Magazine article Behavioral Healthcare Executive

The Future

Magazine article Behavioral Healthcare Executive

The Future

Article excerpt

Planning for the future is no small task. Behavioral health executives are chipping away at long-term visions, such as integration, operationalization and new technology application. Individual organizations are seeking to build out not just limited projects but foundational infrastructure across their enterprises in the next three to five years.


One of the larger infrastructure goals for behavioral health delivery is the advancement of integration. Many believe the best way to provide comprehensive care to consumers is to seamlessly mesh mental health and addiction medicine with medical specialties, particularly primary care. However, in realworld practice, implementation is wrought with logistical and philosophical barriers.

Even though most stakeholders know what the future should look like, the adoption of the integrated model is currently quite rare, according to C. Scott McMillin, consultant and principal with Recovery SI.

"It really is a vast challenge," McMillin says. "We talk about integration, but it's so far into the future, it's almost an impossible dream. You find isolaced examples of real integrated care, but you drive 50 miles in any one direction, and you see the complete absence of that."

Too often, the best a primary care patient with behavioral needs can often hope fot*«"* a handout from a family doctor that lists phone numbers for local addiction and mental health providers. McMillin envisions a "no wrong door" approach in the future, in which those seeking health services can receive comprehensive care regardless of the access point.

For example, there is a growing number of federally qualified health centers (FQHCs) that have achieved degrees of integration, often in the form of two providers co-located or in close proximity that mutually can offer warm handoffs. In some cases, local providers count on grant money to drive integration, but efforts risk fadingaway when the funding dries up, McMillin says.

SAM HSA has allocated grants fora variety of projects, including technology integration and co-location of service providers. For example, the administration offers grants to establish projects to coordinate services with primary and specialty care providers in community-based behavioral health settings. The Primary and Behavioral Health Care Integration grant program also offers tools for provider communities to help them figure out how to implement the integration vision on the ground.

Robert Wergin, a family physician in Milford, Neb., and board chair of the American Academy of Family Physicians (AAFP), says integration is indeed happening-right now. Primary care providers want to include the behavioral element of care because they're driving toward the medical home model that offers them financial rewardsfor comprehensive care. Such care is incomplete withoyAw addressing behavioral health.

"Integrated behavioral health is the thing ofthç future, and as we move to value-based *payment, I think it's going to be accelerated," Wergin says. "But it's already happening now."

For most treatment centers, a co-location arrangement isn't possible. In that case, the way to foster integration is to grow a patientcentered medical community, he says.

AAFP created its "Joint Principles" of behavioral health integration last year which include recommendations for co-location or patient-centered medical communities as an alternative. I he principles also recognize that behavioral health providers should be paid as valuable members of the medical home and the comprehensive aire team.

Likewise, the advent of accountable care organizations (ACOs) with their neighborhoods of cooperating, risk-sharing provider networks could signal an opportunity for behavioral health to integrate with comprehensive health systems. At the moment ACOs, whether driven by Medicare or commercial payers, are still getting their footing. Behavioral health components could be a later iteration for many communities. …

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