Capitated Doc Is Indicted in First MA Upcoding Criminal Case in S. Fla.

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care.

In the first criminal case the U.S. Attorney’s Office in South Florida has brought on alleged fraud via up-coding of Medicare Advantage diagnoses, the feds this month obtained a grand-jury indictment against a Palm Beach County physician accused of causing at least $2.11 million in excessive MA payments. At the time, Isaac Kojo Anakwah Thompson, M.D., was a capitated member of Humana Inc.’s MA provider network, but he no longer is in the network, says the company, which is not accused of wrongdoing in the indictment and contends it has repaid money as part of cooperating with the feds on the case.

Thompson pleaded not guilty in U.S. District Court in West Palm Beach, Fla., on Feb. 18, and a trial was set for March 23.

On the same date as Thompson’s plea, Humana disclosed Feb. 18 that it “recently” has received a request for information from the U.S. Department of Justice’s Civil Division about how it oversees risk-adjustment data in MA, including such aspects as medical-record reviews, use of health assessments and fraud-detection efforts. The company said in its Form 10-K filing with the SEC that it is cooperating with that request as well.

The grand jury in Florida on Feb. 3 indicted Thompson on eight counts of health care fraud that it said occurred between about January 2006 and April 2010. He allegedly did this by reporting to Humana “false and fraudulent diagnoses of Medicare beneficiaries enrolled in a Humana Medicare Advantage plan, thereby increasing the capitated payments that Medicare made to Humana and that Humana in turn made to” two entities in which Thompson was a principal.

Diagnoses Submitted Were for Serious Illnesses

The indictment charges that the claimed diagnoses the beneficiaries involved “did not suffer from” included ankylosing spondylitis (a chronic inflammatory disease of the spine), sacroiliitis (an inflammation in joints in the pelvis), inflammatory polyarropathy (five or more inflamed, swollen, tender joints) and major depressive affective disorder. Humana, which paid Thompson’s medical center about 80% of the MA capitation pay it got for beneficiaries who picked one of two Thompson entities as their primary care provider, “reported the false and fraudulent diagnoses to Medicare,” the indictment says.

The document adds that Thompson “obtained control of the fraudulent proceeds” that Humana paid to the two entities and “diverted these monies for his personal use and benefit, as well as that of others.” The charges carry maximum penalties that include 10 years of imprisonment.

Robert Nicholson, a Fort Lauderdale, Fla., attorney representing Thompson, told MAN Feb. 19 that his firm had “just entered” this case and had been told by the court not to comment on it to the media.

Asked by MAN to elaborate on the company’s role in the Thompson situation and investigation, Humana spokesperson Tom Noland said only, “We are cooperating fully with the authorities. Dr. Thompson is no longer a participating physician with Humana and was never a Humana employee. Humana has reimbursed the government to ensure that both the 20% [portion of Thompson’s billed charges kept by the insurer] and the 80% [Thompson portion] were paid back in full, thus making the government whole.”

He declined to comment on why Humana’s systems themselves wouldn’t have detected such large amounts for unusual diagnoses being billed by one of its capitated network providers or to say how much money the company reimbursed the government.

Asked whether in DOJ’s view Humana did anything wrong in the Thompson situation, a spokesperson for the U.S. attorney’s offices in south Florida told MAN, “Since this matter is ongoing, we will decline the opportunity to comment.” She also wouldn’t discuss the Humana filing.

http://aishealth.com/archive/nman022615-05

Diagnoses from 2/3/15 indictment:

..., ::::: :::: 0 u	Date	Entity	i'.:' «"J" :1:1:::    ..., <l)   .... i:o  ..::	HICN (last 5 d igits)	Fraudulent Diagnosis
1	2/8/ 2010	IM Med ical	M H	9471A	Inflammatory polyarthropathy
2	2/ 16/ 2010	IKAT	BB	2528A	Ankylosing spondylitis
3	2/ 16/ 2010	IKAT	ECi	5014A	Ankylosing spondylitis
4	2/ 16/2010	IKAT	RH	3396A	Ankylosing spondylitis
5	2/ 16/ 2010	IKAT	cs	4705A	Ankylosing spondylitis
6	4/ 5/2010	IM Med ical	RI	5697A	Major depressive affective disorder
7	4/9/2010	IM Med ical	TV	4666M	Major depressive affective disorder

New CMS rules boost consumer protections in exchange plans

CMS Friday issued final market rules for 2016 (PDF) for the state and federal insurance exchanges. The regulations include stronger requirements for insurers to provide accessible, reliable information about provider networks and drug formularies so that exchange customers can make informed choices. 

