I want to bring your attention to an important report and contribution to the literature released today by The Commonwealth Fund (August 28) titled: State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment.
As we know, states across the country are working to advance integrated health care as part of their efforts to deliver what I call “Triple Aim” care (care that results in better outcomes, increased patient satisfaction, and cost effectiveness) to Medicaid beneficiaries with both physical and behavioral health conditions. The efforts to ensure that Medicaid beneficiaries have access to integrated health care, however, are challenged by the fragmented behavioral health system, administered and regulated by multiple state agencies (health, mental health, substance use, etc) and varying levels of local, county and state government, and by purchasing models that separate behavioral health services from other Medicaid-covered services.
Structures that govern state administration, regulation, and procurement have not kept up with emerging and best practices in the delivery of integrated health care to Medicaid recipients with both physical and behavioral health conditions. Systemic barriers remain: policy, program, practice and financing, just to name a few. Why should we disrupt the status quo? Turns out that persons with both physical and behavioral health conditions are among Medicaid’s most medically complex and costly cases. But beyond that, there are more effective ways of delivering care that result in better health outcomes! There is also a large body of evidence showing that patients have better health outcomes when both their physical and behavioral health needs are addressed together.
The report emphasizes there is no singular route through which all states will be able to achieve integrated behavioral and physical health care and that the best strategy (or combination of strategies) will depend largely on a state’s political climate, health care environment and political will. So true. The report concludes that regardless of the approach, states will succeed only with a cohesive framework with policies in place that enable health care providers to deliver high quality, integrated health care to Medicaid beneficiaries with both comorbid physical and behavioral health conditions.
Where does your state stand on this important health care reform issue? Is the political climate and health care environment in your state conducive to taking bold and necessary steps to transform the system to support integrated health care?