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  • Integration (bidirectional) of behavioral health and public health is the cornerstone of Colorado’s transformation vision. (p. 55-78)
  • One Regional Coordinated Care Organization (RCCO) is integrating behavioral health and primary care in its global payment from Medicaid.
  • Moving primary care and behavioral health providers to teams to share patients. A lot of provider support to accomplish integration.
  • Recognizes essential contribution of public health to the “Health Extension System” aimed at supporting behavioral health integration.
  • Most of expected savings likely to come from behavioral health integration with chronic disease complex patients.

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  • Studying regulatory barriers to behavioral health/primary care integration. (p. 158)

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  • Primary care Graduate Medical Education (GME) changes to align with transformation.

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  • Behavioral Health/Primary Care integration is a focal point of Plan, with strategies to: increase primary care telemedicine consults with behavioral health, screening for depression, behavioral health policy analysis to develop further advances, co-locate behavioral health and Primary Care, Develop learning collaboratives. (p. 47)

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  • Provides for behavioral health integration in Patient Centered Medical Home (PCMH) with the goal of “10X10”: increase life expectancy of those with serious mental illness by 10 years in 10 years.

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  • Plan recommends behavioral health integration into primary care via Screening, Brief Intervention, and Referral to Treatment (SBIRT), adding types of behavioral health providers able to direct bill Medicaid, establishing a core set of behavioral health services that various providers could deliver, develop metrics for quality outcomes and shared savings in behavioral health.
  • Use peer mental health counselors.

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  • Plans to phase in behavioral health during phase 2 of 3. Behavioral health issue/barriers (pg. 53); Serious Emotional Disturbance (pg. 73)

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  • Behavioral Health integration into services of the Community Integrated Medical Home (CIMH), including in large practices the addition of onsite social workers and addiction counselors, is essential since over 50% of Maryland superutilizers have a behavioral health co-morbidity.
  • Analysis of behavioral health integration through the “Four Quadrant Clinical Integration Model,” (pg. 46).

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  • Behavioral health integrated into Patient Centered Medical Homes (PCMHs) and Accountable Systems of Care (pgs. 88-89)
  • Convened a " privacy work group to examine consent issues that will help facilitate appropriate information exchange between physical and behavioral health care providers." (pg. 118)

New Hampshire:
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  • "We plan to use this model as a means for incentivizing the provision of certain types of substance use disorders (SUD) treatment, as well as adding a broader array of this targeted care into the Life Plan itself. We recognize that incorporating screening for SUDs during the initial assessment phase for each of these populations (developmentally disabled, elderly, and behavioral health) is an important step to inform the individual’s Life Plan creation and its periodic updates. we also recognize the role of the Team Coordinator in this area. Specifically, we have identified a role for SUD treatment in both the training and evaluation components of the Team Coordinator function." (Pg. 43)

New York:
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  • Behavioral health integration (pg. 70) - The Collaborative Care approach aims to detect and manage common mental health conditions in primary care settings, with an initial focus on depression
  • This approach is widely recognized as best practice, including by the Substance Abuse and Mental Health Services Administration (SAMHSA). It has demonstrated improved outcomes for mental health and other chronic health conditions such as diabetes, hypertension, and high cholesterol. Savings, over time, principally accrue in reduced high intensity medical services, including emergency departments and inpatient medical care (i.e., not mental health services).
  • Advanced Primary Care (APC)' practices also identify and respond to the needs of patients who use alcohol and other drugs at risky levels, and engage in behavior associated with health consequences, disease, accident, and injury. They will use techniques like Screening, Brief Intervention and Referral to Treatment (SBIRT)
  • Integrated licensing program. (pg. 80)
  • Dual-eligible work. (pg. 80)

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  • Focusing on mental health and developmental disabilities populations (as well as long term services and supports (LTSS). Pursuing managed care model with dual population (integrated care delivery system (ICDS). The ICDS will address the fragmented nature of services offered through the two separate entities by taking a person-centered approach to care coordination and providing a single point of contact across both Medicare and Medicaid.
  • Launched severe and persistent mental illness (SPMI) medical homes in 5 counties – plan to roll model out statewide in 2014.

