Medicaid Redesign & the Integration of Care

Over two hundred people registered for a webinar hosted by the McSilver Institute and Dr. Peter Campanelli on Medicaid Redesign and the Affordable Care Act and their impact on mental health care delivery.  Keynote speaker, Dr. Robert Myers, Senior Deputy Commissioner & Division Director of Adult Services and Managed Care at the New York State Office of Mental Health provided us with an overview of the major opportunities on the horizon as a result of Medicaid Redesign. A main highlight from the webinar was the integration of primary and behavioral health care with health homes.  

 

Why integrate care? 

The prevalence of mental illness is higher than most people would expect – 1 in 4 adults has a diagnosable mental health disorder and 1 in 17 adults have a serious mental illness. Providing mental health care alone to those with a behavioral health condition is not enough because there is a large overlap in care needs among those with a behavioral health condition and those with a physical health condition. However, currently, the systems of care are separate from one another and thus, those with comorbid chronic illnesses do not always receive care that meets their complex needs. And when any aspect of care is neglected, the symptoms of one condition may exacerbate the symptoms of another. For example, Dr. Myers noted that “the symptoms and the functioning issues of a person’s mental health or substance abuse condition can have an impact on that person’s ability not to manage their physical health.”  

In addition to overlapping care needs, there are also cost concerns associated with separate systems of care. Even though individuals with both physical and behavioral health conditions are only a small fraction of the adult population, both state and nationwide, they account for a disproportionate amount of the health care expenditure due to hospital admissions and readmissions.

As such, the integration of care is an attempt to more adequately meet the health care needs of those with comorbid conditions and reduce the cost of care.

 

How will care be integrated? 

Health homes are one of the major initiatives put forth by the Affordable Care Act to integrate care and improve chronic disease management. They are a network of providers focused around care management and the provision of physical health, behavioral health and social support needs like income and housing stability. There are many benefits to being part of a health home for both mental health consumers and providers.

For providers, several advantages include being able to work within multidisciplinary teams of providers, having access to referrals, and “getting connected to the future as health homes are the network integrator on the ground moving forward.” Dr. Myers urged providers to approach health homes with the mindset of "not how you can join but what you can bring to the table” because behavioral health providers are already familiar with and proficient at many of the highly valued skills needed in working with consumers in a health homes setting such as engagement and motivation as well as providing case management, rehabilitation and recovery services, housing and employment assistance, and person-centered planning.

For consumers, the advantages are having a team of providers working together around their care. The team will help consumers to navigate the health care system in order to gain increased access to services and better care management that will meet their multiple needs. In addition, there is an emphasis on wellness and person-centered care. As such, consumers will be an integral member of the care team, making decisions with providers about what’s best for their health care needs. 

Click here to view a recording of the webinar.