1. Primary Care and Behavioral Health (MH/SA) Integration Presented by: Kathleen Reynolds LMSW, ACSW kathyr@thenationalcouncil.org

3. 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

4. ARRA and ACA Funding Bureau or Primary Health Care ARRA Funding = $2 Billion + SAMHSA – $0 Bureau of Primary Health Care Patient Protection and Affordable Health Act = $11 Billion + SAMHSA - $50 Million

5. 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

6. The Role of Behavioral Health in an ACO Opportunity to define the role of behavioral health in the system Specialty mental health only Specialty substance abuse organization only? Specialty mental health + substance abuse + physical health Behavioral health (MH/SA) for all Other? Expand role of mental health/substance abuse in primary care Reduce stigma and increase access

7. Four Quadrant Model for Co-Occurring Disorders Quadrant III High SA/Low MH Quadrant IV High SA/High MH Quadrant I Low MH/Low SA Quadrant II High MH/Low SA Low Mental Illness High

9. Opportunities for Integration SBIRT Services Medication Assisted Treatment Local Integration Opportunities

10. SBIRT Screening What evidence based tool should be used? Brief Intervention Motivational Interviewing training Physician based interventions Referral Establish solid referral relationships with primary care Self help options Treatment Specialty treatment options

11. Medication Assisted Treatment Expanding into primary care and into SA/MH organizations Support for prescribers in primary care Assistance with protocols and management techniques

12. Local Integration Options Who are potential behavioral health partners? Who is positioning themselves to be an ACO? Methadone programs becoming primary care sites Business models Contractual relationship Merger Co-location Four quadrant model to guide discussions

13. Resources: www.centerforintegratedhealthsolutions.org email: integration@thenationalcouncil.org phone: 202.684.7457 www.centerforintegratedhealthsolutions.orgintegration@thenationalcouncil.org