e-Solutions June 2015
eSolutions: June 2015
Feature article: How Are States Paving the Way for (Thriving) Integrated Care
Grantee Feature: Staking a Claim in State Planning: Regional Mental Health Center
Quick Tips: How to Keep Up with State Integration Initiatives
Featured resource: NASHP brief
Based on an interview with Kitty Purington, Program Manager, National Academy for State Health Policy
The Affordable Care Act has prompted many states to take a new look at payment design and system delivery. As states take a dive into redesigning policies and payments, there are many opportunities to ensure new policies support successful integrated primary and behavioral health care delivery.
Integrated primary and behavioral health care aligns with the ACA’s triple aim – improved outcomes, cost containment, and enhanced patient care.
What changes are happening at the state level?
Many states are taking a multifaceted approach to supporting integration efforts, both building and capitalizing on existing initiatives and pursuing new changes.
Through the State Innovation Models (SIM) Initiative, funded by the Centers for Medicare and Medicaid Services (CMS), states get financial and technical support for developing state-led, multipayer health care payment and service delivery models for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. Many of the states awarded these grants focus on improving population health through integrated care. Minnesota uses the award to build accountable communities for health through accountable care organization-style contracts to coordinate care.
Other states take different approaches to supporting integrated care.
- In Vermont, the Blueprint for Health supports primary care practices in acquiring recognition as patient-centered medical homes and operating effectively as one.
- The Kentucky legislature passed a law permitting physical health delivery in mental health settings.
- Maine amended the Mental Health Confidentiality Act to allow disclosure of mental health information for care coordination and planning.
- Arizona’s regional behavioral health authorities promote integrated behavioral health and primary care, particularly among individuals served by Medicaid, in coordination with the Department of Health Services/Division of Behavioral Health Services and the Arizona Health Care Cost Containment System. The department also revised licensing rules for health care facilities to allow for a range of facilities, including outpatient treatment centers, to be able to provide both physical and behavioral health services under a single license.
How can integrated care providers be involved in changes?
While states work to make these kinds of changes, often rapidly, providers must stay informed and understand how certain initiatives impact the delivery of integrated primary and behavioral health care.
To ensure efforts are accurate and structures exist to support them, providers – organizations involved in the day-to-day delivery and reality of integrated care – should be part of the process. Providers can only bring attention to potential challenges and barriers to proposed policies and procedures when they engage in the conversation with state officials, legislators and other decision makers.
Providers can also engage with unlikely partners, like criminal justice agencies and schools, to identify common goals and the biggest opportunities for change. Serving the whole health of an individual also involves collaboration with community supports and it is important to understand the perspectives and needs of these organizations.
What is happening in your state? Check out this map from the Integrated Care Resource Center.
Based on an interview with John Kern, MD, Chief Medical Officer, Regional Mental Health Center
Nationwide, state changes to health care are occurring rapidly. Providers have critical insight into what policies and regulations can be established as the states deliver integrated primary and behavioral health care.
The Indiana Family and Social Services Administration (FSSA) launched a 2012 initiative in partnership with the Indiana State Department of Health (ISDH) to develop a statewide strategic plan to integrate primary and behavioral health care services and the Regional Mental Health Center, a SAMHSA Primary and Behavioral Health Care Integration (PBHCI) grantee in Merrillville, Indiana, was a key partner.
The Indiana Primary Care Behavioral Health Integration Initiative is a statewide effort to promote the development and implementation of bidirectional integrated primary and behavioral care. The initiative provides advice and counsel to FSSA and ISDH and includes a breadth of provider types involved with the delivery of integrated care: community mental health centers, federally qualified health centers (FQHCs), rural health clinics (RHCs), and community health centers (CHCs). They are working to define quality, desired outcomes, and financing mechanisms such as the services that would qualify for payments and the appropriate, sustainable cost for services. The group grew organically out of a common need for primary care, behavioral health and other community partners to understand each other’s needs for integrated care to work and to identify opportunities for change. The initiative is comprised of stakeholders representing all spectra of care—behavioral health providers (many of which are PBHCI grantees), FQHCs, CHCs, RHCs, consumers, trade associations, and other advocates. The group meets bimonthly to discuss goals and barriers for integrated care across the state.
Supporting real change
The initiative established six subcommittees that align with the project’s objectives—policy, funding, data/technology, workforce development, quality assurance, and future opportunities. Each subcommittee examines the group’s identified goals and barriers related to the objective area, and then works to identify potential practical solutions to overcome the barriers. Through this collaborative approach to problem solving, the subcommittees established billing codes for integrated primary care and behavioral health services.
FSSA was also awarded a Transformation Transfer Initiative (TTI) Grant from SAMHSA and the National Association of State Mental Health Program Directors (NASHMHPD), which allowed the state to hire a full-time coordinator of statewide integration efforts and who then completed a statewide integration survey, offered training for community health workers and certified recovery specialists, and established a process for community health worker certification.
Having a seat at the table
Through continual participation in the meetings, the Regional Mental Health Center lends a vital provider voice to the initiative. Offering this continual perspective is important to ensuring the group continues to learn from each other and to make change possible.
How do you stay connected to decision makers in integration across your state? Let us know, email Integration@theNationalCouncil.org.
How can you stay informed and engaged with state decision-makers to support integrated care? Here are some tips to help you get started.
- Stay up to date on current state legislation. View resources for your state from CMS’ Integrated Care Resource Center, which provides information on state integration activities related to Medicare and Medicaid.
- Be ready to demonstrate the value of integrated care with evidence, examples, and models. Check out CIHS’ Integrated Care model webpage for resources.
- Look for opportunities to engage with unlikely partners like advocacy groups and educational institutions.
- Be vocal about your needs and your concerns. Keep in touch with decision makers (including insurers and other stakeholders) and look for opportunities to share both the successes and the needs of integrated care providers.
Learn how other providers, including PBHCI grantees, share information about their integrated care models.
Promoting Physical and Behavioral Health Integration: Considerations for Aligning Federal and State Policy, a brief from the National Academy for State Health Policy, shares key lessons and opportunities for federal and state policy alignment on integrated care. The brief features different payment models, data sharing approaches, and operational strategies for achieving integration.
SAMHSA’s four-part webinar series, Addressing Serious Mental Illness (SMI): Effective Prevention, Treatment and Recovery Strategies will describe new and emerging practices to effectively address serious mental illness across a variety of settings.
HHS’ EvidenceNOW initiative awarded $112 million to primary care professionals in 12 states to incorporate best practices for cardiovascular prevention and to improve heart health.
SAMHSA is accepting applications for state planning grants for Certified Community Behavioral Health Clinics (CCBHCs). The purpose of this program is to support comprehensive and coordinated care as states certify clinics as CCBHCs, establish prospective payment systems (through CMS), and prepare to participate in a two year demonstration program.
The National LGBT Health Education Center developed learning modules to help clinicians and other health care professionals improve the quality of health care for lesbian, gay, bisexual, and transgender (LGBT) people. Continuing education credit is available.
SAMHSA released a new report on Medicaid spending information for the treatment of mental illness and substance use disorders as well as those dually enrolled in Medicare and Medicaid.