Magazine article Behavioral Healthcare Executive

Global-Pay Model Aims to Fully Integrate Behavioral Health

Magazine article Behavioral Healthcare Executive

Global-Pay Model Aims to Fully Integrate Behavioral Health

Article excerpt

In western Colorado, community health workers are now providing non-medical support services such as grocery shopping or driving patients to physician appointments-tasks not reimbursed in a fee-for-service model, but beneficial for patients nonetheless. The new services are just a small example what's different about Medicaid Prime, a two-year pilot launched in September that replaces the traditional fee-for-service model with comprehensive, populationbased payments in seven participating counties.

Integrated care coupled with a global payment model has become a trend nationwide, and the Colorado participants expect to slow spending by 1.5 percent to 2 percent within two years over current Medicaid trends.

Behavioral health providers Mind Springs Health and Midwestern Colorado Mental Health Center are participating. Rocky Mountain Health Plans, a key local insurer is also onboard and serves as the regional care collaborative organization, providing risk based capital and bearing the insurance risk. The healthcare community has collectively assumed accountability for spending and will share in savings and downside losses. The effort is part of Colorado's Accountable Care Collaborative program, a Medicaid initiative to shift a portion of the program's fee-for-service population into an accountable care organization (ACO).

Under Medicaid Prime, Rocky Mountain Health Plans makes global payments to participating primary care practices and expects them to integrate behavioral health providers on their care teams.

"Behavioral health is critical for getting your arms around the total cost of health for any population, particularly the Medicaid population," says Patrick Gordon, associate vice president of Rocky Mountain.

Decades of managed care and disease management efforts by third parties that didn't integrate behavioral health failed to move the needle, he says. Reducing costs hinges on the ability to address patient needs outside the scope of traditional clinical services.

"We need to address the behavioral and social determinants of health outcomes and work as far upstream as possible and slow the progression of disease and disability," Gordon says. "We need to reduce the barriers to connect to people when they need it. …

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