A Partnership to Develop Behavioral Health Quality and Performance Measures.

The New York State Medicaid program is pursuing reforms that would shift reimbursement from fee-for-service to value-based models. Behavioral health populations and services are key to these reforms, but important gaps exist in the breadth and relevance of available quality measures for the behavioral health field. This column describes how the state addressed these gaps by using both inter- and intra-agency collaborations. As part of this effort, the state convened a panel of consultants, including academics, providers, and consumers, to develop a behavioral health quality measurement agenda. Panel recommendations and ongoing partnerships are described as a model for states considering similar value-based reform initiatives.

New York State Medicaid Reforms: Opportunities and Challenges to Improve the Health of Those with Serious Mental Illness.

Individuals with serious mental illness face multiple barriers to accessing care and experience disproportionately poor health outcomes. Starting in 2011, New York State undertook a series of major reforms of its Medicaid system designed to address these concerns. In this commentary we review three reforms that aim to change the way New York Medicaid is delivered and experienced, especially for underserved individuals with SMI: Health Homes, Behavioral Health Managed Care, and the Delivery System Reform Incentive Payment Program. We describe the history of these reforms' and their core themes: coordination and collaboration, cross-sector collaborations to address social determinants of health, prevention and early intervention, and financial reform. We describe the challenges and opportunities these reforms present for improving the health and health care of Medicaid members with SMI, both in New York and as models for change elsewhere.

Changes in Percutaneous Coronary Interventions Deemed "Inappropriate" by Appropriate Use Criteria.

BACKGROUND: Recent studies have demonstrated relatively high rates of percutaneous coronary interventions (PCIs) classified as "inappropriate." The New York State Department of Health shared rates with hospitals and announced the intention of withholding reimbursement pending demonstration of clinical rationale for Medicaid patients with inappropriate PCIs. OBJECTIVES: The objective was to examine changes over time in the number and rate of inappropriate PCIs. METHODS: Appropriate use criteria were applied to PCIs performed in New York in patients without acute coronary syndromes or previous coronary artery bypass graft surgery in periods before (2010 through 2011) and after (2012 through 2014) efforts were made to decrease inappropriateness rates. Changes in the number of appropriate PCIs were also assessed. RESULTS: The percentage of inappropriate PCIs for all patients dropped from 18.2% in 2010 to 10.6% in 2014 (from 15.3% to 6.8% for Medicaid patients, and from 18.6% to 11.2% for other patients). The total number of PCIs in patients with no acute coronary syndrome/no prior coronary artery bypass graft surgery that were rated as inappropriate decreased from 2,956 patients in 2010 to 911 patients in 2014, a reduction of 69%. For Medicaid patients, the decrease was from 340 patients to 84 patients, a decrease of 75%. For a select set of higher-risk scenarios, there were higher numbers of appropriate PCIs per year in the period from 2012 to 2014. CONCLUSIONS: The inappropriateness rate for PCIs and the use of PCI for elective procedures in New York has decreased substantially between 2010 and 2014. This decrease has occurred for a large proportion of PCI hospitals.

Guillain-Barré syndrome associated with immune reconstitution.

We report a case of acute Guillain-Barré syndrome (GBS) associated with a prompt and vigorous immune reconstitution and decrease in the virus load noted during treatment with a potent regimen of highly active antiretroviral therapy. We hypothesize that GBS may have been due to an aberrant immune response or an adverse drug reaction in association with preexisting peripheral neurologic disease.