Bill Overview
Title: Mental and Physical Health Care Comorbidities Act of 2022
Description: This bill establishes a demonstration program to test hospital innovations that support low-income or uninsured individuals with serious mental and physical health comorbidities and to identify appropriate payment reforms under Medicare and Medicaid. Participating hospitals must (1) have a proportionally high number of Medicare or Medicaid patients, and (2) develop a plan and related quality metrics for innovations to provide coordinated care and address social determinants of health for individuals with serious mental illness or emotional disturbance and physical comorbidities (e.g., chronic conditions).
Sponsors: Rep. Boyle, Brendan F. [D-PA-2]
Target Audience
Population: Individuals with serious mental and physical comorbidities relying on low-income healthcare programs
Estimated Size: 4000000
- The bill targets individuals with serious mental and physical health comorbidities, such as chronic conditions coupled with serious mental illness or emotional disturbances.
- It specifies that these individuals are typically low-income or uninsured, leading to their reliance on programs like Medicare or Medicaid.
- The focus is on innovative care delivery and payment reforms for populations who struggle with multiple, simultaneous health challenges.
- Because the innovations and reforms are to be tested in hospitals, it is likely that the most direct impacted group will be individuals who receive regular care or hospitalizations.
Reasoning
- The target group consists of low-income or uninsured individuals with serious mental and physical health comorbidities, so interviews should include individuals with chronic physical conditions and mental health issues, specifically those on Medicaid and Medicare.
- Since the policy focuses on innovative care and payment reform, those who frequently interact with hospitals or need regular medical interventions are most susceptible to policy impacts.
- The cost and size of the program suggest that not all members of the target group can or will be reached immediately, and some may experience spillover benefits.
- The baseline and expected outcomes should be varied to reflect a range of current well-being and potential improvements, accounting for some who may not see an impact.
Simulated Interviews
Unemployed (Detroit, MI)
Age: 62 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- I keep getting bounced around between doctors who don't talk to each other. It's frustrating and exhausting.
- This program sounds like it could finally coordinate care better, which might really help someone like me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 2 |
Part-time laborer (Rural Alabama)
Age: 45 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- Healthcare right now is a juggling act of trying to get help for my heart and my mind.
- If the hospitals coordinate better care for folks like me, it could really lighten my load.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Freelance artist (San Francisco, CA)
Age: 33 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- I try to manage my pain and anxiety with minimal healthcare because it's so disjointed.
- This could potentially bring back some stability in receiving treatment if I am eligible again.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
Retail worker (Phoenix, AZ)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- Getting both my mental and physical health treated requires multiple appointments and lots of travel.
- This program might reduce the hassle if treatments are better coordinated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Student (New York, NY)
Age: 28 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- It is hard to balance school and frequent hospital visits, often affecting my studies.
- Coordinated care could really ease my stress and boost my academic performance.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Caregiver (Orlando, FL)
Age: 53 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 4/20
Statement of Opinion:
- I often feel like I'm playing medicine Tetris, trying to get everything lined up just to manage.
- If this act can help align my treatments, it would lift a huge burden from me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 7 | 2 |
| Year 20 | 6 | 2 |
Retired (Chicago, IL)
Age: 70 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- Healthcare feels like an uphill battle and it's tiring.
- This new approach to care might just keep me out of more hospitalizations.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 8 | 2 |
Homemaker (Dallas, TX)
Age: 39 | Gender: female
Wellbeing Before Policy: 2
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- It’s a constant struggle finding the right doctor who accepts my insurance.
- Centralized care as proposed might save me time and trouble, benefiting my children too.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 3 | 2 |
| Year 2 | 4 | 1 |
| Year 3 | 5 | 1 |
| Year 5 | 6 | 1 |
| Year 10 | 7 | 0 |
| Year 20 | 6 | 0 |
Retired teacher (Los Angeles, CA)
Age: 65 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 2/20
Statement of Opinion:
- While my healthcare is decent, better integration could still improve my quality of life.
- Knowing someone's keeping an eye on all my treatments would give me peace of mind.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Part-time consultant (Boston, MA)
Age: 60 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 15.0 years
Commonness: 3/20
Statement of Opinion:
- Juggling multiple appointments is hard without close family around.
- A program that supports me across the board feels overdue and welcome.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 2 |
| Year 5 | 6 | 2 |
| Year 10 | 6 | 1 |
| Year 20 | 5 | 1 |
Cost Estimates
Year 1: $75000000 (Low: $60000000, High: $90000000)
Year 2: $60000000 (Low: $50000000, High: $70000000)
Year 3: $60000000 (Low: $50000000, High: $70000000)
Year 5: $50000000 (Low: $40000000, High: $60000000)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- The policy focuses on hospitals with a high number of Medicare or Medicaid patients, meaning it's largely dependent on public healthcare funding.
- The success of the demonstration program will heavily depend on the ability of hospitals to effectively implement and sustain innovative care practices.
- There is potential for variability in cost and savings based on regional healthcare needs and the existing infrastructure of hospitals.
- Coordinated care for comorbidity patients has been shown to reduce long-term healthcare costs, though initial investments can be substantial.
- The integration of mental health care can significantly affect patient outcomes and consequent healthcare expenditure.