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New Partnership to Study Mental Health in Managed Care

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AHCPR and Kaiser Permanente Announce Joint Research Project

Press Release Date: February 10, 1998

The Federal Agency for Health Care Policy and Research (AHCPR) today announced a joint research project with Kaiser Permanente Medical Care Program in Northern California that could help all managed care organizations target and provide appropriate health services for enrollees and family members suffering from depression or other mental health symptoms. As a result, health plan enrollees could benefit from improved access to high quality, preventive services, more productive mental health treatment, and added resources invested in continued service enhancements.

"The effect of mental health symptoms on physical health and health resources in general is not well understood," said AHCPR Administrator John M. Eisenberg, M.D. "This study is very timely and could have a great impact on improving the quality and more appropriate use of targeted mental health services."

The research effort, led by Kaiser Permanente's Enid M. Hunkeler, M.A., and AHCPR's William D. Spector, Ph.D. will mainly focus on mild depression—one of the most prevalent mental health problems among managed care patients—and on the interactions with chronic diseases, such as heart disease, and risky behaviors, such as alcohol, drug and cigarette use, on nonpsychiatric health services utilization and costs. The researchers will also explore whether family members of enrollees who have mental health symptoms differ in their use of non-mental health services from family members of enrollees who do not.

"The ultimate goal of Kaiser Permanente is to alleviate the suffering of patients with depression and other mental health symptoms," said Philip Madvig, M.D., Associate Executive Director for Quality for The Permanente Medical Group in Northern California. "If we can determine the kinds of patients to target, clinicians may be more effective at preventing and treating mental health problems."

Findings from the project are expected to contribute to a more complete understanding of the actual health care costs of depression and other mental health symptoms, such as panic disorder, anxiety and violent impulses, in both people who have other illnesses as well as those who do not. The research will also look at persons who may exhibit these symptoms but do not use health services.

"This AHCPR-Kaiser Permanente collaboration is a prototype of new innovative partnerships that the Agency is undertaking to provide vitally needed research-based evidence to improve medical decision-making in the private and public sectors," said Dr. Eisenberg.

Current research suggests that better targeting and appropriate use of mental health services are most likely to have the most significant impact on persons with less severe mental problems and in the elderly. Studies also suggest that many visits for physical health problems really stem from mental health problems. Around 10 percent of the population suffers from some form of depressive illness. About four percent of the population meet the criteria for major depression. Among people seeking healthcare, those rates are twice as high.

"This research supports Kaiser Permanente's recent national efforts to provide what everyone hopes for—effective, targeted interventions integrated with primary care without increased costs to our members," added Jed Weissberg, M.D., associate executive director for quality and performance improvement for The Permanente Federation, the newly-formed body overseeing all Permanente Medical Groups nationwide.

The research will be based on Kaiser Permanente data from a recent, large-scale telephone survey of a random sample of enrollees regarding their mental health symptoms, chronic disease, and alcohol, cigarette and drug use, as well as data regarding their use and expenditures for in Kaiser Permanente hospitals, emergency rooms, outpatient facilities and other medical services in Northern California. "All precautions have been taken to safeguard the confidentiality of information about the individual patients and family members," notes Hunkeler.

Findings will be published in peer-reviewed journals and summarized in AHCPR's Research Activities, a free monthly subscription publication also available on-line through the Agency's web site. The first findings are expected in 1999.

AHCPR is charged with supporting research that improves the quality of health care, reduces its costs, and enhances access to essential services. AHCPR's broad programs of research and assessment bring practical, science-based information to medical practitioners, consumers, and other health care purchasers.

Kaiser Permanente is America's leading health care organization. Founded in 1945, it is a non-profit, group-practice prepayment program with headquarters in Oakland, CA. Kaiser Permanente serves the health care needs of nearly 8.9 million members in 19 states and the District of Columbia. Today, it encompasses Kaiser Foundation Health Plan, Inc.; Kaiser Foundation Hospitals; and the Permanente Medical Groups, as well as Community Health Plan in New York and an alliance with Group Health Cooperative in Washington and Idaho. The California Division of Kaiser Permanente serves more than 5.3 million members throughout the state. The Division has more than 7,000 physicians and over 55,000 employees. It is organized into 12 service areas which are served by 26 major medical centers.

For additional information, please contact AHCPR Public Affairs: Karen Migdail (301) 427-1855 , or Kaiser Permanente: Laura Rohde, (510) 987-3900.

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