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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.

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.

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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