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

History of Funding for Mental Health and Substance Abuse Services

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

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

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

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

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

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

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

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 2011. 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.

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 (http://www.pcpcc.net/)

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

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?

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

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

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

Local Initiatives Baltimore Learning Community with HRSA and SAMHSA

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

Questions?