2014 STATE LEADERSHIP CONFERENCE
Because Kaiser can’t produce guidelines for all diagnoses,
it currently focuses on conditions with high volume or high
cost, significant practice variation and areas with multiple
treatments, including adult and teen depression, alcohol use
and serious mental illness.
Once created, added Bertagnolli, “the guidelines take a
tremendous amount of effort and upkeep” to ensure they’re up
• Public health system. For Evans, reducing variation is
also a key factor behind the city’s practice guidelines. “Payers
are under enormous fiscal pressures,” he said. “Because of
that, what we’re trying to do is reduce variability in practice
so we’re more likely to get the outcomes we want as a payer.”
That’s challenging when you consider the 200 providers that
serve the system’s 120,000 patients. “Some organizations
have highly trained individuals; others have people with high
school educations who have clinical responsibility,” he said.
The guidelines also support the system’s shift to a recovery
framework. Designed to give clinicians the information they
need to make that happen, the guidelines depend on three types
of information: empirical data, professional consensus and
the perspective of people with “lived experience” of behavioral
health problems. The guidelines lay out the system’s philosophy
of helping people have productive lives in the community;
values, such as promoting hope and letting patients and
families direct services; goals, such as focusing on strengths
and integrating services; and domains, such as recruitment
and retention in treatment, practices associated with improved
outcomes and connections to the next level of care.
“What we’re trying to do is create not an algorithm as much
as ‘Here are things you have to pay attention to as a provider,’”
said Evans. n
Rebecca A. Clay is a journalist in Washington, D.C.
Presenters from the workshop, “Clinical Practice Guidelines as Used in Health Care,” from left: Dr. Andrew Bertagnolli, principal
consultant-Integrated Behavioral Health Care Management Institute, Kaiser Permanente; Dr. Rhonda Robinson-Beale, chief medical
officer, external affairs, Optum, Behavioral Division; Dr. Raquel Halfond, project officer for APA Practice Directorate’s Practice
Research and Policy office; Dr. Arthur C. Evans Jr., commissioner, Philadelphia Department of Behavioral Health and Intellectual
DisAbility Services; and Dr. Lynn Bufka, APA’s assistant executive director for practice research and policy, APA Practice Directorate.