HHS Requests Your Comments on Draft Strategic Framework for Addressing Key Behavioral Health Issues

HHS Requests Your Comments on Draft Strategic Framework for Addressing Key Behavioral Health Issues

Dear Colleagues:
Individuals with behavioral health disorders often experience multiple co-occurring, long-term, or chronic health conditions (e.g., heart disease, diabetes, other behavioral health disorders) that can result in increased early mortality, greater functional loss, unnecessary hospitalizations, and increased costs. Addressing these issues is a key U.S. Department of Health and Human Services (HHS) Secretarial strategic initiative.

For the past year, SAMHSA has been an active member in the HHS Interagency Workgroup on Multiple Chronic Conditions. Recently, the workgroup released a draft strategic framework for the Department that provides a roadmap for improving the health status of persons with these conditions.

HHS has requested comments from the public and other stakeholders on this draft strategic framework. Please note that:
Comments on the draft strategic framework should be received no later than June 18, 2010, at
5 p.m. eastern time.

Electronic responses are highly preferred and should be addressed to MCC@hhs.gov. Written responses should be addressed to:

U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 736-E
Washington, DC 20201
Attention: MCC Strategic Framework

When providing comments, please self-identify with your name. Anonymous submissions will not be considered.

The submission of written materials should not exceed five pages, not including appendices and supplemental documents. Responders may submit other forms of electronic materials to demonstrate or exhibit concepts of their written responses.

For further information, contact:

Ms. Monica Stevenson
U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 736-E
Washington, DC 20201

Phone: (202) 205-5834
Email: Monica.Stevenson@hhs.gov

Want to know more about this effort? View the Federal Register Notice.
SAMHSA is particularly interested in having behavioral health stakeholders comment on this document to ensure that mental health and addictions issues are adequately addressed.
Thank you for your attention to this important issue.
Pamela S. Hyde, J.D.
Administrator
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
1 Choke Cherry Road, 8th Floor
Rockville, Maryland 20857
240 276 2000

Prevention Works. Treatment is Effective. People Recover.



HHS Initiative on Multiple Chronic Conditions
Overview
This website presents information on the Department of Health and Human Services (HHS) initiative on multiple chronic conditions. This information includes background on the scope of this public health, medical, and social issue; the roles of HHS in addressing multiple chronic conditions; functions of the HHS Interagency Workgroup on Multiple Chronic Conditions; and the Draft HHS Strategic Framework on Multiple Chronic Conditions, for which comments from the public and other stakeholders are invited during the period as specified in the Federal Register (see below).

Background
Approximately 75 million Americans have multiple (2 or more) concurrent chronic conditions (MCC), including, for example, arthritis, chronic respiratory conditions, diabetes, heart disease, hypertension, and mental health conditions.1 Chronic illnesses are “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living.”2,3 The prevalence of multiple chronic conditions in an individual increases with age, but the majority of Americans with MCC are under the age of 65 years. As the number of chronic conditions in an individual increases, the risks of the following outcomes also increase: mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice.1,2,4,5,6 Moreover, 66% of total health care spending is directed toward care for the approximately 27% of Americans with MCC.1 Increased spending on chronic diseases among Medicare beneficiaries is a key factor driving the overall growth in spending in the traditional Medicare program.7 Individuals with MCC have faced substantial challenges related to the out-of-pocket costs of their care, including higher costs for prescription drugs and total out-of-pocket health care.1

The combined effects of increasing life expectancy and the aging of the population will dramatically increase the challenges of managing multiple chronic conditions among the burgeoning population of older persons. While there has been tacit appreciation of the quality of care and cost implications prompted by the increasing MCC population, the delivery of community health and health care services generally continues to be centered around individual chronic disease silos. The new health reform law – the Patient Protection and Affordable Care Act – provides HHS with new opportunities for addressing the prevention of chronic conditions, as well as enhancing the clinical management and improving the health status of individuals with MCC.