“CMS is working to improve the consumer experience and promote accountability, uniformity and transparency in private health insurance,” CMS Administrator Marilyn Tavenner said in a written statement. Tavenner is stepping down from the agency's top post later this month. 

For 2016 coverage, the open-enrollment period will run from Nov. 1 through Jan. 31, moving it up by two weeks from this year. Previously, the CMS had proposed closing the sign-up period on Dec. 15, 2015. “We were persuaded by the concerns expressed by many commenters about the additional burden caused by shifting the annual open-enrollment period, and therefore we are finalizing an annual open-enrollment period for the 2016 benefit year that begins one month later than the one we had proposed,” the final rule states.

Critics, though, said the agency should either have moved the enrollment period up to before the Christmas holiday period or moved it back to coincide with tax return filing season.

In addition, the agency announced that there will be a 3.5% fee assessed on premiums purchased through the federal exchange to cover operational costs. That's the same assessment level as in the first two years of operations and is expected to raise $1.5 billion. 

The final rule indicates that HHS is monitoring the adequacy of provider networks offered by exchange health plans. But the agency reiterated that it is waiting to see how a model law being drafted by the National Association of Insurance Commissioners turns out before it takes additional regulatory action. 

However, HHS is encouraging insurers to allow new customers a 30-day grace period to find an in-network provider to meet their needs before imposing out-of-network cost-sharing. That would allow clients to continue getting the treatment they need without worrying about incurring exorbitant medical bills. 

After hearing widespread complaints of insurers not having up-to-date provider directories, HHS is expecting health plans to publish up-to-date, accurate, and complete provider directories, including information on which providers are accepting new patients, the provider’s location, contact information and any institutional affiliations in a manner that is easily accessible.

As part of this requirement, insurers must update the directory information at least once a month. A provider directory will be considered easily accessible when the general public is able to view all of the current providers for a plan on a public website through a clearly identifiable link or tab without having to create or access an account or enter a policy number.

Similarly, HHS is requiring health plans to post their drug formularies on their websites and that they be updated in real time. In addition, HHS is requiring that drug formularies and provider networks be made available in “machine-readable” files. That will allow independent entities to extract the data and create tools to help consumers make more informed choices about which plans will best meet their needs. 

The agency increased protections for consumers to appeal decisions when they find out that drugs aren't covered by their plans. Under the final rule, insurers must review those decisions within 72 hours if a customer files an appeal. In addition, the client can seek an expedited review that must be conducted within 24 hours. The customer can also ask for an external review of the decision to deny coverage for the drug in some circumstances. 

The CMS also issued updated rules for risk-mitigation programs designed to shield insurers selling products on the exchanges from exorbitant financial losses if they sign up a sicker-than-expected member pool. The reinsurance program, which provides financial relief to insurers that end up with exorbitantly expensive customers, is expected to cost $4 billion in 2016. Insurers will be able to offset 50% of costs for customers whose medical bills top $90,000 up until they reach $250,000. During the current year, insurers can begin collecting reinsurance funds when a customer's medical bills reach $45,000. 

“We believe setting the coinsurance rate at 50% and increasing the attachment point allows for the reinsurance program to help pay for nearly the same group of high-cost enrollees as was the case for the 2014 and 2015 benefit years, while still encouraging issuers to contain costs,” the rule states. 

HHS also reiterated that it expects the risk corridor program to be budget-neutral, but indicated that it will make good on all payments if that does not prove to be the case. Under that program, insurers that end up with a disproportionately expensive exchange customer pool receive payments from the federal government, while those that attract a healthier, less-costly customer pool must pay into the fund. 

“HHS recognizes that the Affordable Care Act requires the Secretary to make full payments to issuers,” the rule states. “In the unlikely event that risk corridors collections, including any potential carryover from the prior years, are insufficient to make risk corridors payments for the 2016 program year, HHS will use other sources of funding for the risk corridors payments, subject to the availability of appropriations.”

HHS is also bolstering language requirements for insurers selling products through the state and federal exchanges. They'll now be compelled to provide interpreter services in at least 150 languages. However, HHS opted not to implement the same language-access requirement for navigators that help individuals enroll in coverage. The agency also opted not to move forward with any language requirements for written materials. 

