effect on its ability to influence change. In 2010, ACP co-convened a Health Education Summit with The Carter Center’s Mental Health Program and produced a white paper entitled, “Five Prescriptions for Ensuring the Future of Primary Care” (The Carter Center & ACP, 2010). The vision expressed in that document emphasizes that the future of patient-centered care is built on, “. . . a foundation of team-based primary care that is fully integrated with behavioral and mental health care, focused on overall wellness and prevention.” We continue to support that vision and sincerely hope that the new “Joint Principles” document can evolve to become a shared approach to the integration of behavioral health care into the PCMH and provide benefits to all stakeholders.
References AAFP, AAP, ACP, & AOA. (2007). Joint principles of the PCMH. Retrieved from http:// www.acponline.org/acp_policy/policies/joint_ principles_pcmh_2007.pdf AAFP, AAP, ACP, & AOA. (2009). Guidelines for PCMH demonstration projects. Retrieved from http://www.acponline.org/running_practice/ delivery_and_payment_models/pcmh/demonstrations/ guidedemo.pdf AAFP, AAP, ACP, & AOA. (2010). Joint principles of accountable care organizations. Retrieved from http://www.acponline.org/advocacy/where_we_ stand/assets/aco-principles-2010.pdf ACP. (2010). The patient-centered medical home neighbor: The interface of the patient-centered medical home with specialty/subspecialty practices. Retrieved from http://www.acponline.org/ acp_policy/policies/pcmh_interface_subspecialty_ practices_2010.pdf PCPCC. (2014). The medical home’s impact on cost and quality: An annual update of the evidence, 20122013. Retrieved from http://www.pcpcc.org/resource/ medical-homes-impact-cost-quality The Carter Center & ACP. (2010). Five prescriptions for ensuring the future of primary care. Retrieved from http://www.acponline.org/advocacy/ current_policy_papers/five_prescriptions_future_pc .pdf Received February 28, 2014 Accepted March 5, 2014 䡲
