Nicole Truhe Dec 12, 2019
Caring for the whole person. That is the
guiding principle for why primary care services and behavioral health services
should be integrated in our health care system. Unfortunately, the funding for
these services, the service delivery, the service policies , and the education
and training of physical health and behavioral health providers are different.
At all levels, the systems designed to deliver primary care services and
behavioral health services were built separately and without
coordination.
The data that is emerging, driven largely by local
initiatives and pilots, there is strong evidence now that the integration of
behavioral health with physical health care “improves health care access,
minimizes stigma associated with seeking mental health services, increases
overall health outcomes, and lowers health care costs.”[1] This
movement to integration is particularly significant for the Medicaid system as
a large portion of the medical expenses in Medicaid are driven by behavioral
health needs. According to the Kaiser Family Foundation, more than 9 million
Medicaid beneficiaries had a mental illness and more than 3 million had a
substance use disorder in 2015.[2]
Policy is starting to catch up to the data and
evidence with an increasing amount of both federal and state legislation
recently introduced and/or signed into law that support integration. As of
January of this year, 30 states have integrated the financing of behavioral
health in their Medicaid managed care health plans.[3] As
states consider or implement integration, they should consider some
critical program design features
to ensure high quality services, improved outcomes, and sustainable programs.
1.
When integrating
delivery systems, states should include a comprehensive package of behavioral
health services to ensure the holistic mental health and substance use needs an
individual can be met.
2.
States should leverage
their Medicaid managed care organization partners in the management of these
integrated services.
3.
In addition to
integrating services at the health plan level, states should consider policies
that support provider integration such as same-day billing, integrated health
records, and cross-training of providers.
4.
States should remove
the barriers that exist between behavioral health and primary care
administrative systems, including licensing, information technology,
contracting, and eligibility, in order to fully support integrated
services.
As the movement to integrate behavioral health
and primary care continues, the next step is to incorporate
non-clinical or social needs into the delivery system to provide a truly
holistic, person-centered approach to care. If caring for the whole person is
our goal, considering a person’s head, heart, and home as part of our approach
to care should be the rule and not the exception.
References
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