induced cytokine production and its relationship to depression (Raison and Miller, 2003), as well as the pharmacological treatment of such depression in the presence of a complex drug regimen for the treatment of cancer and other comorbid conditions, is required. For such situations, in 2003 ABMS approved a new subspecialty in psychosomatic medicine to address “the high prevalence of psychiatric disorders in patients with medical, surgical, obstetrical and neurological conditions, particularly for patients with complex and/or chronic conditions (‘the complex medically ill’)” (Lyketsos et al., 2001:5). Although there were only 583 psychiatrists in the United States with certification in this subspecialty as of 2007,14 to the extent that these specialists are available in the community and the oncologist believes this expertise is needed to address the patient’s depression, failure of the patient’s health plan to allow these clinicians admittance to its network or otherwise provide reimbursement for their services can effectively deny the patient access to this care.

Additionally, some oncology providers wish to locate mental health care clinicians within their practices. Doing so facilitates collocated, integrated care—one of the recommended approaches for coordination of health care described in Chapters 4 and 5. However, if these practices’ mental health clinicians cannot receive reimbursement because they are not admitted to the insuring health plan’s network, this prevents integrated care and decreases access to mental health services for the patient. The Moffitt Cancer Center in Florida, for example, reports that some managed behavioral health plans will not reimburse staff mental health clinicians because they are not part of the plan’s network, but also will not allow them to become part of the network.15,16 Such problems with health plan networks are not explicitly addressed in leading accreditation standards for behavioral health plans.17 However, health plans need to consider expertise in the mental health treatment of patients with complex chronic diseases as an important competency of their provider panels. This is consistent with the findings and recommendations of other health care quality improvement initiatives (President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998; Shalala, 2000).

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14Personal communication, Jennifer Vollmer, American Board of Psychiatry and Neurology, September 4, 2007.

15Personal communication, Paul B. Jacobsen, PhD, Clinical Program Leader, Psychosocial and Palliative Care Program, Moffitt Cancer Center, April 6, 2007.

16The Rebecca and John Moores Cancer Center, University of California, San Diego, reports similar experiences, as described in Chapter 5.

17Personal communication, Kathleen C. Mudd, MBA, RN, Vice President, National Committee for Quality Assurance, April 4, 2007.



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