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By Monica E. Oss

In the move toward integrated care coordination (what I call the shift from horizontal to vertical), there have been many changes.  Of the U.S. population, 17% have their care delivered by ACOs (see Accountable Care Organizations Now Serve Up To 17% of Americans). The specialty-focused carve-out is being replaced by consumer-focused financing (see Mercy Maricopa Integrated Care Launches Arizona Regional Behavioral Health Authority Contract and Magellan Complete Care Florida Medicaid Contract Goes Live).  There are now 7,525 sites in 46 states that have received NCQA medical home recognition, and another 27 states that will soon adopt a health home construct (see The Many Pathways To Coordinated Care – The Restructuring Continues).

So it shouldn’t be a surprise to see this shift in financing and delivery system structure “trickle down” to the specialty level. An example? The proposal by Dr. David Hsu, in his Psychiatric Times article, Vascular Psychiatry: A New Specialty? to create a new specialty – vascular psychiatry. His premise?  “Comorbidity of psychiatric syndromes, such as depression, and vascular diseases has already been firmly established….In daily practice, psychiatrists commonly encounter vascular syndromes, such as vascular depression, vascular cognitive impairment, and depression in heart disease.” And, if there are vascular surgeons, internists, and neurologists, there should also be “vascular psychiatrists.”  The current working definition of vascular psychiatry, courtesy of the Royal College of Psychiatrists is “the interface between vascular disease and mental disorders, and its clinical relevance.”

The proposition piqued my interest and the research literature “fills in the gaps” in this proposal. Vascular dementia is the second most common form of dementia after Alzheimer disease (AD).  Apparently healthy individuals with depression have at least a two-fold higher risk of developing cardiovascular disease. The biological connection between anxiety and cardiovascular disease (and IBS and chronic pain) are now established.  Research exists that indicates that 30 to 40% of all coronary artery bypass graft (CABG) surgery patients are affected by depression – and that these patients have an increased risk of mortality and morbidity in the short and longer term. The overlap is extensive and the need for “interdisciplinary” knowledge is evident.

I think we will see the increase in the evolution of “subspecialties” in health care – for a number of reasons. The need for “boundary spanning” knowledge is obvious as our knowledge of the interaction between cognitive and medical functions increases. And the focus on “whole person” care management has made this boundary spanning knowledge highly desirable. At the same time, better technology tools have made “standard knowledge” available through expert systems – the “decentralization of expertise” in this era of disruptive innovation. Analytics-imbued technology now is available for routine diagnosis, treatment planning, prescribing, and referrals.  But the “complex” – in terms of both clinical and consumer engagement – remains beyond the scope of the current technology offerings.

For more on the intersection of behavioral health and vascular health, check out these resources in our Industry Library:

  1. Medicare Reimburses For Intensive Cardiac Rehabilitation: A Future With Provider Supported Non-Traditional Treatment
  2. Psychosocial Conditions Found to Promote Heart Disease
  3. AbilTo Receives Funding to Expand Innovative Behavioral Intervention Platform
  4. Telephone-Based Collaborative Care Model Manages Depression & Anxiety In Patients With Heart Disease
  5. NQF Endorses Health Care Resource Use Measures for Primary Care, Diabetes, & Cardiovascular Care Costs
  6. Telephone-Based Depression Treatment Program Found To Reduce Costs Of Heart Surgery Patients
  7. Depression and Heart Disease Linked in Women
  8. Alliance’s Happy Heart Program Screens Patients for Depression
  9. Depression Increases Heart Failure Risk By 40%
  10. Biofeedback May Offer A New Restorative Therapy For Heart Failure Patients
  11. Remote Monitoring Care For Heart Failure Reduces Hospitalization Costs
  12. Impact Of Social Factors On Risk Of Readmission Or Mortality In Pneumonia And Heart Failure: Systematic Review

And for a look at the “state of the art” in the integrated care coordination models, don’t miss the session Pay-For-Performance In Emerging Care Coordination Models: How ACOs, Health Homes, & New Models Of Care Are Managing Value In Health Care, led by my colleague, Steve Ramsland, Ed.D. at the 2015 OPEN MINDS Performance Management Institute.


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