primary care and behavioral health (mh/sa) integration presented by: kathleen reynolds lmsw, acsw...
TRANSCRIPT
Primary Care and Behavioral Health (MH/SA) Integration
Presented by:
Kathleen Reynolds LMSW, ACSW
# 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
