1. Health Care Reform: Opportunities and Challenges for Behavioral Health and Primary Care Integration
Presented by:
Kathleen Reynolds, LMSW, ACSW
Vice President for Health Integration and Wellness

2. History of Funding for Mental Health and Substance Abuse Services

3. What Created the U Turn?
The Impact of Block Grants on Mental Health and Substance Abuse Funding
During Regan Administration funding went to block grants to the states
Good at the time
Little if any increase to mental health or substance abuse block grants since

4. Movement to Medicaid as a Source of Funding for Mental Health
Substance abuse not included
Created entitlement to services for some who are Medicaid eligible
Less funding for persons without Medicaid

5. ARRA and Health Care Act Funding
Bureau or Primary Health Care ARRA Funding = $2 Billion +
SAMHSA – Did not ask for any
Bureau of Primary Health Care Patient Protection and Affordable Health Act = $11 Billion +
SAMHSA - $50 Million

6. Patient Protection and Affordable Health Care Act
Medicaid Expansion
Parity
Accountable Care Organizations
Medicaid/Medicare Medical Home Pilots

7. Accountable Care Organizations
An ACO would have at least one hospital, a minimum of 50 physicians (primary care and specialists), commit to be in business for at least 3-5 years, and serve at least 5,000 patients. If the ACO met pre-established quality goals, it would receive an incentive payment. Penalties would be assessed if care did not meet the established quality goals. Incentive payments and penalties would be split between the members of the ACO. The providers in the ACO would follow best practices, be patient-centered and contribute to the development of best clinical practices to build standards of evidenced-based medicine

8. Behavioral Health Role in an ACO
Opportunity to define the role of behavioral health in the system
Specialty mental health only
Specialty mental health + physical health
Mental health for all
Other?
Expand role of mental health substance abuse role in primary care
Reduce stigma and increase access

9. Behavioral Health Role in ACO
Challenge to determine who will be the ACO in your area
Challenge to establish your position in the system if not already there
Important role for advocacy in the process

10. Medicaid/Medicare Medical Home Pilots
The Medicaid Medical Home pilots allow states to enroll Medicaid beneficiaries with chronic conditions in medical home pilot projects as early as January This includes individuals with serious and persistent mental illnesses. Up to $25 million is available for states to plan and implement these projects.
Beginning in January 2012 Medicare can establish a pilot program that includes community health teams to increase access to comprehensive, community-based, coordinated care.

11. Medical Home Definition
While definitions of medical homes vary, the most widely accepted definition, supported by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and the American Osteopathic Association, includes the following principles;
Personal physician
Physician directed medical practice (team care that collectively takes responsibility for the ongoing care of patients)
Whole person orientation
Care that is coordinated and/or integrated
Quality and safety (including evidence based care, use of information technology and performance measurement/quality improvement)
Enhanced access to care
Payment structure that reflects these characteristics beyond the current encounter-based reimbursement mechanisms (

12. Medical Homes & Behavioral Health - Opportunities
Need to insure that “medical” home includes mental health and substance abuse services
Get services to more people, earlier
Reduce stigma
As part of health care, reduce “stepchild” phenomena
Improve access to primary care

13. Medical Homes & Behavioral Health - Challenges
Insure that psycho-social treatment, case management and other key services get integrated into the model
Insure that those with the most severe issues do not get lost in the system
Where will the volume of new eligibles go?

14. Integration as Part of the Strategy
Integration does not mean return to a medical model
Provides access to multiple services at one time and place
Improves the quality of all services
Creates space within the current public sector for more consumers
Ultimately reduce the early loss of life for those with a serious and persistent mental illness

16. Bi-Directional Integration
BH in PC
Do it yourself
Work with private partner
Work with FQHC
PC in BH
Do it yourself
Work with private partner
Work with FQHC

18. Health Navigators
Monitoring health issues such as diabetes, COPD and heart disease during regular “case management”
Addressing “personal” health issues with case managers
Registries
Link health work to productivity and culture

19. Local Initiatives
Baltimore Learning Community with HRSA and SAMHSA

20. National Training and Technical Assistance Center for PCBHI
Awarded to the National Council for Community Behavioral HealthCare
Four years; $5.3 Million/year
Target Audience
SAMHSA Grantees
HRSA Grantees
General Public
Services
Training and Technical Assistance
Knowledge Development
Prevention and Wellness
Workforce Development
Health Reform Monitoring and Updates

21. Questions?