State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment

Abstract

States across the country are embracing integrated care delivery models as part of their efforts to deliver high-quality, costeffective care to Medicaid beneficiaries with comorbid physical and behavioral health needs. The Medicaid expansion authorized by the Affordable Care Act brings greater import to these efforts, as millions of previously uninsured low-income adults, many at increased risk for behavioral health conditions, gain coverage. State efforts to ensure that Medicaid beneficiaries have access to integrated care, however, are hindered by a fragmented behavioral health system that is administered and regulated by multiple state agencies and levels of government, and by purchasing models that segregate behavioral health services from other Medicaid-covered services. Drawing on a review of the literature and interviews with consumers, providers, payers, and policymakers, this report explores strategies states are deploying to address or eliminate system-level barriers to integrated care for this medically complex and high-cost Medicaid population. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts. Commonwealth Fund pub. 1767.

Evaluation of an Electronic Health Record (EHR) Tool for Integrated Behavioral Health in Primary Care

“…29–31 This momentum to change practice and policy is crucial because integrated care is specifically designed to identify and address patient medical and behavioral health care needs together and to improve quality, patient experience, and reduce costs. 4,6,32–35 …”

Using electronic health records to improve the physical healthcare of people with serious mental illnesses: A view from the front lines

“…While barriers to integration are numerous (Bachrach et al, 2014), it is clear that information sharing systems are going to be part of the solution towards promoting high quality, integrated care. In order to successfully establish, increase, and sustain integrated care for patients with SMI, a broader network of providers and community resources will have to be engaged, i.e.…”

“…From the patient ' s point of view, research suggests that patients tend to be willing to share their information (Kathol et al, 2010), and are aware of the potential benefi ts of exchanging and consolidating mental and medical health information (Woods et al, 2013). However, there appears to be signifi cant confusion among providers about what constitutes ' meaningful ' exchange of health data (Bachrach et al, 2014). ' Meaningful use ' is defi ned by the use of EHR technology in a meaningful manner (for example e-prescribing), i.e.…”

“…While these workaround are clearly just temporary solutions, more and more states are taking advantage of the opportunity to join HIEs in order to bypass any policy and legal barriers for information exchange between provider organizations (Bachrach et al, 2014).…”

“…In Medicaid-expanding states, many previously uninsured individuals with co-morbid mental health and medical conditions gained coverage. However, the continued fragmented delivery of behavioural health services, often administered by separate and non-coordinating state agencies, the non-adoption of Medicaid by many states, and the lack of fi nancial incentives for behavioural health agencies (Mechanic, 2014), continue to encumber efforts to improve health services for people with SMI (Bachrach et al, 2014). Although many statefunded agencies are struggling to move forward, there are some encouraging case studies of health systems and organizations that work hard to fi nd creative solutions for their patients.…”