The beginnings of the Maryland Psychiatric Society go back to the early nineteen hundreds, when a group of physicians from various specialties got together with the common goal of advocating for improvements in the care of patients with psychiatric disease. At that time, the care of those patients seemed to be integrated across specialties. In contrast, care for patients with psychiatric disease today is disintegrated and fragmented with various carve-outs and silos that limit access to psychiatric and somatic care alike, particularly for patients who need it most. Several studies have reported significantly higher rates of somatic co-morbidities and associated higher rates of mortality in patients with psychiatric diseases. Several possible causes have been cited, including genetic predisposition, adverse effects of pharmacotherapy, and lack of access to somatic care as well as delayed and inconsistent initiation of interventions for somatic conditions like metabolic syndrome, and related complications.
The State of Maryland, under the leadership of Secretary of Health Joshua Sharfstein, is exploring the possibility of integrating and better aligning all “behavioral health” care with all “somatic” care. To that end, Deputy Secretary Chuck Milligan has been asked to develop recommendations for an Integration Model by September 30, 2012. This plan will then be presented to the General Assembly, which will introduce corresponding legislation. The model will include financial and administrative recommendations, as well as clinical components and related infrastructures. The State’s initiative involves only Medicaid and uninsured patients, whose numbers may grow substantially when and if the Affordable Care Act is implemented. Various models of integration have already been implemented in different parts of the country, and some of their data were presented in May at the annual APA meeting, whose theme was “Integration.”
In response to these developments, the MPS Executive Committee seized the opportunity and formed an Integration Workgroup. The goal of the workgroup is to play an instrumental role in informing and influencing the process and outcome of this undertaking. Our strategy includes identifying potential risks and opportunities, identifying potential partners and resources, and implementing an operational plan for our involvement in the process. The group has already met with Deputy Secretary Milligan, who thanked us for our initiative, urged us to continue our active involvement and invited us to return with our recommendations and supporting data.
The MPS Integration Workgroup has now grown to fourteen members and we continue to seek the participation of all members who are interested in Integration. I would like to thank Drs. Ray DePaulo and Tony Lehman, Chairmen of Psychiatry from the two main academic institutions in Maryland, for joining this effort to ensure that Psychiatry leads the way in the integration of “behavioral health” with “somatic” health and that the care of psychiatric patients is optimized.
The MPS has had a good beginning. As the State of Maryland transforms healthcare, let’s work together on continuing that tradition.