Primary Care and Behavioral Health (MH/SA) Integration Presented by: Kathleen Reynolds LMSW, ACSW [email protected].

Primary Care and Behavioral Health (MH/SA) Integration

Presented by:

Kathleen Reynolds LMSW, ACSW

[email protected]

# o

f P

eo

ple

Se

rve

d

(millio

ns

)

Federal/State Funding

(billions)

Current State of Federal Funding and Persons Served

(2007 OMB)

Community Mental Health

Community Primary Care

2

4

6

8

.5 1 1.5 2

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

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

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

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

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

Opportunities for Integration

• SBIRT Services• Medication Assisted Treatment• Local Integration Opportunities

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

Medication Assisted Treatment

• Expanding into primary care and into SA/MH organizations

• Support for prescribers in primary care • Assistance with protocols and management techniques

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

Resources:www.centerforintegratedhealthsolutions.org

email: [email protected]: 202.684.7457