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Impact of Physical/Behavioral Healthcare Integration

The American Psychiatric Association (APA) recently released a report prepared for them by Milliman, Inc., entitled, “Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry”.  The analysis provided in the report summarizes by payor (Commercial, Medicare, Medicaid) the elevated levels of MedicalSymbolhealthcare costs related to beneficiaries who have chronic medical and behavioral comorbidities. Based on the outcomes of several recent integration projects, the actuaries estimate the portion of the elevated healthcare costs that can be controlled through such programs. The report is interesting with its detailed, claims based analysis of costs, its methodology for conducting the analysis, and for producing per member per cost data by payor for enrollees with no behavioral health services, those with non-SPMI behavioral health, those with SPMI, and those with substance use disorders.

Themes from Innovative Complex Care Management Programs

solutionIn many regions across the country, robust “super-utilizer” programs providing intensive outpatient care management to high-need, high-cost patients are beginning to emerge. The term “super-utilizer” describes individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health care system. As a result, these individuals often bounce from emergency department to emergency department, from inpatient admission to readmission or institutionalization—all costly, chaotic, and ineffective ways to provide care and improve patient outcomes.

The Center for Health Care Strategies (CHCS), in partnership with the National Governors Association, hosted a Super-Utilizer Summit on February 11 and 12, 2013. The Summit brought together leaders from super-utilizer programs across the country, states, the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation (RWJF) Aligning Forces for Quality (AF4Q) alliances, health plans, and other key stakeholders to share strategies for changing how our health care system interacts with these high-need, high-cost patients.

This report presents the Summit’s common themes and key recommendations for building better systems of care for high utilizers. The appendices also include materials related to existing complex care management programs that can be educational resources for states and policy-makers considering ways to implement, spread, and sustain such programs.SuperUtilizersSummitReport 2013

Emerging Models of Integrated Care Coordination

As behavioral health providers strategize on where they can fit in healthcare reform, I see care coordination as an obvious role where many providers could thrive. Central to healthcare reform is improved coordination and navigation of the complex healthcare delivery system to ensure whole-person, whole-life prevention, early intervention, supports, and care. Some of the models for care coordination read like good old fashion social work, while other more intensive models sound like modified ACT teams.

Sure, to really excel at this “new” care coordination, behavioral health providers will need to makes some changes but bottom line, this work should be in the wheelhouse of behavioral health core competencies. Likely behavioral health provider development needs include:
~ Shift of staff resources from “therapies” to care coordination
~ Robust training, development, and supervision in medical management
~ Effective partnering with primary care organizations
~ State of the art care coordination data management system

The Institute for Healthcare Innovations published a white paper in 2011 IHICareCoordinationModelWhitePaper2011 which provides a great overview of successful care coordination models.

NM 1115 Waiver Re-Submitted

The New Mexico Human Service Department re-submitted its Medicaid 1115 Waiver on August 17, 2012 reflecting changes based on the recently completed series of public comment opportunities. The waiver continues to plan for an expected “go live” of January 1, 2014. Largely consistent with the Centennial Care Concept Paper released early this year, the waiver represents an ambitious model of integration of the management of physical, behavioral, and long term services. The HSD request for proposals to select the vendors to manage the integrated program is anticipated to be released around September 1, 2012.

Summary of Health Home SPAs (Section 2703)

By the end of June, CMS had approved 8 health home SPAs (Section 2703) in 6 states–IA, MO, NY, NC, OR and RI. While all include persons with serious mental illness, the other provisions related to enrollment, provider types and reimbursement structures vary widely across states. The link below provides an excellent summary of each state’s waiver(s). As implementation of these health home models progress, it will be fascinating to watch the operational details and client impact develop in each state.

New Mexico Medicaid Modernization

New Mexico has released a Concept Paper describing “Centennial Care”, the framework for ambitious changes to Medicaid. Built on the values of health care integration, it seeks to combine up to 12 existing Medicaid waivers into one 1115 Demonstration Waiver. In addition it would integrate long term care, physical care, and behavioral healthcare, all of which would be administered and managed by 3-5 managed care organizations. Building upon their experience with a single statewide managed care entity for the management of Medicaid and non-Medicaid behavioral health services, New Mexico has set forth a vision that while integrating behavioral health, affords specific protections to ensure that any savings from behavioral health are not shifted elsewhere. The state intends to release their draft 1115 waiver application soon in order to stay on track with an expected “go live” date of October, 2013.

NCCBH Receives HHS Primary Integration Grant

HHS Awards $26.2 Million in Grants to Expand Primary Care Services for Individuals with Behavioral Health Disorders: On September 24, HHS awarded $26.2 million in grants to improve primary care services for individuals with behavioral health disorders. To integrate primary care intobehavioral health services, HHS awarded four-year grants of up to $2 million to 43 community behavioral health agencies. The remaining $5.3 million went to the National Council for Community Behavioral Healthcare (NCCBH) to establish a national resource center to foster the integration of primary and behavioral health care services at the community level. Financed jointly by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Health Resources Services Administration, the center will offer training and technical assistance to community-based behavioral health programs and develop models of integrated care.

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