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Introduction
In the context of the changing American healthcare system that is passing its way toward universal care, the relevance of incorporating evidence-based, high-quality, and affordable mental and behavioral healthcare is high. The healthcare delivery system in the USA is unique and different from the universal care of most developed countries of the world (Shi & Singh, 2017). The contemporary medical system implies high costs of health care delivery that are inherent in patients’ payments through medical insurance.
Under the impact of high costs and the non-availability of proper health care for all population groups, the current system requires improvement. The growing consensus is that Patient-Centered Medical Homes (PCMH) should incorporate mental and behavioral health care in general and substance abuse treatment in particular (Fu et al., 2020). A prime care practice’s full panel of patients is intended to get whole-person care through the PCMH. As originally described, it only obliquely recognized the presence of mental health, drug misuse, and health behavior difficulties in patient presentations or how these requirements must be met. This research paper claims that the contemporary American healthcare system is insufficient in terms of high costs and the lack of proper integration of mental and behavioral healthcare in the concept of PCMH.
Overview of American Health Care
Health care in the United States is a unique sector, the functioning of which is predetermined by the lack of universal coverage. Indeed, as stated by Shi and Singh (2017), “almost all other developed countries have universal health insurance programs in which the government plays a dominant role,” while the American medical system lacks a centralized institution (p. 1). Moreover, contemporary US health care prioritizes acute care with the initiation of a transition toward preventative care and public health systems development.
Healthcare delivery is regulated under the Affordable Care Act, the country’s main medical law. The Affordable Care Act, the nation’s health policy law, was enacted in March 2010 (Shi & Singh, 2017). According to the bill, public and commercial health coverage systems are subject to change (Choi, 2018). The bill aims to improve consumer benefits while lowering prices, provide new funding for community health advocacy and protection, and support the population and facilities in healthcare services. Reduced administrative expenses on healthcare institutions are among the policy adjustments for the Affordable Care Act that are anticipated with the new National Administration (The White House, 2022). Promotion of online healthcare, elimination of pointless lab testing for patients, control of drug prices, permitting Medicare to bargain for pricing, and enabling individuals to purchase health insurance from any provider are also an adjustment to be made.
The responsibilities of healthcare workers are aligned with the structure of the medical system in the USA. Doctors, nurses, pharmacies, and other medical entities are a few distinct kinds of healthcare professionals employed in the United States, diverse groups, institutions, and individual operations (Shi & Singh, 2017). While some are based in the government sector, others are often for- or non-profit businesses that operate in the private sector. There are various regulators for the healthcare sector, some of which are national and others voluntary. Although it is privately administered, the American healthcare system offers coverage to vulnerable populations and free treatment at the point of interaction and is publicly supported through taxes (Yule, 2019). Therefore, the availability and quality of treatment largely depend on the payability of patients.
Since the American healthcare system does not provide full universal coverage for patients as other developed countries do, the payment for treatment depends on patients’ insurance. Many doctors are independent contractors who submit treatment claims exclusively to the insurance company for reimbursement and are paid on a service charge basis (Shi & Singh, 2017). Indeed, most services are provided through agreements with providers like doctors, hospitals, and diagnostic centers (Shi & Singh, 2017). When a patient receives a medical service, their provider issues a bill to the individual in charge of paying for the associated expenses. The billed cost is determined based on the service performed and the agreed-upon sum that Medicaid or one’s health insurer has agreed to reimburse.
The American approach to governing health care differs from developed countries. Indeed, “almost all citizens in these countries are entitled to receive health care services that include routine and basic health care” (Shi & Singh, 2017, p. 1). However, in the USA, patients encounter “the lack of “adequate access to health care services and health care costs at both the individual and national levels” (Shi & Singh, 2017, p. 1). The general population’s requirements may be the future focus of American healthcare (Brucker et al., 2022). Indeed, the medical system of the USA is aimed at transforming into a holistic and interdisciplinary care delivery system (Shi & Singh, 2017). Moreover, as outlined by the new National Administration, specific measures should be implemented to reduce the costs of health care under the Affordable Care Act (The White House, 2022). Thus, being significantly distinctive from the majority of developed countries’ healthcare systems, the US healthcare system aims at transforming into a patient-centered, affordable, and holistic structure.
