![]() ![]() The state of Oregon currently has organized its Medicaid program into 16 coordinated care organizations (CCO) focused on primary care service delivery that includes integrated mental health services. These studies provide a snapshot of the role(s) of psychologists within a rapidly changing health care system - and document the impact and value of the interventions delivered by psychologists. Over 40 proposals were received and five were funded, which covered a range of clinical services and relied on the analysis of archival billing and electronic health record data. To survey the current state of clinical practice effectiveness in health psychology, the Office of Integrated Care at the American Psychological Association issued a request for proposals in 2015 to fund psychologists in practice in health care settings in order to evaluate existing clinical data to determine the impact of psychological services on clinical outcome. ![]() At times, programs that have been shown to work well over many replications fail to produce results in large effectiveness studies (Solberg et al., 2015). Translation of well-established, efficacious interventions to real-world effectiveness is always a challenge. (1999) and evaluation of the effectiveness of typical health psychology practice. There is a critical divide, however, between research-funded random control efficacy trials such as those reviewed by Chiles et al. study, the field has improved in addressing the needs of both medical specialty clinics and primary care service sites. In the 20 years since the publication of the Chiles et al. The analysis of this data also revealed that planned, evidence-supported psychoeducational interventions yielded greater positive outcomes than open-ended, nonspecific interventions, but all yielded positive results. The reduced costs were the result of the decreasing length of inpatient stays for medical and surgical patients and fewer emergency department visits. This analysis of 91 research studies, conducted between 19 across a range of clinical problems in all age groups, for both inpatients and outpatients, and in both surgical and medical settings, found a decreased use of health services after psychological interventions in 90 percent of the studies, with an average 15.7 percent reduction in costs, whereas costs increased an average of 12.2 percent in control groups. The positive impact of psychological interventions on health outcomes and the subsequent reduction in the need for health services was summarized in classic meta-analysis by Chiles, Lambert, and Hatch (1999). If the health care system is to truly achieve the quadruple aim, it must systematically address behavior change. Thus, both health behaviors and mental health disorders contribute significantly to overall costs and outcomes. In addition, the presence of such high-frequency disorders as anxiety and depression result in much higher health care costs for commonly occurring diagnoses such as diabetes or heart disease (Melek, Norris, & Paulus, 2014). We know from existing public health research that 45 percent or more of all health outcomes are due to such behaviors as sedentary behavior, poor diet, smoking, substance misuse, stress, and nonadherence to prescribed treatments (World Health Organization, 2009). These disparate studies have been compiled in a volume (see Hunter, Hunter, & Kessler, 2014) that encompasses psychological interventions in primary and specialty medical and surgical care, as well as both outpatient and inpatient care. They have also addressed the needs of entire patient panels and developed systems to improve providers’ satisfaction with their work. Psychologists have long been participating on teams that have produced positive outcomes in terms of clinical improvement and reduced costs resulting from the improved health of patients. ![]() Individual researchers and groups have addressed each of the components of these goals in a range of studies over the years. Psychology is uniquely positioned within the health professions to help the system achieve the goals of the quadruple aim. As work has proceeded on this “triple aim,” the additional goal of provider satisfaction - improving the work life of health care providers - has resulted in the quadruple aim (Bodenheimer & Sinsky, 2014). Reorienting the health care system to achieve three interdependent goals - improved patient experience, leading to better health, resulting in lower costs, all carried out within a population-based framework focused on the health of a community - has been the subject of much research (e.g., Berwick, Nolan, & Whittington, 2008). ![]()
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