Measuring Physical and Behavioral Health Integration: A Look at State Approaches in the Context of Value-Based Purchasing

The case for an integrated approach to care—one that can seamlessly and collaboratively address patients’ physical and behavioral health needs—is compelling. Individuals with behavioral health conditions, either a mental health diagnosis, a substance use disorder, or both, are some of the Medicaid’s most costly enrollees.^[i] Analyses indicate this subset of high-cost enrollees typically has a complex combination of chronic physical and behavioral health conditions. Comprehensive and effective treatment for this population is challenging, due to siloed systems, access issues in behavioral health, and fee-for-service payment methodologies that do not support the integrated care of people with complex needs. Physical and behavioral health integration as a clinical approach presents an opportunity to promote quality, enhance access, and lower costs.[ii] Research indicates that integrated care management strategies such as health homes[iii] and evidence-based models such as Collaborative Care[iv]^,[v] can improve outcomes for people with complex, co-morbid physical and behavioral health conditions while potentially reducing costs.
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[i] Government Accountability Office. (2015) A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures (GAO Publication No. 15-460). Washington, D.C.: U.S. Government Printing Office.

[ii] American Hospital Association, Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, Washington, DC: American Hospital Association, 2012, https://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf.

[iii] “Health Homes,” Medicaid.gov, accessed on September 26, 2016, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Integrating-Care/Health-Homes/Health-Homes.html.

[iv] Jürgen Unützer, Henry Harbin, Michael Schoenbaum, and Benjamin Druss, The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes, Hamilton, NJ: Center for Health Care Strategies, 2013, https://www.medicaid.gov/state-resource-center/medicaid-state-technical-assistance/health-homes-technical-assistance/downloads/hh-irc-collaborative-5-13.pdf.

[v] Simon Gilbody, Peter Bower, Janine Fletcher, et al., “Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes,” Archives of Internal Medicine 166 (2006):2314 – 2321; Community Preventive Services Task Force, “Recommendation from the Community Preventive Services Task Force for Use of Collaborative Care for the Management of Depressive Disorders,” American Journal of Preventive Medicine 42 (2012):521-524; and Anilkrishna B. Thota, Theresa Ann Sipe, Guthrie J. Byard, et al., “Collaborative Care to Improve the Management of Depressive Disorders: A Community Guide, Systematic Review and Meta-analysis,” American Journal of Preventive Medicine 42 (2012):525-538.