Applications for Cardiovascular Prevention Enhancement Program due Feb. 28

The Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) and Transform Wisconsin have issued a call for applications for their CDC-funded Cardiovascular Prevention Enhancement Program (CPEP). CPEP aims to help Wisconsin clinics improve outcomes for their patients with type 2 diabetes, hypertension or lipid disorders.

Transform Wisconsin and WIPHL will select up to six Wisconsin clinics to participate. Ideally, at least two clinics will be located in rural counties. The application deadline is February 28, 2014.

WIPHL and Transform Wisconsin cite the following as possible advantages of participation in the program:

  • Satisfy dozens of NCQA Patient-Centered Medical Home recognition criteria.
  • Improve performance on several WCHQ and CMS Accountable Care Organization (ACO) quality measures.
  • Generate shared savings for ACOs.
  • Have a staff member trained in motivational interviewing.
  • Generate additional fee-for-service revenue.
  • Gain an additional edge in competing for contracts.
  • Take an important step toward delivering team-administered, value-based health care.
  • Help prevent cardiovascular disease among patients with important risk factors.

To download a more detailed program description click here. A program application is available here.

For more information or to register for the webinars, e-mail Rich Brown, MD.


Erroneous POEM Analysis on Alcohol Screening and Intervention

By Richard L. Brown, MD, MPH

Earlier this year, a randomized control trial by Eileen Kaner analyzing the effectiveness of screening and brief alcohol intervention in primary care settings was released. It concluded that, “All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. “

I believe an analysis of the trial by Essential Evidence Plus POEM, which stated the bottom line was that alcohol screening and intervention did not decrease the percentage of patients drinking to excess at six months, completely misinterpreted Kaner’s study.

Kaner’s study did not assess the efficacy of alcohol screening and intervention, which is already well-established in dozens of randomized controlled trials, including Mike Fleming’s seminal study published in JAMA in the 1990s. Kaner’s study assessed the effectiveness of training physicians and nurses in primary care settings in delivering these services. And of course, the physicians and nurses did poorly, because they simply don’t have time to adequately screen and intervene.

The message that I take away from Kaner’s study is:

  • If you really want to generate the improved health outcomes and cost savings that alcohol screening and intervention will yield, you need to expand your healthcare team with staff who have the time to deliver these services.
  • The same goes for evidence-based – widely-recommended, yet seldom delivered – evidence-based interventions for tobacco and depression.
  • We can increase one-year quit rates from 6% to as high as 28% if we have additional staff who can spend as much as five hours with each patient over more than eight visits, according to a metaanalyses published in the most recent update of the Federal Guideline for Tobacco Cessation.
  • We can increase one-year rates of complete remission from depression from 30% to 54% if we have additional staff who can deliver “collaborative care,” which includes educating patients, engaging them fully in treatment and in behaviors that help lift symptoms (such as exercise and socializing), tracking depressive symptom scores (PHQ-9), and alerting other providers when poor improvement in PHQ-9 scores indicates a need to reconsider the treatment plan. (See a metaanalysis of 69 studies by Thota, Am J Prev Med, 2012.)

If you have questions regarding Kaner’s study, the POEM analysis or my response to the POEM analysis, please email me at info@wiphl.org.

For more information, see wiphl.org.


Spring Brings New Policy Developments in SBIRT

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By Richard L. Brown, MD, MPH

One of the exciting aspects of serving as the WIPHL’s director has been witnessing the rapid growth and depth of support for healthcare settings to deliver behavioral screening and intervention (BSI).  In just the past few months, there has been several important policy developments regarding the recommendation and delivery of alcohol and drug screening, brief intervention and referral-to-treatment (SBIRT), both on a national and state level.

Every year, the White House and Director of the Office of National Drug Policy (also known as the “drug czar”) release an update of the nation’s strategy to address its drug problems. Chapter two of the newly-released National Drug Control Policy of 2013 is titled “Seek Early Intervention Opportunities in Healthcare” and details steps the federal government is taking to promote delivery of  SBIRT. These efforts include promoting better education for healthcare professionals, enhancing fee-for-service reimbursement for services, and updating educational resources. The document cites WIPHL and its partnerships with universities and employers as a “model public-private collaboration.”

Toward enhancing the delivery of SBIRT services, the Center for Medicare and Medicaid Services recently released a plan to update its rules on reimbursing hospitals for services delivered to Medicare patients. An exciting aspect of the plan is to require hospitals to report to Medicare the proportion of Medicare patients who have received SBIRT services and to institute strong financial incentives based on quality metric reporting. This aspect of the proposal would be implemented in 2016, which gives hospitals liberal lead time to plan how they will deliver these services.

Finally, at the state level, Wisconsin’s State Council on Alcohol and Other Drug Abuse (SCAODA) is charged with making recommendations to the Governor and legislature on preventing and addressing alcohol and drug problems in our state. SCAODA will soon consider adopting its subcommittee recommendations intended to help make BSI a routinely delivered service in primary healthcare settings, emergency departments and hospital inpatient units throughout the state. Recommendations include eliciting the support of the Governor’s Office in convening representatives of private and public healthcare  purchasers, and requiring payers to publicize fee-for-service reimbursement policies for behavioral screening and intervention.

Also at the state level, the Wisconsin Department of Health Services submitted a grant application to the US Substance Abuse and Mental Health Services Administration for approximately $8 million to continue disseminating alcohol, drug, tobacco and depression screening and intervention in primary care clinics throughout the state. The Wisconsin Primary Health Care Association (WPHCA) would be a lead organization in this project. Although WPHCA serves as an umbrella organization for Wisconsin’s federally-qualified health centers, all primary care clinics will be invited to participate. Notification of a funding decision will likely come in the early fall, and service delivery will start at some clinics by early 2014.

These exciting developments are further evidence of momentum for behavioral screening and intervention. If your clinic and hospital aren’t yet delivering BSI, they will in the future. Please contact WIPHL if you have any questions on how to get BSI started in your clinic or hospital, or on what you can do to accelerate implementation of evidence-based, cost-saving BSI in your community.

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Noble Wray: Hire health educators to reduce DUI

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In yesterday’s Wisconsin State Journal (WSJ), Madison Police Chief Noble Wray demonstrated his support for the important role BSI can play in addressing Wisconsin’s binge drinking & intoxicated driving problems. More than 70 percent of police calls and incarcerations involve alcohol or drugs. Administering BSI is proven to reduce binge drinking and drug use – reducing the burden on our police departments and making our communities a safer place to live. Read Chief Wray’s WSJ column here.

Thank you Chief Wray for your support! You can advocate for BSI by going to our website and pledging your support for this proven-effective service in Wisconsin.