Some consumer advocates had been lobbying HHS to include pregnancy as a life-change circumstance that would allow women to enroll in coverage outside of the open-enrollment window. But the agency didn't include such a provision in the final rule. Insurers had strongly opposed it, arguing that would lead some women to wait to sign up for coverage until they got pregnant, leading to adverse selection and higher costs.

“We believe the Department of Health and Human Services can and should fix this problem," Christina Postolowski, health policy manager at Young Invincibles, said in a written statement. "The average cost of maternity care and delivery without complications is $23,000. HHS has stood on the side of expanding access to coverage for millions of people. That shouldn't change now."

Follow Paul Demko on Twitter: @MHpdemko

Follow Virgil Dickson on Twitter: @MHVDickson

http://www.modernhealthcare.com/article/20150220/NEWS/150229986

CY2016 Medicare Part C and D Advance Notice

February 20, 2015

NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and
Other Interested Parties

SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for
Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016
Call Letter

In accordance with section 1853(b)(2) of the Social Security Act, we are notifying you of
planned changes in the MA capitation rate methodology and risk adjustment methodology
applied under Part C of the Act for CY 2016. Also included with this notice are proposed
changes in the payment methodology for CY 2016 for Part D benefits and annual adjustments for
CY 2016 to the Medicare Part D benefit parameters for the defined standard benefit. For 2016,
CMS will announce the MA capitation rates and final payment policies on Monday, April 6,
2015, in accordance with the timetable established in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA).

Attachment I shows the preliminary estimates of the national per capita MA growth percentage
and the national Medicare fee-for-service growth percentage, which are key factors in
determining the MA capitation rates. Attachment II sets forth changes in the Part C payment
methodology for CY 2016. Attachment III sets forth the changes in payment methodology for
CY 2016 for Part D benefits. Attachment IV presents the annual adjustments for CY 2016 to the
Medicare Part D benefit parameters for the defined standard benefit. Attachment V presents the
preliminary risk adjustment factors.

Attachment VI provides the draft CY 2016 Call Letter for MA organizations; section 1876 costbased
contractors; prescription drug plan (PDP) sponsors; demonstrations; Programs of AllInclusive
Care for the Elderly (PACE) organizations; and employer and union-sponsored group
plans, including both employer/union-only group health plans (EGWPs) and direct contract
plans. The Call Letter contains information these plan sponsor organizations will find useful as
they prepare their bids for the new contract year.

Comments or questions may be submitted electronically to the following address:
AdvanceNotice2016@cms.hhs.gov.


READ 2016 Advance Notice

CMS announces new initiative in Advanced Primary Care

Advanced Primary Care Initiatives

The Centers for Medicare & Medicaid Services (CMS) is seeking input on initiatives to test innovations in advanced primary care, particularly mechanisms to encourage more comprehensiveness in primary care delivery; to improve the care of complex patients; to facilitate robust connections to the medical neighborhood and community-based services; and to move reimbursement from encounter-based towards value-driven, population-based care.

Background

Advanced primary care is based on principles of the Patient Centered Medical Home and builds on the care delivery models employed in other CMS model tests, including the Comprehensive Primary Care Initiative. Next generation model(s) for advanced primary care would seek to improve further the delivery of patient-centered care and population health. General topics of interest include:

• increased comprehensiveness of, and patient continuity with, primary care (i.e., care provided with greater depth and breadth and through longitudinal relationships between patients and primary care providers),
• care of patients with complex needs, 
• closer connections between primary care and other clinical care (“the medical neighborhood”) and community-based services, 
• moving from encounter-based payment or encounter-based payment with care management fees towards population-based payments (PBPs) to support the infrastructure needed for advanced primary care, create incentives for innovation in care delivery, and promote accountability for costs and quality of care, including consideration of appropriate mechanisms to assign beneficiaries to unique practices, 
• mechanisms to support small primary care practices in the transformation to advanced primary care,
• advanced primary care within accountable care organizations (ACOs),
• multi-payer participation,
• performance measurement that is meaningful to beneficiaries and clinicians,
• matching documentation requirements to the goals of advanced primary care while protecting MS program integrity, and
• use of health information technology (HIT), including electronic health records, data analytics, and population health tools, to support advanced primary care.

