Physical and behavioral healthcare integration remains a challenge. With outdated funding models and disparate state-by-state priorities, physical health is still not well integrated with behavioral health because there aren’t many incentives to do so. Behavioral and physical health are equally important as we see suicide risk, overdose risk and serious mental illness on the rise, and care must be properly integrated and incentivized to ensure value-based outcomes. These fast-growing issues exacerbate the strain on both the physical and behavioral health systems, as hospitals and EDs experience downstream effects due to a lack of access to integrated care. But it doesn’t have to stay this way. Certified Community Behavioral Health Clinics (CCBHCs) offer lessons on how we can solve this challenge.
Did You Know?
- More than 109,000 people in the U.S. have died from drug-involved overdoses, including illicit drugs and prescription opioids (according to the Centers for Disease Control and Prevention (CDC).
- Over half (54.7%) of adults with a mental illness do not receive treatment, totaling over 28 million individuals (according to Mental Health America).
CCHBCs are health entities that expand access to comprehensive behavioral healthcare. They are required to meet specific standards, including providing crisis services 24/7 and providing care coordination services to navigate behavioral healthcare, physical healthcare, social services and more.
One key element of CCBHCs’ sustainability is that costs are covered to increase the number of individuals served. This is often funded through the Section 223 CCBHC Medicaid Demonstration Program, in which states can apply to be demonstration sites to begin CCBHC work. Another element of expanding access to integrated healthcare in the long run is CCBHCs engaging in several care coordination activities, from electronic information sharing with care coordination partners (94% currently do this or plan to) to co-locating physical health services on site (88% currently do this or plan to), according to the National Council’s 2022 CCBHC impact report.
CCBHCs show how stronger behavioral health financial incentives can be a step in the right direction toward increased value-based care outcomes. With financial support and incentives, CCBHCs achieved key improvements, including a 72% reduction in hospitalizations, 40.7% reduction in homelessness and 60.3% less time in jails (according to the National Council).
But how can we extend these CCBHC outcomes to our healthcare system?
Each organization in our healthcare continuum serves a role in improving value-based care outcomes. Let’s explore specific tactics for state governments, payers and providers.
State Governments’ Role
- Incentivizing care through payment structure and funding: State governments should continue to allocate funding to better integrate physical and behavioral healthcare. State agencies and the federal government can do more to create financial incentives to adopt technology that facilitates integration.
- Clarifying regulations: In addition, state governments can do more to clarify the intersection between the recent federal 42 Part 2 final rules and state laws, to encourage information sharing between providers in physical and behavioral health settings.
- Encouraging transparency and sharing of best practices across state lines: As more states become demonstration sites for CCBHCs, states can play a key role in greater interoperability among and between states. According to a 2023 KFF survey of state Medicaid officials, each state takes a disparate approach to delivering behavioral healthcare, using multiple behavioral health delivery system models and varying degrees of financial quality incentives. With greater alignment with CCBHCs and the CCBHC model of reporting, states can better standardize and share insights around behavioral healthcare management and access.
Payers’ Role
- Updating payment structures: To spur change, payers and providers can implement integrated reimbursement structures with bundled payments for comprehensive care. However, aligning costs with positive outcomes will also necessitate time.
- Investing in data-sharing programs: Like CCBHCs, payers can invest in data-gathering and data-sharing programs to better monitor and align costs with outcomes.
Providers’ Role
- Recognizing the shifting needs for mental healthcare for adolescents: Primary care providers (PCPs) are often the first entry point for healthcare, especially for kids and teens. Following recommendations from the American Academy of Pediatrics in 2022 for pediatric health providers to screen everyone for suicide risk once a year, PCPs have identified high rates of suicide risk among adolescents (notably recognizing suicide risk is present for 10-12-year-olds) and are best situated to standardize screening and identify behavioral health risks. Then, providers can connect them to the right care at the right time. When more PCPs are trained to identify and assess behavioral health risks, whole person care can become a reality for patients.
- Expanding integrated care trainings: With specific trainings aimed at empowering physical healthcare providers with the knowledge necessary to handle physical and behavioral health crises, providers can better realize their role as the first point of entry for physical and preliminary behavioral healthcare.
- Maintain focus on workforce shortages and impact: While providers will need support from payers and state governments to see further integration of behavioral and physical health, they will also need to focus on workforce shortages and gaps in staff training. CCBHCs offer an example of how this can be done, as CCBHC demonstration sites have built-in planning periods to hire and train staff to address both physical and behavioral health needs, as well as to establish new billing processes.
Real-time insights can be a crucial tool for organizations looking to improve value-based care outcomes. With data directly in unified workflows, organizations along the care continuum can seamlessly coordinate and facilitate holistic treatment planning with instant access to critical patient contexts and needs. This approach enables organizations to quickly identify gaps in care or opportunities for improved patient outreach and cost savings.
Change is needed now from everyone in healthcare to address simultaneous behavioral and physical health crises. We can all gain valuable, transferrable lessons from CCBHCs.
Contact us to learn how Real-Time Care Intelligence™ can help your organization bridge the gap between behavioral and physical health.
