Integrating Mental Health, Physical Health and Substance Use for low income Medi- Cal and Uninsured Populations in California ITUP Conference – Panel Discussion February 10, 2010 Mary Rainwater, L.C.S.W., Moderator Integrated Behavioral Health Project

What is Integrated Healthcare? the systematic coordination of physical and behavioral health care. “It allows patients to feel that, for almost any problem, they have come to the right place.” Alexander Blount The question is not whether to integrate, but how. Hogg Foundation for Mental Health

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Team based care Physician lead team; but, collective responsibility for ongoing care, including patient self-management Whole person orientation Care is coordinated/integrated Quality and safety Enhanced access to care Payment appropriate to model 4

3 “Models” Fully Integrated Model integrated care, under one roof, comprehensive PC and specialty BH services The Partnership Model focused partnership between full scope PC and specialty BH with clearly defined components and minimum standards The Linkage Model PC and Specialty BH separate but collaborate on shared clients 5

Focus on High Need/High Cost Enrollees –Ten percent of Medi-Cal beneficiaries account for 74 percent of the total program costs. Within this population, four percent account for 60 percent of the costs, according to a recent study by the Public Policy Institute of California. –Approximately 30 percent of Medi-Cal beneficiaries with disabilities have received treatment throughout the year for a mental health condition, while close to 9 percent are diagnosed with schizophrenia. These individuals are also far more costly than persons with disabilities who do not have a mental health condition. (Note: 49% prevalence rate for this group) Promote Organized Delivery Systems of Care in 4 Phases –Seniors and persons with disabilities and children and families in rural counties –Children with special health care needs –Dual-eligible beneficiaries –Adults with severe mental illness Note: All four priority groups include persons with MH/SU conditions CA 1115 Medi-Cal Waiver Concept Paper 6

Behavioral Health is now on the Health Policy Community’s “Radar Screen ” Morbidity and Mortality in People with Serious Mental Illness Persons with serious mental illness (SMI) are dying earlier than the general population (average age of death is 53) While suicide and injury account for about 30-40% of excess mortality, 60% of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases (NASMHPD, 2006) OR state study found that those with co-occurring MH/SU disorders were at greatest risk (45.1 years) 7

Behavioral Health is now on the Health Policy Community’s “Radar Screen ” 49% of Medicaid beneficiaries with disabilities have a psychiatric illness (this is new information ; previous studies that excluded pharmacy claims calculated the rate at 29%) Substance use conditions do not show up in this study at the expected levels because it’s based on an analysis of claims and pharmacy scripts The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions Center for Health Care Strategies, Inc., October

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