2 posts tagged “integrated”

Primary care that treats mind and body? It’s happening in Alaska

Posted January 25th, 2018 by

Integrated care for both mind and body under one roof? It may sound pie in the sky, but it’s really happening at an award-winning healthcare center in Anchorage, recently featured in Politico. How does it work? And can it be replicated?

A shining example in Anchorage

“It’s a truism that the mind and body are connected, but the U.S. health care system has long treated them as separate — with separate doctors, separate hospitals, separate payment systems,” Politico reports (detailing the history of these health care “silos”).

The Southcentral Foundation, which runs a healthcare center for native Alaskans in Anchorage, is in the spotlight for successfully bridging the mind/body divide.

“In part because of their Alaska Native heritage, which puts a high value on spiritual health, the leaders of Southcentral recognized decades ago that behavioral health is tightly linked with bodily health,” Politico says. “So they became one of the early adopters of integrated care.”

At Southcentral, checkups include a mental health evaluation, and a patient’s primary care team includes on-site psychologists or social workers.

For one patient, Vera, profiled in the Politico piece, “accessing mental health treatment was as easy as going to her regular doctor, and there was no stigma attached: Her mental health services were provided at the same time and in the same place as other medical care, just like heading down the hall for an X-ray or a blood test.” Vera was sexually abused as a child and later diagnosed with major depression. She experienced suicidal thoughts and may not be alive today without the integrated care she received at Southcentral, she says.

Advantages of integrated care

The World Health Organization (WHO) has recommended integrating mental health care into primary care for decades. Here are some of the benefits of integrated mental/physical health care that WHO outlined back in 2001:

  • Less stigmatization of patients and staff, as mental and behavioral disorders are being seen and managed alongside physical health problems
  • Improved screening and treatment, in particular improved detection rates for patients presenting with vague somatic (physical/bodily) complaints which are related to mental and behavioral disorders
  • The potential for improved treatment of the physical problems of those suffering from mental illness, and vice versa
  • Better treatment of mental aspects associated with “physical” problems

A popular notion — and the roadblocks

Research has shown that Americans value physical health and mental health equally. Also, “nearly half of Americans think they have or have ever had a mental health condition (47 percent), yet fewer than two in five have received treatment (38 percent),” according to a 2015 survey by the Anxiety and Depression Association of America.

In a 2017 PatientsLikeMe poll of more than 2,000 members, support for the Affordable Care Act (or “Obamacare”) is highly popular among those living with mental health conditions, perhaps because the policy’s “parity” requirement means that insurers have to cover mental and physical health issues equally.

Politico reports that there’s broad support for physical/mental (behavioral) health integration in both the healthcare sector and in Congress.

The Southcentral Foundation won the Malcolm Baldridge National Quality Award in both 2011 and 2017 for its innovative, top-quality care (psst: 97% patient satisfaction) at a relatively low cost. Douglas Eby, vice president of medical services at Southcentral, says he is often invited to speak at conferences in Washington, D.C., because the Southcentral model is “popular with the whole political spectrum.” (What? Whoa.)

So what are the biggest hangups? Money and stigma.

The U.S. health care and insurance system is structured in such a way that doctors are paid more for (physical) procedures, and they can actually lose money by integrating mental health. The longtime stigma of mental illness extends into the provider space, where mental health clinicians and services are valued much less, dollar-for-dollar, than their “physical care” counterparts.

“Solving these problems will take more than money; it will require changing the culture of medicine,” Politico concludes.

On PatientsLikeMe, thousands of members are living with both physical and mental-health conditions. Join the community today to talk about topics like this with patients like you!

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Hacking our way to new and better treatments with integrated biology

Posted March 13th, 2015 by

When it comes to discovery and healthcare advancements, too many of us are more focused on the processes we use today rather than at a first principals level looking and what’s possible. We are a sector desperately in need of disruption to accelerate the generation of knowledge and lower the costs of developing new treatments for patients today. We need to ask what are the best ways to generate actionable evidence that can benefit patients, clinicians, payers and regulators.

We need to take an integrated approach to biology and treatment discovery.

Large-scale approaches like genetics, the biome, metabolomics, and proteomics are coming down in price faster than the famous Moors law that has driven computer improvements. These tools are beginning to allow us to understand the biological variation that makes up each of us. This is the technology I used at ALS TDI; the organization I founded, to help learn about the early changes in ALS. This emerging technology needs to be met with well-measured human outcomes.

PatientsLikeMe is working to build that network. Our goal is to be a virtual global registry with millions of individuals sharing health information, translated into every language and normalized to local traditions fully integrated into the medical system so it’s part of care and incorporates information from the electronic medical record, imaging, diagnostics and emerging technologies for interrogating biology.  We are doing this because to understand the biology of disease we needed to understand the experience of disease with the patients as true research partners.

This isn’t just about integrating biological methods to forge discovery. You can’t just consider the science; you also have to consider the person. No two health journeys are exactly the same. With integrated biology, you have to look at the whole person: their social interactions, socioeconomic status, comorbities, environmental impacts, lifestyle factors, geographical location, etc. To accurately model a condition like ALS, or any of the other 2,300 conditions that PatientsLikeMe members are living with, we need to understand everything that can impact progression. We need to use those real-world patient experiences to inform and improve the drug discovery process.

There is much that needs to be solved to move from our current siloed approach to the integrated one and we have had the privilege of being involved in one of the most innovative. Orion Bionetworks brought together leaders from across the MS Field to develop an integrated model of the disease and they are now moving forward with an even more ambitious project.

They’re using computational predictive modeling to bring together different scientific methods and big patient data to find treatments that work and biomarkers that measure them to the people that need them faster. Said differently, they are hacking their way to treatments, because that’s the only way it’s going to work.

They’ve already got a validated model: Orion MS 1.0. And now they want to develop a new Orion MS 2.0 model. Learn more about their #HackMS campaign and how you can help.

We are highlighting Orion here because what they are doing is so innovative and worthy of support. I donate to ALS TDI, the institution I founded, because I believe in the mission and their approach. I also have donated to Orion because if we need to do anything in discovery we need to support the people that are trying to do it differently. What they are proposing is so innovative and powerful in its scale that it has the potential to redefine how we understand and treat MS. That’s why we are partners with them and it’s how we meet our responsibility to our MS patients to use their data for good.

PatientsLikeMe member JamesHeywood

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