Medicaid integration of physical and mental health has lessons for other providers

by Roy Edroso on Dec 27, 2017

Medicare's decision to reimburse providers for behavioral health integration (BHI) and Collaborative Care Management (CoCM) codes shows the feds want primary care providers (PCPs) to address mental health in Medicare. But some Medicaid programs have gotten there first, and can serve as a guide to how it can be done. 

Medicaid has become a frontline provider for mental health treatment in America. The Kaiser Family Foundation reports that Medicaid expansion under the ACA "has enabled many low-income individuals with mental health conditions to obtain coverage and access treatment."

One such case is Arizona's, on which the Commonwealth Fund has an interesting report: The state is using an ACA 1115 waiver, which allows states to use their Medicaid expansion funds in creative ways, to accelerate the merger of its Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS), and its behavioral health services agency, Department of Health Services’ Division of Behavioral Health Services (DBHS). The combined agency uses incentives to attract practices into an "integrated care" model in which screening and treatment of mental and behavioral issues are baked into patient intake and care.

"Typically Medicaid follows Medicare, but with the waivers Medicaid is really pushing innovation," says Shar Najafi, vice-president of behavioral health at Equality Health, a provider network and parent company of HealthBI (Health Business Intelligence Corp), a population health management technology company in Scottsdale, Ariz.

The Arizona Medicaid director actually proposed a one-year demonstration in October 2016, "but he extended it because so many practices asked for it" and it's now in the midst of a five-year plan, says Najafi.

As Najafi explains it, "basically any practice that wants to bring on behavioral health, and make [itself] a 'integrated clinic,' gets a 10% bump on some codes" from Medicaid. To qualify the practices have to comply with program policies and procedures, and meet physical space and staffing requirements.

According to research, Najafi tells us, between 60% and 90% individuals getting primary care also have a mental health issue. "Normally there's no screening in PCPs, so if they get [behavioral health] it would be in the acute setting, or going undetected till it becomes a crisis," she says.

Majafi gives an example of how the integrated clinics change that paradigm: "Let's say a member, [we'll call him] Joe Smith, is 45, a widower who just lost his wife, and he has episodes of depression. Say that his PCP now has a screening method for depression, substance abuse, anxiety, etc., and Joe tests positive for [a] mental health diagnosis. It's escalated to a medical assistant, and if the MA recommends 'urgent' intake, they phone an affiliated behavioral health organization. Our network has an immediate Access to Care model, so any urgent request can literally get him [behavioral health] intake within 48 hours rather than to the hospitals." 

Najafi sees this trend moving into Medicare and even private Medicare Advatage plans -- "I've talked with them, contracted with them; we discuss how to include behavioral health." It may be that your own care networks can make this model work for your practice.

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