The Place of Patient-Centered Medical Homes within American Public Health
Public health is considered the quality of health of the whole nation with respect to illness monitoring, prevention, and treatment. Public health strives to improve the population’s overall health, protect it from environmental dangers, the spread of infectious diseases, and other risks, and ensure that everyone in the community has access to high-quality medical services (Shi & Singh, 2017). It has become clear that new treatment paradigms are required due to the disintegration of the current American healthcare system and the rise in chronic conditions nationwide (D’Arrigo, 2019). Chronic disease maintenance is frequently accompanied by various related psychological concerns that must be addressed as part of an all-encompassing treatment approach. Holistic, whole-person care should be integrated into diabetes care. PCMH, a concept for improved primary care focusing on fully integrated care, has evolved as a solution to the complexities of intersectional and multi-disciplinary treatment of patient issues (Shi & Singh, 2017). Improvements in the standard of treatment, patient satisfaction, coordination of care, availability of care, and quality metrics for diabetes have been seen in PCMH demonstration programs.
The integration of the concept of PCMH is essential for achieving public health goals. Indeed, PCMH entails the partnership between providers and patients that pertain to the chronic care model (Shi and Singh, 2017). This model implies that “chronic conditions are best managed with multidisciplinary practice-based teams, use of evidence-based guidelines, appropriate health information technology, and accountability for the quality and value of care provided” (Shi & Singh, 2017, p. 185). In such a manner, a patient obtains long-term individualized guidance from the professional team led by a physician who manages the health-related decisions of a patient throughout the healthcare system. Such an approach allows for obtaining high-quality support from professionals with access to treatment and consultation at different levels. However, it is essential to ensure that mental and behavioral health issues are incorporated into the scope of PCMH due to the prevalence of mental health concerns in the US population.
The Relevance of Mental and Behavioral Health to PCMH
Regardless of the relevance of mental and behavioral healthcare, it remains underrepresented in the scope of primary care in the USA. Indeed, as research indicates, less than 10% of the mental health profession, according to Zerden, is thought to work in primary care (de Saxe Zerden et al., 2021). Except for information on services provided in federally certified healthcare centers, data on the proportion of primary care practices with incorporated mental health are not accessible. A contemporary concurrent set of common ideologies for the PCMH indicate that mental well-being should be completely incorporated within the PCMH (Shi & Singh et al., 2017). With the rising concerns about the inherent dependence of human well-being on emotional, psychological, and physical health justifies the essential role of introducing mental healthcare services to primary care.
The issue of insufficient implementation of mental health interventions within the primary care setting has been widely addressed by academics and professionals. The American Academy of Family Physicians (AAFP), AAFP Foundation, American Board of Family Medicine, and Association of Family Medicine Residency Directors have all endorsed the importance of mental healthcare integration into PCMH (Shi & Singh, 207). Apparently, in reaction to some circumstances, there is a significant amount of implementation and planning of psychological health, drug misuse, and health performance treatments within PCMHs. These issues include a growing awareness of the necessity and frustration on the part of the providers over the fact that primary healthcare patients cannot easily obtain behavioral health treatments. There is no data to determine how these initiatives will change how PCMH providers attend to their clients’ behavioral health issues.
Planning, communication, and the use of computerized health data are fundamental practice flow issues that are not addressed in the same manner in other medical subfields as in behavioral health. This shows that if primary care continues to advance to include treatment for mental illness, substance misuse, and healthy behavior, there is still a need for a fundamental transformation. Additionally, few attempts have identified individuals with behavioral, psychiatric, or drug misuse issues. Another concerning aspect of behavioral health is that attention is paid more to drug misuse and unhealthy conduct than mental health issues. Primary care has to alter the existing situation to ensure that mental and behavioral health and drug addiction care is delivered in unity within PCMHs (Shi & Singh, 2017). According to research, the requirement for drug abuse and behavioral health therapies that emphasize lifestyle modification and active engagement in care is just as problematic as mental health concerns (Enos, 2018). It has a similar impact on health conditions and function.
Substance Abuse and Mental Health Care Management
Care management plays a vital role in behavioral health homes and has become a crucial part of the medical patient-centered model and coordinated care. When actively starting to work with a treating clinician, care management is based on client engagement and education, coordinated care, and evaluating the consumers’ involvement in and reaction to treatment. Finding customers who would benefit from having a care director is the first phase in care administration.