Request For Information

CMS seeks broad input from consumers and consumer organizations, health care providers, associations, purchasers and health plans, Medicaid agencies and other state offices, quality review organizations, social service providers, HIT vendors, and other stakeholders. Submissions must be supplied using the Request for Information (RFI) (PDF). To be assured consideration, comments must be received on or before 11:59pm EDT, March 16, 2015. For questions regarding RFI submission please contact APC@cms.hhs.gov.

Additional Information

• Request for Information (RFI) (PDF)

Medicare Program; Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs

Executive Summary

1. Purpose

The purpose of this final rule is to revise the Medicare Advantage (MA) program (Part C) regulations and Medicare Prescription Drug Benefit Program (Part D) regulations to implement statutory requirements, improve program efficiencies, strengthen beneficiary protections, clarify program requirements, improve payment accuracy, and make various technical changes for contract year 2016.

2. Summary of the Major Provisions

a. Changes to Audit and Inspection Authority (§§ 422.503(d)(2), 423.504(d)(2))

We proposed three changes to our audit and inspection authority. Due to significant concerns raised during the public comment period, we are finalizing only two of those three proposals. First, under section 6408 of the Affordable Care Act, new authority was provided to the Secretary that now requires that each contract provide the right to “timely” inspection and audit.

We are revising both §§ 422.503(d)(2) and 423.504(d)(2) to insert the word “timely” at the end of both of the introductory paragraphs.

We are also adding language to §§ 422.503(d)(2) and 423.504(d)(2) that will allow us to require that a sponsoring organization hire an independent auditor, working in accordance with CMS specifications, to validate if the deficiencies that were found during a CMS full or partial program audit have been corrected and provide CMS with a copy of the audit findings.

The proposal to require MA organizations and Part D plan sponsors to hire an independent auditor to conduct full or partial program audits will not be finalized.

b. Enrollment Eligibility for Individuals Not Lawfully Present in the United States (§§ 417.2, 417.420, 417.422, 417.460, 422.1, 422.50, 422.74, 423.1, 423.30, 423.44)

After consideration of the public comments, we are finalizing the policies mostly as proposed, with the exception of changes to the regulation text at §§ 417.422, 417.460, 422.50, 423.1, 423.3 and 423.44 to clarify that any individual not lawfully present is no longer eligible to remain enrolled in a cost, MA, or Part D plan, to establish the disenrollment effective date to be the first of the month following notice by CMS of ineligibility, and to delete the term “qualified alien.” Further, we are redesignating the current text at § 417.460(b)(2)(iv) as paragraph (b)(2)(v) and finalizing the provision establishing a lack of lawful presence as a basis for disenrollment from a cost plan at paragraph (b)(2)(iv). This provision is consistent with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and with recommendations made by the Office of the Inspector General (OIG) in its January 2013 and October 2013 reports.

c. Business Continuity for MA Organizations & PDP Sponsors (§§ 422.504(o) and 423.505(p))

To respond to concerns raised during the comment period, we revised the regulation text by providing a 72, rather than 24 hour, restoration time period for MA organizations and Part D sponsors after a systems failure. We also revised text as necessary to make clear that we require MA organizations and sponsors to “plan to” restore essential functions within the 72-hour time period, rather than guarantee complete restoration within the timeframe. Some commenters thought our intent was to require continuous operations under all conditions, and we revised language from the proposed regulation to make clear that that was not the case in our final rule. Lastly commenters distinguished between Part C and D operations and noted, for instance, that provider payments are not a 24-hour critical function for MA plans since payment is allowed to be made within 30 days and that health and safety would not be put at risk by failure of Part C claims processing and appeals processing. We removed language related to that requirement for MA plans.

d. Efficient Dispensing in Long Term Care Facilities and Other Changes (§ 423.154)

