As one who has been advocating for change in addressing childhood trauma for many years now, I have learned that change is extremely difficult for most people. There needs to be a reason for it. When Dr. Felitti was in Juneau last week, his planned testimony before the House Health & Social Services Committee was cancelled. The Legislative leadership mandated no hearings could be held unless they dealt with the state budget deficit. It was odd because what Dr. Felitti has to say is of enormous benefit in reducing cost to the State of Alaska. We made up the time by talking to individual legislators about the benefits available through screening adult patients for childhood trauma.
Here is what Dr. Felitti told the House Minority Caucus. After the ACE Study results were complete. he had an offer from a professor with a new business to assess 130,000 online assessments. It was over two years of data, and what it showed was a 35% reduction in doctor office visits by patients who went through the ACEs assessment for a period of one year. That means that 58,000 patients with 3.2 annual visits would experience a reduction of about 65,000 visits annually. The cost savings for 65,000 visits is substantial. The online assessment was used in doctor office visits at Kaiser Permanente to address patient medical and trauma issues.
In about 2004, Dr. Chuck Grim, head of the Indian Health Service (IHC), encouraged as one of his initiatives the integration of behavioral health with medical care. Unfortunately, there was little guidance like that available at Cherokee Health Systems, and most health care systems in the IHS used a variant of the PHQ-9. Most patients found the questions offensive or intrusive and many systems reduced them to two questions: Do you smoke? and Have you had more than X number of drinks in the past week? Neither question provides much information of any value to medical advice other than you should quit smoking or slow down your drinking. The benefits Dr. Felitti described do not work, in my experience, with the PHQ-9.
About 2010, I visited Cherokee Health Systems in Tennessee. At that time, they had decades of experience with an integrated behavioral health/medical center. Touring exam rooms, we saw stations for the behavioral health specialist next to the MD and medical assistant. They collaborated all the time on patient issues, and rightly so. Some of the research I conducted during this period of time revealed that many patients whom doctors saw had what were described as MUS (medically undiagnosed symptoms). A lot of the literature about MUS attributes the diagnosis to anxiety and stress. The symptoms are real, but there is no medical explanation. As we have learned in the ACE community, fear, anxiety and stress compromise our immune system and have symptoms that are real, but related to our childhood trauma. So the treatment is not medical, but behavioral. This knowledge has been with us for decades, but not adopted in medical facilities. Why? Well, what CEO wants to give up the 65,000 doctor office visits by using an online document to assess patients. More patients and more severe illnesses mean more income and greater profits.
So what advice are Alaska executives and government officials giving to the Alaska Legislature today, in 2016? Here is a link to an article about testimony from Alaska Commissioner of Health & Social Services and the head of the Alaska Mental Health Trust [LINK HERE]. The advice: “State leaders believe they can lower the long-term growth in Medicaid costs and make Alaskans healthier mentally and physically. They plan to do that by better coordinating behavioral health care — the treatment of mental health and addiction.” The concept that has existed for decades and pioneered at Cherokee Health Systems is finally arriving in Alaska. I celebrate that, but wonder why the more current knowledge provided by Dr. Felitti and others is not getting the same type of consideration.
In recent years, health care growth has been the driver behind the Alaskan economy. It’s the bright spot. Yet many proposed solutions have been discussed that would reduce the cost of health care by off-loading care to non-medical services. But because non-medical services aren't compensated for as health insurance is, they get treated in health care facilities. I am happy the conversation is starting, but it’s not a state-of-the-art conversation and it’s occurring during a time of considerable stress in health care. There are other solutions available that can pay for the $5 million cost, but it won’t be considered for a variety of reasons.
Let’s start the alternate conversation.
Comments (0)