Behavioral Health

Problem: 

Health is more than physical: A truly person-centered approach to care must include behavioral health, focusing on the mental health, functional and social needs of individuals.

Traditionally, behavioral health is paid for as a separate benefit. The Affordable Care Act increased the focus on the importance of behavioral health.Treating behavioral health and physical health separately has resulted in poorer outcomes and higher costs; in contrast, the body of evidence supporting integration of behavioral health in the primary care setting continues to grow.[1],[2],[3]

Our Solutions: 

Addressing behavioral health requires community building, health system transformation and new models of payment. Through its various programs, RMHP links health care with services that address patients in a personalized way, and closes gaps around the social, behavioral, domestic and economic factors that increase costs and contribute to poor health outcomes.  

The Accountable Care Collaborative (ACC) is designed to support effective care management that integrates behavioral health. The RCCO provides data, expertise, organizational support and funding for primary care providers to coordinate care for Medicaid clients and work to better align clinical services with behavioral health providers, hospitals, specialists and human services.

Community Care Teams (CCTs) are an important aspect of this effort. CCTs meet individuals where they are --in their homes, in the community and among their peers-- and work to create a strong, out-of-the-medical-office relationship. CCTs have been established across RCCO Region 1 to extend the medical home model into the community, by connecting primary care providers with care coordination, social and behavioral health services. These teams may include social workers, behavioral health specialists and others. CCT members may be embedded in practice or they may rotate on a schedule through practices. They actively create a continuum with local community mental health centers when patients need more acute mental health and substance abuse interventions.

For targeted cohorts of patients, community health workers (CHWs) are also part of the team. Each of these non-medical health workers interacts closely with a small caseload of patients to connect them with needed services and help them make the behavioral changes required to become healthier. 

PRIME, launched in September 2014, is a two-year pilot designed to improve the health of individuals and the community while reducing costs and boosting efficiency. Integrated behavioral health with supporting payment reforms is the key to success in any program with full cost and performance accountability. Because PRIME uses population-based payments, providers are not confined to the traditional 10-15-minute patient visit – and to encounter-based processes overall, in providing care for empaneled patients. They are free to be more deeply involved in providing care to the whole person, including behavioral health care and supporting community services. 

Medicaid PRIME builds upon the Community Care Teams and community health worker resources established within the ACC framework, described above. 

Partnering with Rocky Mountain Health Plans as a learning laboratory, the Colorado Health Foundation selected three pilots and three controls from the Grand Junction area to test a global payment model for sustaining integrated behavioral health care. That model--Financially Sustaining Integrated Behavioral Health and Primary Care: Testing a Global Payment Model-- is also called “SHAPE” (“Sustaining Healthcare Across integrated Primary care Efforts”).

SHAPE re-envisions the role of behavioral health in primary care and changes how it is reimbursed. Practices that, on their own initiative, have taken steps toward behavioral health integration are provided with a reliable source of funding to let them move forward. The project has three primary aims: 

  • test a different payment method to financially support and sustain behavioral health in primary care; 
  • better understand the costs associated with integration and a global payment methodology for behavioral health and primary care; and
  • inform policy. 

The goal is to improve care for the long term, and changing payment models can accomplish that. As with PRIME, this approach to payment releases patients and doctors from the 10- to 15-minute patient visit and supports integrated, coordinated, person-centered care.

Behavioral health integration is one element included in CPC+’s focus on comprehensive primary care and care coordination. Practices can choose one of two foundational strategies:

  • Care management for mental illnesses treated in primary care
  • Including a primary care behaviorist in the clinic to provide mental health treatment

For more information about the role of behavioral health in CPC+, visit https://innovation.cms.gov/Files/x/cpcplus-bhinteg-options.pdf

 

The Colorado State Innovation Model (SIM) is an initiative funded by the Center for Medicare & Medicaid Services (CMS). The goal is to improve the health of Coloradans by increasing access to integrated physical and behavioral healthcare services in coordinated systems and encouraging SIM practices to test value-based payment structures. With three cohorts over five years, the initiative aims to work with 400 primary care practices and four community mental health centers. RMHP serves as a Practice Transformation Organization (PTO) for SIM practices on the Western Slope and provided coaching support related to quality improvement and health IT. In addition, the SIM program includes collaboration with regional health connectors and local public health agencies to coordinate multiple types of services needed to promote health and wellbeing.

Visit http://www.practiceinnovationco.org/sim or the State website https://www.colorado.gov/healthinnovation for more information about the SIM program.

The CO-EARTH program represents a collaborative effort between St. Mary’s Family Medicine Residency, RMHP, the Caring for Colorado Foundation, and the University of Colorado Department of Family Medicine. The program is designed to offer three levels of training and support uniquely tailored to the needs of primary care practices to enhance patients’ access to behavioral health services. Practices of any size from rural communities or smaller practices from urban communities are encouraged to apply and determine how best to meet their patients’ behavioral health needs:

  • Enhancing coordination with community mental health centers and local mental health providers
  • Co-locating a behavioral health provider on-site at the clinic
  • Integrating a behavioral health provider in the primary care clinic’s team

An additional benefit of the CO-EARTH program includes its ability to pair participating practices for rural rotations with family practice resident physicians who have been trained in integrated care processes. This opportunity aims to strengthen the primary care workforce in Western Colorado. RMHP partners with CO-EARTH staff in providing quality improvement coaching to develop sustainable models of practice transformation to support CO-EARTH aims.

 

[1] Butler M, Kane RL, McAlpine D, Kathol, RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Mental Health/Substance Abuse and Primary Care No. 173. AHRQ Publication No. 09-E003. Rockville, MD. Agency for Healthcare Research and Quality. October 2008.

[2] Goddell S, Druss B, Reisinger Walker E. Mental Disorders and Medical Comorbidity, Robert Wood Johnson Foundation, Policy Brief, 2011.

[3] Kathol RG, Butler M, McAlpine D, Kane RL. Barriers to Physical and Mental Condition Integrated Service Delivery. Psychosomatic Medicine. July/August 2010 72:511‐518.