5 Takeaways on Improving Behavioral and Physical Health Integration for Medicare and Medicaid

Almost a quarter of all adults with a mental illness reported that they were not able to receive the treatment they needed, according to Mental Health America. This is due, in part, to the fact that behavioral and physical health are still not fully integrated, a challenge even more dire for vulnerable populations. Experts from MostlyMedicaid, the Delaware Division of Substance Abuse and Mental Health (DSAMH) and Bamboo Health discussed current opportunities to improve healthcare integration at the State HIT Connect Summit in April.

The panel featured Michelle Singletary-Twyman, Deputy Director at DSAMH; Kris Vilamaa, Partner and Chief Growth Officer at MostlyMedicaid; Deborah Daly, Senior Director of Strategy at Bamboo Health; and Sean Miller, State Account Director of Bamboo Health.

Let’s explore the panel’s top five noteworthy considerations for expanding healthcare access:

1. Emergency departments (EDs) are often overloaded as entry points for crisis care, but efforts are underway to redirect individuals to appropriate crisis centers or community providers. ED crowding is a dire problem that has only persisted and worsened since the 1980s. The panel discussed assessments of several state crisis systems, which found that EDs often serve as the primary entry point for individuals in crisis. For many states, a top priority is to change this reliance on the ED as the default destination for crisis care. Many people turn to the ED for care, assuming it’s the appropriate place to receive help during a crisis, unaware that other solutions exist. Building trust in the community and ensuring that the broader delivery system can adequately support individuals in crisis is essential. Efforts should be made to direct individuals away from the ED towards crisis state centers or other community providers to appropriate treatment. Law enforcement also plays a role, needing to understand that the ED isn’t always the best option and should be guided to redirect individuals to more appropriate care settings.
2. Training, support and user involvement are crucial for the successful adoption of technology and workflows in crisis care systems. Providers and care coordinators are often overwhelmed by the abundance of tools and adjustments in their day-to-day lives while focusing on patient care. Successful adoption involves preparation and a tailored approach for state governments who may want providers to onboard to a new tool, in addition to providing ongoing, user-friendly training throughout the process. The panel shared real-world examples of how to encourage adoption from implementing DTRN360, a new behavioral health coordination suite offered by Bamboo Health and utilized by DSAMH to unify multiple physical and behavioral health solutions that had typically been siloed.
3. Data insights and analysis are essential to understand and improve crisis care systems. Even data-savvy organizations struggle with data silos or unactionable data. New tools are needed to better integrate data insights directly in workflows and bring in data from partners across our historically siloed health system. With DTRN360, DSAMH can coordinate and aggregate actionable data between several of its partners across the physical and behavioral health system, streamlining collaboration and eliminating silos. Technology platforms like DTRN360 also reduce admin burden and burnout by simplifying and unifying healthcare insights and processes. All organizations will need to continue reducing data silos to improve patient care. This is where technology can be particularly helpful, but only if it works with clinicians, not against them. Collaboration among stakeholders, including providers, policymakers, and community organizations, is essential for effective crisis care delivery. 
4. Medicaid and Medicare populations need focused data aggregation and targeted outreach, as these populations experience higher than average rates of mental illness and substance use disorder (SUD). A quarter of all people enrolled in Medicare experience mental illness, and 40 percent of all adults enrolled in Medicaid experience mental illness or SUD. These groups often have severe high utilization challenges – with patients showing up to EDs weekly or even daily.Looking at these crises from a population level is a useful tool to address barriers and expand access and outreach. Let’s say you want to focus more on the specific uninsured population.  Leveraging data across multiple key sources can help outreach and collaboration with the uninsured, again going back to this notion of building trust and ultimately reducing these high rates of untreated mental illness and SUD.
5. The behavioral health industry must shift toward bolstering prevention, treatment and long-term recovery strategies in behavioral health beyond reacting to substance use crises. Building a network that connects primary and community providers with crisis and behavioral health providers is critical to any proactive strategy. Many organizations and providers already work together through state programs to incentivize care integration, but other networks are needed. Each entity across our healthcare system shares many of the same challenges and issues due to funding and the platforms used to collect information, so there is still potential for greater collaboration to integrate with behavioral healthcare in a concrete and measurable way.

If you missed us at the State HIT Connect Summit this year, contact us to continue this discussion or meet us at an upcoming event.