We are finalizing changes to the rule requiring efficient dispensing to Medicare Part D enrollees in long term care (LTC) facilities. Some Part D sponsors (or their pharmacy benefit managers) implemented the short-cycle dispensing requirement by pro-rating monthly dispensing fees, which penalize the offering and adoption of more efficient LTC dispensing techniques compared to less efficient LTC dispensing techniques. This is because when a medication is discontinued before a month's supply has been dispensed, a pharmacy that dispenses the maximum amount of the medication at a time permitted under § 423.154 (which is 14 days' supplies), collects more in dispensing fees than a pharmacy that utilizes dispensing techniques that result in less than maximum quantities being dispensed at a time. In other words, a less efficient pharmacy collects more in dispensing fees than a more efficient pharmacy. This is contrary to the Congress' intent in enacting section 3310 of the Affordable Care Act, which is to reduce medication waste. Therefore, we have finalized a prohibition on payment arrangements that penalize the offering and adoption of more efficient LTC dispensing techniques by prorating dispensing fees based on days' supply or quantity dispensed. We have also finalized a requirement to ensure that any difference in payment methodology among LTC pharmacies incentivizes more efficient dispensing techniques. Other changes to the rule requiring efficient dispensing to Medicare Part D enrollees in LTC facilities are eliminating language that has been misinterpreted as requiring the proration of dispensing fees and making a technical change to the requirement that Part D sponsors report on the nature and quantity of unused brand and generic drugs. We are not finalizing an additional waiver for LTC pharmacies using restock and reuse dispensing methodologies under certain conditions at this time.

Read More: https://www.federalregister.gov/articles/2015/02/12/2015-02671/medicare-program-contract-year-2016-policy-and-technical-changes-to-the-medicare-advantage-and-the

FAQ - Calculation of member months for the Cost-Sharing Reductions Reconciliation simplified methodology

Q. On November 21, 2014, HHS clarified that a plan benefit year could begin as late as March
31, 2014 for the purpose of establishing member months to meet the credibility threshold
required by the cost-sharing reduction reconciliation simplified methodology. Does the new
March 31, 2014 deadline include people who applied or tried to apply by March 31, 2014, but
whose enrollments were not effectuated?

A: Yes. A Qualified Health Plan issuer assessing whether enrollment meets the credibility
threshold for the simplified methodology may count members who applied or tried to apply by
March 31, 2014, but whose enrollment did not become effective until later because of technology
challenges. This includes members whose applications were not processed until after March 31,
2014, postponing their start date until May, and members who received a special enrollment
period because Exchange issues prevented them from filing an application by March 31, 2014.

The cost-sharing reduction reconciliation simplified methodology provided in 45 CFR
156.430(c)(4) allows issuers to develop a set of effective cost-sharing parameters based on the
average experience of enrollees in a standard plan. HHS in 45 CFR 156.430(c)(4)(v) set a
minimum of 12,000 member months per benefit year in the standard plan to establish a credible
claims data base on which to measure cost-sharing parameters.

Because of 2014 enrollment delays, we will consider this standard met if at least 12,000 member
months are accumulated for enrollees, each of whom applied or tried to apply to the plan
beginning no later than March 31, 2014 and remained in the plan until the end of the benefit year
on December 31, 2014. This includes members who received special enrollment periods that
resulted in an effective date up to but not later than May 31, 2014.

Issuers that selected the simplified methodology but do not meet the foregoing 12,000-member
month credibility standard must use the Actuarial Value simplified methodology described at 45
CFR 156.430 (c)(4) (v).

 FAQ - January 13, 2015      https://www.regtap.info/uploads/library/APTC_FAQ_CSRRecon_MemberMnths_5CR_011315.pdf

CMS issues final rule on reimbursement for chronic care management services

• McGuireWoods LLP
• Kerri A. Eble and Kimberly J. Kannensohn

On November 13, 2014, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare Physician Fee Schedule final rule, including a new code and guidance for billing for chronic care management services (CCM), effective January 1, 2015. The final rule sets forth criteria for submitting claims to Medicare for CCM services and establishes a base reimbursement rate of $42.60 for such services. The provision of coverage for CCM services is an important corollary to the population management goals of accountable care organizations, and is consistent with various incentives established by the Affordable Care Act. While some questions remain unanswered, Medicare reimbursement for CCM services should greatly benefit the growing population of elderly patients with multiple comorbidities, many of whom depend on proactive care management, including remote monitoring, to avoid medical complications, hospitalization and unnecessary readmissions.

The final rule contains a number of criteria for billing CCM services, including the following: (1) over the course of a month, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional must be devoted to provision of the services; (2) the patient must have multiple chronic conditions that are expected to last at least 12 months, or until the death of the patient; (3) the chronic conditions must place the patient at significant risk of death, acute exacerbation/decompensation or functional decline; and (4) a comprehensive care plan must be established, implemented, revised or monitored. CCM services do not have to be provided face-to-face and include overseeing patient self-medication, ensuring receipt of all recommended preventative services, monitoring a patient’s conditions and reviewing data reported about the patient from a remote monitoring device.

