TREATING THE WHOLE PERSON WHILE REDUCING COSTS: Practical Lessons from the California Integrated Behavioral Health Project Mary Rainwater, L.C.S.W. Project Director Altarum Institute Policy Roundtable July 21, 2010

OUTLINE: √ Brief Overview of Our Initiative √ Key Findings √ The “Business Case” – Quality and Cost Improvements √ The Challenges in Moving from Business Case to Policy and Financing Reforms

IN SUPPORT OF THE FIELD: IBHP BACKGROUND AND GOALS Launched in 2006 by the Tides Center and The California Endowment to accelerate the integration of behavioral health services at primary care community clinics throughout California Goals: * Improve behavioral health treatment access * Reduce stigma of seeking mental health services * Improve patient outcomes * Strengthen collaboration between mental health and primary care providers

BUILDING AND SUPPORTING CONNECTIONS ACROSS THE FIELD * Grants * Build and Support a Learning Community * Policy and Advocacy Work * Training and Technical Assistance * Partnerships and Collaborations

LESSONS LEARNED: Clinical: √ Higher Quality √ Improved Access Operational: √ Requires Customization √ Not One-Size-Fits-All Financial: √ Lower Health Care Costs

1115 MEDICAID WAIVER BEHAVIORAL HEALTH GROUP’S MENU Five Core Elements Care Management Data Management and Information Exchange Consumer Engagement Clear Designation of Person-Centered Health Care Home Performance Measures Five Domains to Track Best Practices Clinical Operational/Administrative Financial Oversight Population-Specific Considerations

INTEGRATED CARE’S BOTTOM LINE: Lower Overall Health Costs

6-STEP INTEGRATION GAME PLAN: √ Design Clinical Model √ Identify and Address Funding Barriers √ Craft Integration Budget √ Revise Business Processes and Obtain Necessary Approvals √ Design Implementation Plan √ Monitor and Adjust

IDENTIFY & ADDRESS FUNDING BARRIERS

ALIGNMENT OF CURRENT FUNDING

HEALTH CARE REFORM Three Components of Health Care Reform: √ Universal Coverage √ Delivery System Redesign √ Payment Reform

THE “BIG FIX”

CALIFORNIA’S PUZZLE

HEALTH CARE REFORM AND PARITY CHANGES EVERYTHING... …How services are organized …How mental illness/substance abuse are addressed …How mental health/substance abuse treatment are funded

THANK YOU Please visit for more information, tools and trainings. Contact Information: Mary Rainwater: References: “The Business Case for Integrated Care; Mental Health, Substance Use and Primary Care Services”, June 2010; Barb Mauer and Dale Jarvis, MCPP Healthcare Consulting “Paying for Integrated Services: FQHC, Medi-Cal and Other Funding Strategies”, June 24, 2010; Dale Jarvis, CPA, MCPP Healthcare Consulting