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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.

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