HHS Role
The U.S. Department of Health and Human Services administers a large number of federal programs directed toward the prevention and management of chronic conditions. Because of the leading role HHS plays in health research, and payment for and delivery of health care services, it is incumbent upon HHS also to provide leadership in improving health outcomes in patients with MCC. Moreover, the increasing costs of, poor outcomes among, and complexity of managing those with MCC necessitate that HHS develop, implement, and coordinate programs and policies that improve the care to and health of patients. To achieve this goal, HHS must further increase coordination of its efforts internally and intensify its collaboration with stakeholders externally.

HHS Interagency Workgroup
To identify HHS options for improving the health of the heterogeneous population of persons with MCC, in mid-2008, the HHS Office of Public Health and Science (OPHS) convened a departmental workgroup on individuals with multiple chronic conditions (the HHS Interagency Workgroup on Multiple Chronic Conditions: see roster). Nearly all HHS operating divisions have participated in this workgroup. An initial major effort of the workgroup was to produce a collation of existing HHS programs, activities, and initiatives focused on improving the health of individuals with MCC. This inventory (PDF), released in March 2009, contains over 50 current efforts across HHS directed primarily to the health care needs of people with two or more chronic health conditions. In addition, multiple interagency workgroup meetings have been held, including one with an academic external stakeholder panel (see meeting summary) and others on topics such as reducing re-hospitalizations and reducing adverse drug events in this population. The workgroup also has assisted the Department in both health reform and comparative effectiveness research efforts related to MCC. Many other efforts that focus on this population are currently underway across the Department. The workgroup believes that, among other beneficial effects, a strategic framework for the Department that provides a roadmap for improving the health status of persons with MCC will help to ensure a more coordinated and comprehensive approach to the implementation of the considerable work already directed toward this need.

Draft HHS Strategic Framework on Multiple Chronic Conditions
As noted above, the draft HHS Strategic Framework on Multiple Chronic Conditions addresses approaches to improving the health of individuals with concurrent MCC by providing options for HHS to strengthen coordination of its efforts internally and collaboration with stakeholders externally.
http://www.hhs.gov/ophs/initiatives/mcc/federal-register051410.pdf

To assist the HHS Interagency Workgroup in obtaining broad input in the development of the strategic framework, HHS has requested comments from the public and other stakeholders.

Comments on the draft strategic framework should be received no later than 5:00pm EDST on 30 days after date of publication in Federal Register.
Electronic responses are highly preferred and should be addressed to MCC@hhs.gov. Written responses should be addressed to U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 736-E, Washington D.C. 20201, Attention: MCC Strategic Framework.
When providing comments, please self-identify with your name. Anonymous submissions will not be considered.
The submission of written materials should not exceed 5 pages, not including appendices and supplemental documents. Responders may submit other forms of electronic materials to demonstrate or exhibit concepts of their written responses.
For further information, contact: Ms. Monica Stevenson, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 736-E, Washington D.C. 20201; telephone (202) 205-5834; e-mail Monica.Stevenson@hhs.gov.
Contact Information
For more information regarding the HHS initiative on multiple chronic conditions, contact:
Ms. Mahak Nayyar at Mahak.Nayyar@hhs.gov (e-mail), (202) 690-6385 (phone), or (202) 690-7425 (fax).


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1 Anderson G. Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Woods Johnson Foundation, 2010. Available at http://www.rwjf.org/files/research/50968chronic.care.chartbook.pdf. Last accessed May 11, 2010.
2 Warshaw G. Introduction: advances and challenges in care of older people with chronic illness. Generations. 2006;30(3):5–10.
3 Chronic conditions are inclusive of mental illnesses and substance abuse disorders.
4 Lee TA, Shields AE, Vogeli C, Gibson TB, Woong-Sohn M, Marder WD, Blumenthal D, Weiss KB. Mortality rate in veterans with multiple chronic conditions. J Gen Intern Med. 2007;22(Suppl 3):403–407.
5 Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–395.
6 Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269–2276.
7 Thorpe KE, Ogden LL, Galactionova K. Chronic conditions account for rise in Medicare spending from 1987 to 2006. Health Affairs. 2010;29(4):1-7.

open here please:
http://www.hhs.gov/ophs/initiatives/mcc/index.html