Behavioral Health Q&A with Jeffrey Buck

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Jeffrey Buck, Centers for Medicare & Medicaid Services
Jeffrey Buck, Centers for Medicare & Medicaid Services

Jeffrey Buck, PhD is the Program Lead for the Inpatient Psychiatric Facility (IPF) Quality Reporting Program and the Senior Advisor for Behavioral Health in the Center for Clinical Standards and Quality (CCSQ) at the Centers for Medicare & Medicaid Services (CMS). He serves as the subject matter expert for the QIO Program’s behavioral health work. Previously, he served as a senior advisor with the agency’s Center for Strategic Planning. Before coming to CMS, Dr. Buck held senior positions in the Substance Abuse and Mental Health Services Administration (SAMHSA). There, he directed many of SAMHSA’s analytic studies of behavioral health services and financing. Dr. Buck’s publications have addressed behavioral health issues in the financing and utilization of services, insurance coverage and parity, Medicaid, health care reform and administrative data systems.

Q. In July 2015, the CMS Quality Improvement Organization (QIO) Program kicked off its behavioral health work under its current five-year performance period. What was the background or impetus behind this work, and what are its goals?

Under the Affordable Care Act, one of the Administration’s major priorities has been to improve care coordination and to treat the whole patient; behavioral health is one important element of this holistic health approach. In alignment with the U.S. Department of Health & Human Services’ National Quality Strategy and the CMS Quality Strategy, the CMS QIO Program began focusing for the first time last year on improving the quality of Medicare beneficiaries’ behavioral health. It’s also the first time that Quality Innovation Network-QIOs (QIN-QIOs) have begun working directly with inpatient psychiatric facilities (IPFs). As far as goals are concerned, the six QIN-QIOs selected to conduct behavioral health work are required to recruit 200 physician practices per state to help them increase rates of alcohol and depression screenings, and five IPFs per state to help them improve care transitions.

Q. At what stage are the six QIN-QIOs in their recruitment and quality improvement activities, and how are things going overall?

The recruitment period ended in February 2016, and the QIN-QIOs started their actual quality improvement work in March. We’re happy with the level of recruitment activity and are looking forward to seeing results from the actual implementation work. Several QIN-QIOs exceeded their recruitment requirements.

Q. What types of national and community-level partners are QIN-QIOs collaborating with in their behavioral health work?

The QIN-QIOs are working with all sorts of partners, mostly at the state and community levels. Specifically, they are collaborating with the following types of partners and stakeholders:

  • Accountable Care Organizations (ACOs) and Practice Transformation Networks (PTNs)
  • Community-based advisory boards
  • Community Mental Health Centers (CMHCs)
  • Councils on Aging
  • Regional provider associations
  • Local chapters of national organizations (e.g., National Alliance on Mental Illness)
  • Other behavioral health initiatives

"PCPs need to feel equipped with the right resources and referral options for patients."

Q. How is the patient voice” being incorporated into behavioral health quality improvement activities?

Part of the QIN-QIOs’ work involves developing a beneficiary and family engagement process. This is currently in the works. For example, some QIN-QIOs are recruiting beneficiaries and their families to participate in upcoming learning and action networks. One QIN-QIO has engaged patient advisors to help design their interventions with practices.

Q. Are there any high-level lessons learned” or takeaways that you can share based on the behavioral health work to date?

When recruiting primary care practices (PCPs) for the depression and alcohol screening work, QIN-QIOs have learned that understanding physician’s knowledge about and comfort with diagnosing and handling mental health problems is a key factor in securing their buy-in. PCPs need to feel equipped with the right resources and referral options for patients. They also need to understand the potential impact of their new screening activities on their workflows and how they will be impacted from a business perspective. Addressing these issues has helped QIN-QIOs build effective working relationships with physicians.

Several QINs created tiers of recruitment based on size and system-based nature of providers, with different approaches and resources devoted to each tier. For example, Lake Superior QIN prioritized large health systems due to the amount of practices that could be reached throughout the system. Second-tier recruitment focused on physician organizations, large group practices and ACOs. The third tier was the small, independent practices that typically are less agile in their decision-making compared to larger entities. In working with less agile, large health systems, QINs recommend proposing staged implementation of behavioral health work, selecting a handful of practices as pilot implementers.

Q. Anything else you would like QIO News readers to know? 

Behavioral health is an area to which CMS is paying more and more attention, and that is a positive development. Beyond the QIO Program, the agency is looking at important issues like how to respond to the opioid abuse crisis, how health care and mortality issues are intertwined with substance abuse treatment, and how practitioners treat patients. Behavioral health is an important area in which CMS wants to do more work, including with Medicaid & CHIP as well.