Health Care Gap Analysis

The ACA’s progress in expanding the health care industry to include various incomes levels comes leaves room for errors. For the purpose of this paper I have chosen to focus on the poor working class gap left due to the federal decision to leave states with the option to expand Medicaid. When the expansion was initially announced in 2010 24 of the 50 states opted out of the Medicaid expansion. As of September 2015, 20 states were not expanding their programs. Individuals and families that fall within this gap further are limited as they disqualify, for financial purpose, for federal subsidy (Geyman, 2015). 90% of those individuals and families that fall within this coverage gap reside in southern states and over half are between the ages of
35 and 54 (Garfield & Damico, 2015). Further, nearly half of those in the coverage gap work for small firms that are not mandated by the ACA to offer coverage.
Medicaid Expansion
With the expansion of Medicaid in all states, all of the individuals within this coverage gap would be covered under Medicaid health care (Garfield & Damico, 2015).
Research has indicated that of the individuals within 133% of the federal poverty limit 18.8% to 29.5% had “probable depression” and “19.%-29.9% had serious psychological distress”. Additionally, higher rates of substance abuse disorders have been found to exist among those individuals “who may” gain insurance under ACA with far fewer receiving treatment for such illnesses (Mark, T., Wier, L., Penne, K., & Cowell, A.
(2014).
Mental Health Team
To continue to ensure that access to mental health care expands with the rise in mental health needs is to create a integrative team approach as done is other areas of illnesses and chronic conditions.
In this model primary care provides mental health needs for mild conditions with support from mental health specialists (Cummings, (2015). Studies have shown that this type of intervention, consisting of six components, are effective for outcomes across mental health conditions (Woltmann, Grogan-Kaylor, Perron, Hebert, & Kilbourne, (2012) . In a study by Jones, Cochran, Leibowitz, Wells, & Kominski (2015), patients who were seen in a patient care medical home were more likely to receive mental health counseling with a mental health specialist than those seeing a “usual
provider”.
Implementation
The patient centered medical home (PCMH) is coordinated by a primary care physician or nurse practitioner, with coordination with specialty care in this case mental health specialists. Six domains within the PCMH include patient self-management support, clinical information systems use, delivery system redesign, provider decision support, community resource linkage, and health care organization support (Woltmann, Grogan-Kaylor, Perron, Hebert, & Kilbourne, (2012). Primary care providers in this model with need to have the education to provide mental health services to chronically ill and have the knowledge of when to refer to mental health specialists. Strategies to implement this program begin with “formal demonstration projects, ongoing experimentation, and experience from real world settings” (Croghan & Brown, 2010). Performance measures would be used to assess the outcome of care beginning from the first patient encounter through the course of treatment.
In Closing
PCMH have been shown to provide quality mental and behavioral health services from a primary care provider. Since these illnesses are commonly seen together with physical impairments, it seems crucial for providers to have the knowledge of treatment approaches and when coordinate care with a specialist. If these impairments can be realized during the immediate stages of care then consistent and accurate coordinated care can begin right away and prevent exacerbating one illness or the other due to the lack of care provided. Successful implementation will depend upon the coordination amongst all stakeholders involved in care planning.