Clients with mental health and drug use problems who frequently use services, such as emergency rooms and inpatient care, as well as people with several comorbid conditions, such as psychological health, drugs use, and medical issues, will be good candidates for the behavioral health home. Different degrees of care management have been offered, including a highly intense model for the most complicated customers and a less comprehensive model for relatively complex customers that still require additional support. Most behavioral health (and healthcare) practitioners lack the mechanisms necessary to ascertain their patients’ needs using services that the agency does not provide (Shi & Singh, 2017). However, when questioned, professionals frequently have a decent understanding of which of their patients are high-utilizers and have complicated healthcare demands.
Consumer results such as satisfaction, symptom decrease, improved function, and life satisfaction have been proven to be enhanced by patient care. Benefits, however, frequently take time to materialize. Family caregivers should be included in care management programs, and healthcare leaders should work in an interdisciplinary team with clinicians. They should also get proper training. The CMS advice for the Medicare home health option notably mentions coordinated care and transition care, two ideas closely resembling care administration.
The goal of care coordination, a key component of care management, is to facilitate communication among healthcare professionals caring for the same patient. Care management for consumers migrating between care venues and systems is a key component of transitional care. Care management has been demonstrated to help ease inpatient-to-outpatient treatment transitions for therapeutically complicated patients, resulting in higher quality, fewer rates of readmission, and reduced prices, as well as for teenagers transitioning into the adult healthcare system. Continually delivering care is at the heart of providing care, coordinated care, and transitional care.
Lastly, it is important to distinguish between the care management discussed here and care management offered through for-profit illness management initiatives. Payers or businesses focusing on offering these services generally provide disease management. The services include many different practices and are typically offered via telephone from a distant, centralized location. Contrary to chronic care methods, disease management is given as a service outside the provider exercise and does not need changes to the treatment provided at the level of practice. When it comes to enhancing clinical outcomes and cutting expenses, telephonic disease management looks to be less successful than onsite patient care.
Conclusion
The structure and particularities of the American healthcare system are unique and differ from conventional universal care delivered in the developed countries of the world. The dependence of the US healthcare on economic and political factors necessitates high costs of coverage and insufficient availability of care for patients. Despite the overall complexities of the whole system, it is characterized by the lack of proper mental and behavioral services within primary care, with a particular concern related to substance use treatment. Currently, the new National Administration aims at transforming the medical system into a more affordable and holistic one. In particular, the use of the concept of PCMH has been widely appraised as an effective tool for interdisciplinary care. However, to achieve its goals, the healthcare system must ensure that PCMH program implementation entails proper mental and behavioral services to address substance use and other mental concerns for long-term patient benefits.
References
Brucker, D., Lauer, E., & Boege, S. (2022). Americans aging with disabilities are more likely to have multiple chronic conditions. Journal of Disability Policy Studies, 35(9), 10-44.
Choi, D. (2018). Future perspective of the government & policy to enhance health insurance coverage. Establishing a new coverage-enhancing policy satisfying both the public and the Physician. Public Health Affairs, 2(1), 9-15.
D’Arrigo, T. (2019). SUDs are less likely to meet Medicaid work requirements for people with mental illness. Psychiatric News, 54(9), 50-59.
de Saxe Zerden, L., Cooper, Z., & Sanii, H. (2021). The primary care behavioral health model (PCBH) and medication for opioid use disorder (MOUD): Integrated models for primary care. Social Work In Mental Health, 20(2), 149-158.
Enos, G. (2018). Psychedelics are gradually gaining attention as potential mental health therapies. Alcoholism &Amp; Drug Abuse Weekly, 30(32), 1-8.
Fu, H., Wolfson, J., Solberg, L., Grey, M., & Peterson, K. (2020). 1173-P: Use patient-centered medical homes–related care management processes to improve glycemic control in Medicaid and non-Medicaid patients. Diabetes, 69(Supplement_1), 89-123.
Shi, L., & Singh, D. A. (2017). Essentials of the U.S. health care system (4th ed.). Jones & Bartlett Learning.
The White House. (2022). Fact sheet: Biden Harris Administration proposes rule to fix “family glitch” and lower health care costs. Web.
Yule, A. (2019). Integrating treatment for co-occurring mental health conditions. Alcohol Research: Current Reviews, 40(1), 80-85.
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