Improving Behavioral Health Services

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Integrating Behavioral and Primary Health

Friday, May 15, 2015

Behavioral health services—encompassing mental health and substance abuse services—are a critical need for Americans. People with behavioral health needs often also have physical ailments that add to the complexity and cost of their conditions.

Many state efforts to reform their health care delivery systems include strategies that integrate primary and behavioral health care—creating incentives that promote behavioral health prevention and the effective delivery of treatment. The speakers for this webinar discuss successful state models for integration, the challenge of implementing these models in rural America and the potential impact on Medicaid.

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  • Sarah Chouinard, M.D., Community Care of West Virginia
  • Miriam Komaromy, M.D., associate director, Project ECHO, medical director, Integrated Addictions and Psychiatry TeleECHO Clinic, University of New Mexico


In Focus: Integrating Behavioral Health and Primary Care
New payment models that reward providers for simultaneously improving health outcomes and reducing health care spending may provide an impetus for integrating behavioral health and primary care services. Such integration has long been recommended but has been difficult to achieve because restrictive payment methods and practice patterns have impeded collaboration.

Behavioral Health Integration: Approaches from the Field
Even without a direct source of reimbursement, several health systems, hospitals, and community health centers are working to integrate behavioral health services into primary and specialty care practices, emergency departments, and hospital units in an attempt to improve outcomes and reduce costs. The following profiles provide a snapshot of these efforts.

State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment
States across the country are promoting integrated care delivery as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with comorbid physical and behavioral health conditions. The Medicaid expansion authorized by the Affordable Care Act (ACA) brings greater import to these efforts, as millions of uninsured low-income adults, many at increased risk for behavioral health conditions, gain coverage and states are required to provide behavioral health services and meet federal parity laws. 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 diverse stakeholders, 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.

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