Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model

Abstract

Objective: Behavioral health home (BHH) models have been developed to integrate physical and mental health care and address medical comorbidities for individuals with serious mental illnesses (SMIs). Previous studies identified population health management capacity and coordination with primary care providers (PCPs) as key barriers to BHH implementation. This study examines the BHH leaders’ perceptions of and organizational capacity to conduct these functions within the community mental health programs implementing BHHs in Maryland. Methods: Interviews and surveys were conducted with 72 implementation leaders and 627 front-line staff from 46 of the 48 Maryland BHH programs. In-depth coding of the population health management and primary care coordination themes identified sub-themes related to these topics. Results: BHH staff described cultures supportive of evidence-based practices, but limited ability to effectively perform population health management or primary care coordination. Tension between population health management and direct, clinical care, lack of experience, and state regulations for service delivery were identified as key challenges for population health management. Engaging PCPs was the primary barrier to care coordination. Health information technology (HIT) and staffing were barriers to both functions. Conclusions: BHHs face a number of barriers to effective implementation of core program elements. To improve programs’ ability to conduct effective population health management and care coordination and meaningfully impact health outcomes for individuals with SMI, multiple strategies are needed, including formalized protocols, training for staff, changes to financing mechanisms, and HIT improvements.

Behavioral health home impact on transitional care and readmissions among adults with serious mental illness

“…Qualitative data and surveys have shown that BHH staff value the access they have gained through the program to the state's health information exchange (HIE). 8,9 The state's HIE notifies the BHH when one of their enrollees experiences an emergency department visit or hospitalization. 8,9 With this tool, BHHs can initiate contact with hospital staff to facilitate a smoother discharge plan.…”

“…8,9 The state's HIE notifies the BHH when one of their enrollees experiences an emergency department visit or hospitalization. 8,9 With this tool, BHHs can initiate contact with hospital staff to facilitate a smoother discharge plan. BHH staff also reported investing in developing stronger relationships with hospital staff in charge of discharge planning and care coordination so that they could respond effectively when their enrollees were hospitalized.…”

“…With this tool, BHHs can initiate contact with hospital staff to facilitate a smoother discharge plan. BHH staff also reported investing in developing stronger relationships with hospital staff in charge of discharge planning and care coordination so that they could respond effectively when their enrollees were hospitalized 8,9 . Given Maryland BHHs’ location in psychiatric rehabilitation programs, which often have frequent contact (eg, multiple contacts per week) with enrollees, this model may be better suited than BHHs located in organizations with less frequent contact with enrollees to follow up quickly after a hospitalization.…”

“…In a sensitivity analysis excluding dually eligible enrollees, results were similar (Tables ). Finally, effects of BHHs are likely moderated by the extent to which programs were able to implement the BHH model successfully, sustain its core elements, and meaningfully integrate services 8,9,11,38 . Future research should explore how implementation characteristics modify the effect of the BHH exposure on outcomes.…”

“…Research to date suggests that BHHs face implementation challenges and that effects on care utilization and quality have been modest. [7][8][9][10] Maryland, one of the participating states, has a unique model that locates BHHs within psychiatric rehabilitation programs, which also coordinate behavioral and social services, and provide programming to support independent living in the community. The Maryland model includes a nurse care manager who is responsible for delivering health home services, which include somatic care coordination and management, transitional care, health promotion, referrals, and individual and family support.…”