Providers who are eligible to bill for CCM services include physicians, nurse practictioners, physician assistants, clinical nurse specialists and midwives. The CCM provider must: (1) use certified electronic health record technology (but need not qualify for meaningful use incentive payments); (2) create and regularly update a comprehensive electronic care plan for the patient that can be accessed by the care team, other providers who care for the patient, and the patient; (3) offer 24 hours per day, seven days per week access to care for chronic care needs; (4) provide continuity of practice and care management; (5) allow patients to communicate with the provider by phone and asynchronous consultation methods; (6) manage transitions of care within the health care system; and (7) coordinate with home and community-based clinical service providers. CMS will pay for only one provider to furnish CCM to the same patient in the same calendar month.

The patient receiving CCM services must be a Medicare beneficiary and must furnish the provider who is billing for the services, with written consent for the receipt of CCM services. The written consent must be documented in a certified electronic health record and must inform the patient of the following: (1) which CCM services are available; (2) how CCM services are accessed; (3) how patient information will be shared among providers and the care team; (4) that cost sharing applies to services even when they are not delivered face-to-face; (5) that consent to CCM services can be revoked by the patient at any time, effective at the end of the calendar month; and (6) that CMS will pay for the services of only one practitioner in each 30-day period.

There are still certain open questions regarding billing for CCM services. CMS has not provided a definitive list of chronic conditions that qualify a patient to receive the services. Similarly, CMS has not provided standards for evaluating how long the conditions are expected to last or whether the conditions place the patient at significant risk of death, acute exacerbation/decompensation or functional decline. Finally, as most patients with multiple chronic conditions have more than one physician but only one provider may bill for CCM services for a patient in a 30-day period, it is unclear how a patient’s providers will determine who will bill for CCM services. Over time, and with the issuance of manual instructions and medical review policies by CMS and its contractors, certain of these issues may be resolved.

http://www.lexology.com/library/detail.aspx?g=91893ef3-9e65-473e-b078-d2feabaed0e9

Take Two Apps And Call Me In The Morning

By Michael Grothaus

To help tackle depression among teens, Britain’s National Health Service wants to meet them on familiar territory: by prescribing them apps.

Depression is the most common type of mental illness, affecting some 350 million people globally and contributing to other problems like obesity, cardiovascular disease, and cancer. But it often goes undiagnosed, and once you know you suffer from it, sometimes the most difficult part of treatment is just being able to regularly sit down on a therapist's couch.

That’s why Britain’s National Health Service has begun encouraging doctors to prescribe people suffering from depression—and teenagers in particular—a thoroughly modern kind of treatment: apps.

Norman Lamb, Minister of State for Care and Support in the U.K., told The Times last week that treatment-by-app was a way of meeting teens on familiar ground.

"If you’re a teenager and your world revolves around digital access, we must make sure you get access to therapy online. So these programs are being developed."

Using Apps To Treat Teenage Depression

The initiative—which involves a doctor prescribing an app alongside medication or face-to-face therapy sessions—is meant, says Lamb, to achieve "a much more seamless service that allows you access online, face to face or over the telephone, whichever is appropriate."

After a diagnosis, a patient may still be given a course of medicine and offered face-to-face cognitive behavioral therapy sessions. But under the new program, the doctor also now has the option of medically prescribing an app to help with treatment.

One in 10 British patients are waiting for over a year to be assessed for mental health treatment, according to one study. One in six said they had attempted suicide while on an NHS waitlist.

While Britain's nationalized health system hasn't endorsed a single preferred mental health app, it already recommends a handful of apps that allow patients to assess their moods and set goals and reminders—for medication or therapy sessions—that can be sent via alerts or text messages.

Such tools can be helpful in encouraging patients who may be reluctant to attend face-to-face sessions due to shame or embarrassment, or as a stopgap measure, while patients are waiting for treatment—sometimes for over a year.

A recent report by the U.K. coalition of mental health charities We Need to Talk said that one in 10 patients are waiting for more than a year to be assessed for treatment like cognitive behavioral therapy. One in six—thousands of people across the U.K.—have attempted suicide while on an NHS waitlist for psychological treatment, the report said, and two-thirds said their condition had worsened before they had a chance to see a mental health professional.

Lamb has called these long wait times "unacceptable," and said the health agency would be implementing access and waiting time standards for mental health beginning next year.

