Integrating Publicly-Financed Behavioral Health Care: Minnesota’s Developing Model


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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Glenace Edwall

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Integrating Publicly-Financed Behavioral Health Care: Minnesota’s Developing Model

  1. 1. Integrating Publicly-Financed Behavioral Health Care: Minnesota’s Developing Model National Academy for State Health Policy Denver, CO October 16, 2007
  2. 2. Minnesota Mental Health Action Group (MMHAG) <ul><li>Formed in 2003 as joint project of Minnesota Council of Health Plans and MN Department of Human Services </li></ul><ul><li>Convened and archived by Citizens League </li></ul><ul><li>Wide spectrum stakeholders: health plans and care systems, providers, advocates, consumers and families </li></ul>
  3. 3. MMHAG, continued <ul><li>3 generations of work groups on actionable issues in mental health system </li></ul><ul><li>By 2006, 2 priorities and corresponding champions: </li></ul><ul><ul><li>Creation of a funding model that is consistent across state and makes access as easy as possible; champion: DHS </li></ul></ul><ul><ul><li>Accountability and quality issues; champion: MN Council of Health Plans </li></ul></ul>
  4. 4. Integrated Care Background <ul><li>The case for integration: </li></ul><ul><li>Persons with SMI have numerous physical health problems that often go undiagnosed or untreated </li></ul><ul><ul><li>High rates of diabetes, hypertension, cardiac disease, obesity, cancers, HIV infection, hepatitis B and C </li></ul></ul><ul><ul><li>Increasingly serious implications for life expectancy: 25 years less than age cohorts </li></ul></ul>
  5. 5. Integrated Care Background <ul><li>Mental Health needs of children and adults with acute and chronic illness also underestimated and undertreated </li></ul><ul><ul><li>Adjustment disorders and depression are common concomitants of diabetes, cardiac illness, cancers and HIV infection </li></ul></ul><ul><ul><li>Children with special health care needs have elevated levels of depressed mood and suicidal ideation </li></ul></ul>
  6. 6. Integrated Care Background <ul><li>Most mental health care occurs in primary care, despite not often being identified as such </li></ul><ul><ul><li>10 most common problems that bring patients to primary care, including chest pain, fatigue, dizziness, headaches, back pain and insomnia, account for 40% of all primary care visits </li></ul></ul><ul><ul><li>In only 26% of these visits, though, can a biological cause for the complaint be confirmed </li></ul></ul><ul><ul><li>60% of psychotropic prescriptions for children in Minnesota Health Care Programs occurred without any other mental health service provided </li></ul></ul>
  7. 7. Integrated Care Background <ul><li>Primary care is particularly likely to be the only site in which mental health treatment is obtained for young children and for the elderly, as well as for those in rural areas (Task Force on Rural Mental Health and Primary Care, Office of Rural Health, MN Department of Health, 2005) </li></ul>
  8. 8. Integrated Care Background: Documents and Studies <ul><li>Bazelon Center for Mental Health Law (2004) identified integrated models to serve adults with SPMI: </li></ul><ul><ul><li>Primary care embedded in a mental health program </li></ul></ul><ul><ul><li>Unified programs </li></ul></ul><ul><ul><li>Co-location of mental health specialists within primary care </li></ul></ul><ul><ul><li>Collaborations between separate providers </li></ul></ul>
  9. 9. Integrated Care Background: Documents and Studies <ul><li>National Council for Community Behavioral Health Care (2003) Four-Quadrant Model </li></ul><ul><ul><li>Population segmentation defined by acuity of physical and mental health care needs </li></ul></ul><ul><ul><li>Care coordination is central, but may be differently located for sub-populations, led by area in which person faces most serious risks </li></ul></ul><ul><ul><li>Identifies needs for specific disease management, psychiatric consultation and connections to community resources </li></ul></ul>
