Sunday, January 6, 2013

Health Homes: Integrating Health Services

The Substance Abuse Mental Health Services Administration (SAMSHA) within HRSA has funded the Center for Integrated Health Solutions (CIHS) to promote the development of integrated primary and behavioral health services.

CIHS provides training and technical assistance to 94 community behavioral health organizations as well as to community health centers and other primary care and behavioral health organizations.

The newsletter “eSolutions” suggests using health homes to treat individuals with multiple chronic conditions since these individuals represent the system’s most costly and complex cases. In fact, 68 percent of people with a mental illness also may have cardiovascular disease, diabetes, and hypertension. These high-need individuals often receive uncoordinated, inefficient care, resulting in higher costs and poorer health outcomes.

To improve the situation, CIHS plans to increase the number of:

  • Individuals trained in specific behavioral health related practices
  • Organizations using integrated healthcare service delivery approaches
  • Consumers credentialed to provide behavioral health related practices
  • Model curriculums developed for bidirectional primary and behavioral health integrated practices
  • Health providers trained in the concepts of wellness and behavioral health recovery
The Affordable Care Act allows the Medicaid Health Home option to help states manage and improve care for beneficiaries experiencing two or more chronic conditions, including behavioral health disorders.

The Medicaid Health Home option is largely built on the Patient-Centered Medical Home (PCMH) which builds on the chronic care model, supports self management, sharing decision making, redesigning the delivery system, embedding clinical guidelines, and using client registries to organize data.

Under the “State Demonstrations to Integrate Care for Dual Eligible Individuals”, CMS selected 15 states to develop new ways to meet the healthcare needs for nine million Americans eligible for both Medicare and Medicaid including those with behavioral health needs.

In California, the Health Plan of San Mateo in close collaboration with SAMHSA’s Primary and Behavioral Health Care Integration (PBHCI) grantee San Mateo County Health Systems was selected for the state demonstration project which is now in the implementation phase. This program is working to eliminate duplication of services for dual eligible individuals, expand access to care, and lower costs.

Missouri and Rhode Island are two states with approved Medicaid health home State Plan Amendments (SPA) that place particular focus on addressing behavioral health needs and enable behavioral health providers to become health homes. Missouri had established 27 community mental health centers that have been designated as health homes and are now coordinating the full range of healthcare services for individuals eligible for health home services.

In states where behavioral health organizations are ineligible to serve as health homes, it is still possible to partner with a designated health home and help to share data, report on quality measures, and implement self-management training and support.

For more information, go to