The app initiative is part of a broader NHS effort to modernize and enhance youth mental health care in Britain, says Lamb, who has also urged doctors against putting patients on anti-depressants as a "sort of default position."

Though using apps as treatment may sound bizarre to older generations of patients and medical professionals, Lamb is quick to point out that there is firm evidence that app-based therapy has been proven to work in expanding access to treatment and to reducing costs.

A Wall, a Buddy, and Games

Click to expand

That proof comes from, among other places, a web-based and mobile app calledBig White Wall. The app, launched in 2007 by a British social entrepreneur named Jen Hyatt, is a hybrid of a social network and task manager for people suffering from depression and other mental health issues. The site allows users to post thoughts, drawings, and pictures in an anonymized forum that is moderated 24/7, and to advice from experts online, leave reviews of therapists, and take Internet-based cognitive behavioral therapy courses.

The site boasts impressive success rates in helping people deal with their psychological distress, noting that 75% of its members used the site to discuss a mental health issue for the first time in their lives. Eighty percent reported that Big White Wall helped them self-manage their psychological distress, and a staggering 95% of users reported one or more improvements in well-being, according to the company, which also cites peer-reviewed studies on its website. In May it launched a U.S. version.

READ MORE

How Do We Activate Engagement in Mental Health Patients?

Did you know?

The National Institute of Mental Health reports that 1 in 4 adults - approximately 57.7 million Americans - experience a mental health disorder in a given year – and less than half get help.

1 in 17 Americans live with a serious mental illness.

The World Health Organization has reported that 4 of the 10 leading causes of disability in the US and other developed countries are mental disorders. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.

The U.S. Surgeon General reports that 10% of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers.

Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives;

With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence.

The economic cost of untreated mental illness is more than $100 billion each year in the United States.

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population).

Anxiety disorders are highly treatable, yet only about 1/3 of those suffering receive treatment.

People with an anxiety disorder are 3 to 5 times more likely to go to the doctor and 6 times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.

What is Patient Activation and Why is it Important?

‘Patient activation’ is a widely recognized concept. It describes the knowledge, skills and confidence a person has in managing their own health and health care.

Highly activated patients are more likely to adopt healthy behavior, to have better clinical outcomes and lower rates of hospitalization, and to report higher levels of satisfaction with services.

People who have low levels of activation are less likely to play an active role in staying healthy. They are not very good at seeking help when they need it, at following their doctor’s advice or at managing their health. Their lack of confidence and their experience of failing to manage their health often means that they prefer not to think about it.

Patients with low activation levels are also more likely to seek treatment in emergency rooms, and are more likely to be hospitalized or to be re-admitted to hospital after being discharged.

Build Self-Efficacy to Activate Engagement

Self-efficacy pertains to an individual’s belief in their capacity to successfully learn and perform a specific behavior. A strong sense of self-efficacy leads to a feeling of control and to the willingness to take on (and persist with) new and difficult tasks.

When applied to health, this concept suggests that patients are empowered and motivated to manage their health problems when they feel confident about their ability to achieve their goal.

Improving Mental Health with mHealth Games

• Is your organization looking ways to educate, engage or assess your membership?

• Do you work with patients recovering from drug and alcohol dependence?

• Are you a provider looking for innovative ways to connect with your patients outside of the clinic?

• Are you an insurer on the health exchange in need of patient generated data?

• Is your health plan or hospital looking to improve quality or satisfaction scores?

If you answered yes to any of those questions - we can help!

Our virtual learning environments provide patients with free on demand access to disease education, self-assessments, games, simulations and interactions that build self-confidence and equip them with the knowledge and skills necessary to become an active partner in their health care.

Click on any picture below to play:

Crack the Case

Earn your Anger Detective Badge! Learn how to identify your triggers and create a personal strategy for dealing with an anger situation.

Motivating Change

Begin to think about aspects of motivation that govern behavior change. Lesson 1 of 4.

Beating Compulsive Behavior

What is a compulsive behavior? -- Anything that has more power over you than you have over it. Anything you do that you don't want to do, but can't seem to stop despite adverse consequences.

My Recovery Tools

Assessments, Prayers and Meditations to help you in your journey to recovery.

The Next Step Toward a Better Life

The first 30 days are often the hardest for those in recovery. Create a plan for success!

Alcoholics Anonymous

Discover the magic of AA: How it works, Steps, Traditions, and The Promises

For more games visit - www.mhealthgames.com