• Some coverage is provided for Health and Behavior Intervention CPT codes
  • Managed care plans’ more flexible reimbursement also facilitates these services (see, e.g., AHIP, 2007)
  • Patient and family instruction/education in managing illness is provided for in E/M codes
  • Some telephonic case management or nurse support systems offered by some private insurers offer support
  • Administration on Aging grant program to states and local communities,Empowering Older People to Take More Control of Their Health through Evidence-Based Prevention, requires use of illness self-management
  • Large number of programs offered in the voluntary sector (see Chapter 3)
  • Employer programs and policies such as Employee Assistance Programs and leave policies, e.g., availability of extended leave of absence, flex time work hours, and unscheduled leave

a barrier to addressing psychosocial issues (Astin et al., 2006). Reimbursement policies could be structured in ways that would reward providers with the best performance in communicating with patients.

Policies Addressing the Identification of Psychosocial Needs

As discussed in Chapter 4, two general means are used to identify patients’ psychosocial needs reliably: screening for problems, followed by an assessment, or bypassing screening and conducting a more comprehensive assessment by itself. Given the brevity of several reliable and valid screening instruments (as discussed in Chapter 4) and the fact that many of these instruments can be self-administered by the patient (often in the waiting room prior to contact with the physician, also as discussed in Chapter 4), the resources required to administer such instruments may not be substantial, although following up on numerous, complex needs thus identified may be, as discussed below.

Screening

Although FFS Medicare generally does not pay explicitly and separately for screening services (except when coverage for a specific screening



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