  10. 10. Integrated Care Background: Documents and Studies <ul><li>Robert Wood Johnson-commissioned study (2007) of publicly-funded integrated service models. Common components: </li></ul><ul><ul><li>Clear conceptual framework </li></ul></ul><ul><ul><li>Use of communication tools and case management </li></ul></ul><ul><ul><li>Screening </li></ul></ul><ul><ul><li>Evidence-based algorithms and treatment approaches </li></ul></ul><ul><ul><li>Dedicated funding for start-up costs </li></ul></ul><ul><ul><li>Financial sustainability, including a funding stream for service coordination </li></ul></ul><ul><ul><li>Outcome measurement and evaluation </li></ul></ul>
  11. 11. MN Experience and Preparation for Integrated Care <ul><li>Minnesota Integrated Behavioral Health Care Network </li></ul><ul><ul><li>Voluntary association of state agencies, health plans and care systems involved in pilot projects of “shared” or integrated care </li></ul></ul><ul><li>ABCD II participation </li></ul><ul><ul><li>Pilots led to introduction of specific codes for developmental and mental health screening, and contract incentives for improving screening performance </li></ul></ul>
  12. 12. MN Experience and Preparation for Integrated Care <ul><li>Minnesota Health Care Programs inclusion of benefits for telehealth and psychiatric consultation to primary care (2005) </li></ul><ul><li>All efforts have crossed public and private sectors </li></ul>
  13. 13. 2007 Governor’s Mental Health Initiative <ul><li>(Adults): Equalizing mental health benefits across health care programs </li></ul><ul><li>(Children): Incorporating remaining intensive mental health services into capitation system: </li></ul><ul><ul><li>Children’s Residential Treatment </li></ul></ul><ul><ul><li>Case Management </li></ul></ul>
  14. 14. 2007 Governor’s Mental Health Initiative <ul><li>Authorization for 3 pilot projects to establish Preferred Integrated Networks (PINS) </li></ul><ul><ul><li>DHS will contract with health plan for product which </li></ul></ul><ul><ul><ul><li>Integrates physical and mental health care </li></ul></ul></ul><ul><ul><ul><li>Demonstrates coordination with local (county) social services for needed services and supports </li></ul></ul></ul>
  15. 15. 2007 Governor’s Mental Health Initiative <ul><li>Infrastructure Investments: targeted at closing service system gaps and/or offering critical services to under/uninsured: </li></ul><ul><ul><li>Provider rate increases </li></ul></ul><ul><ul><li>Crisis services </li></ul></ul><ul><ul><li>Expansion of culturally-specific providers </li></ul></ul><ul><ul><li>Respite care (children) </li></ul></ul><ul><ul><li>School linked services (children) </li></ul></ul><ul><ul><li>Early intervention services (children) </li></ul></ul><ul><ul><li>Housing supports (adults) </li></ul></ul>
  16. 16. Implementation: Challenges and Opportunities <ul><li>Multiple initiatives focused on case management/care coordination </li></ul><ul><ul><li>Expansion of Medical Home projects </li></ul></ul><ul><ul><li>FFS program initiatives: </li></ul></ul><ul><ul><ul><li>Contracted care coordination for high-utilization clients </li></ul></ul></ul><ul><ul><ul><li>Primary care clinic payments for care coordination </li></ul></ul></ul><ul><ul><ul><li>Demonstration projects for special populations </li></ul></ul></ul><ul><ul><li>Incorporation of care coordination in existing capitated products </li></ul></ul>
  17. 17. Implementation: Challenges and Opportunities <ul><li>Dual-eligible clients: Special Needs Plans as platform for mental health? </li></ul><ul><li>Roll-out of basic care product for persons of disabilities </li></ul>
  18. 18. Contact Information <ul><li>Glenace Edwall, Psy.D., Ph.D., LP, M.P.P. </li></ul><ul><li>Director, Children’s Mental Health Division </li></ul><ul><li>Minnesota Department of Human Services </li></ul><ul><li>P.O. Box 64985 </li></ul><ul><li>St. Paul, MN 55164-0985 </li></ul><ul><li>651.431.2326 (phone) </li></ul><ul><li>651.431.7418 (fax) </li></ul><ul><li>[email_address] </li></ul>