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  • Expand telemedicine – provide additional specialty consultation services in outpatient (telepsychiatry).
  • Transformation Support Center will provide support to primary care providers (PCPs) with identifying and coordinating referrals for mental health services.
  • Community-based Care Management Teams (pg. 77) - studies have indicated that many high utilizers have both physical and behavioral health co-morbidities. The diagnoses for many of the highest utilizers suggest that their conditions can be positively impacted by aggressive interventions. This is the target population that intensive care management programs have successfully impacted, resulting in reduced hospitalizations and emergency department visits.

Rhode Island:
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  • Intermediary services for high emergency department (ED) utilizers – Rhode Island Medicaid has implemented “Communities of Care” which identifies high end ED utilizers, offers a progressive array of case management services and tracks utilization. (pg. 65)
  • Effective, meaningful integration with other parts of the system of care resulting in improved health (pg. 66)
    1. Include behavioral health payments in coordinated and integrated payment models
    2. Co-location of behavioral health and primary care – use Screening, Brief Intervention, and Referral to Treatment (SBIRT) and co-locate primary care at community mental health centers (CMHCs).
    3. Community Health Teams

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  • Episode-Based Payments:
    • Wave 2: Wave 2 will expand episode-based payment to additional service lines (e.g., behavioral health, cardiology, and/or oncology). Payers are scheduled to begin reporting in July 2014; the initial performance period will begin in January 2015. Initial gain- and risk-share payments under the current plan will be made in April of 2016.
    • Wave 3: Wave 3a will accelerate the pace of episode introduction, with an emphasis on rapid introduction of reporting followed by a more moderate phase-in of episode-based payment. Wave 3a is scheduled to include an infusion of 16 episodes, including BPCI episodes and additional medical/behavioral health episodes. Payers will begin reporting on these episodes in January 2015. Over the following 18 months, payers will implement a phased rollout of performance periods for Wave 3a episodes. Wave 3b will consist of 3 episodes focused on LTSS and behavioral health. Payers will begin reporting in July 2015; the initial performance period will begin in January 2016.
    • Wave 4: Building on Wave 3a and further accelerating episode introduction, Wave 4a will consist of an infusion of 32 episodes, including BPCI episodes and additional medical/behavioral health episodes. The reporting period for Wave 4a will begin in January 2016, with performance periods rolled out over the following 18 months. Wave 4b will consist of 3 additional medical, behavioral health, and/or quality- and acuity-based episodes.

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  • "Model 1 EHR Adoption Incentive Program would target small, rural and behavioral health and LTSS providers.” (pg. 11)
  • Increase in behavioral health integration in existing and proposed initiatives. The innovation models are designed to have an impact on these outcomes for targeted populations, including people with chronic conditions, chronic conditions with behavioral health comorbidities and pregnant women (pg. 3)
  • Under the transformation of the Delivery System to Models of Patient‐centered Care, patients with a chronic condition and an accompanying behavioral health co-morbidity will receive high quality care that integrates and coordinates physical and behavioral health services based on their needs (pg.30)

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  • AIM 3 of Utah’s plan: To increase access to primary care and behavioral health
  • The goal is to provide these critical services to more Utahns through increased behavioral health screenings, training and use of interdisciplinary teams, and use of telehealth services.
  • Provide behavioral health services via telehealth services:
    • Working to address limited access to psychiatrists, a pilot project was created to improve access to pediatric mental health services in Utah. This early pilot project is known as GATE Utah, Giving Access to Everyone, a novel, web-based consultation model. Their goals are to improve access to mental health services for children and adults, improve collaboration between primary care physicians and mental health professionals, and enhance knowledge of how to manage mental health conditions in the primary care setting. As opposed to the traditional psychiatric clinic, GATE Utah believes they can influence the greatest number of people with the GATE Utah system by providing high quality care to families and children, while at the same time lowering costs and maintaining the majority of the treatment in the medical home.

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  • Supporting the integration of physical and behavioral health care at the delivery level through expanded data accessibility and resources, practice transformation support, increased workforce capabilities, and reduction of administrative and funding silos on a phased basis. More details on pg. 57
  • Restructure Medicaid procurement to support integrated physical and behavioral health care with links to community resources. (pg. 83)