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Behavioral Health Primary Care Integration

  • Overview
  • Publications

Overview

Recovery from mental illness is a life-long process, and therefore requires long-term services and supports. However, programs and providers that serve people with mental illness are too often siloed and marginalized within the overall health and social services system, resulting in fragmented services, exceptional challenges to information sharing and care coordination, and chronic underfunding of programs.

Recognizing that the stigma that people with mental illness face in their daily lives is also reflected in the budgets and regulations of programs that serve them, the Center for Long-Term Care Reform chose to launch a new initiative to make behavioral health policy a priority. Our first major project in this area is a behavioral health-primary care integration learning collaborative that will guide our advocacy agenda and we hope will also drive practice-level changes to improve the lives of people with mental illness.

The Learning Collaborative
Health & Medicine has launched a multi-phase project to help primary care and behavioral health providers develop strategies to better implement evidence-based models for integration of behavioral and physical care that will facilitate more effective utilization of available resources and expand the capacity of behavioral health and primary care providers to provide high quality, person-centered care to more people in need.

In the fall of 2015, Health & Medicine initiated a Behavioral and Primary Care Integration Learning Collaborative --a team-based approach to improving processes, practices, and systems by sharing experiences, resources, and challenges--to identify and adopt best practices for behavioral health-primary care integration in Illinois. The collaborative brings together community behavioral health agencies, primary care providers, facility-based behavioral health providers, and people in recovery to share their experiences, participate in trainings, and prepare to pilot evidence-based models that can be tested and continuously improved based on systematic tracking of processes and outcomes.

Under Health & Medicine’s leadership, since its launch, the Collaborative has made great progress and established consensus criteria standards and definitions for integrated care models—a critical step in launching new integration strategies in Illinois. These criteria include being person-centered, financially-sustainable, and utilizing a robust workforce and effective technology. The group has also addressed current clinical and administrative integration practices; generated ideas to navigate identified barriers to integrated delivery systems; and worked to define a flexible integration framework and strategies to achieve our objective of creating new, impactful models. The Collaborative is now preparing to launch feasibility studies to begin testing promising new integration strategies.


Behavioral and Primary Care Integration Initiative Resources:
Best Practices in Behavioral-Physical Health Integration: A Working Paper for the Behavioral Health Integration Learning Collaborative (August 2015)
This working paper reflects our initial investigation of the current state of best practice in physical and behavioral health integration. The purpose of the paper is to solicit responses from experts and advocates with experience in this field who can advance our understanding of the current state of integration models and guide the direction of the Learning Collaborative.

Behavioral Health Integration Survey Presentation (December 2015)
In the Fall of 2015 Health & Medicine distributed a survey to gather input from a broader constituency, beyond the membership of the Learning Collaborative, in order to understand the diverse perspectives on integrated behavioral-primary health care across the state. This presentation shows the results of that survey and some of the key lessons we learned.We’ll be sending out additional surveys in the coming months, and we appreciate the feedback we receive from providers, consumers, and advocates statewide.


Medicaid Financing and Behavioral Health Care (May 2016)
The Behavioral Health-Primary Care Integration Learning Collaborative has the dual goals of finding practical, testable solutions to improve integration in the short term and also identifying deeper barriers to integration that require long-term policy change. The Medicaid financing system is a major driver of potential solutions and challenges. This working paper offers a brief history of Medicaid funding for behavioral health, describes home- and community-based services waivers, the Medicaid Rehabilitation Option and its implementation in Illinois, and capitated managed care, all with an eye toward unintended consequences and unexpected, though often predictable, reactions of stakeholders to Medicaid payment policies.


As Illinois prepares to submit requests for waivers and state plan amendments to enact the Health and Human Services Plan for Transformation, it is more important than ever for advocates to understand what is at stake in how Medicaid defines, deploys, and reimburses behavioral health interventions. We hope this paper contributes to that conversation.


Behavioral Health-Primary Care Integration Model Criteria Brief (April 2017)
A key outcome of the Collaborative’s work has been establishing consensus criteria for integration models—the factors without which a model cannot be considered an integrated behavioral health-primary care model.


This paper defines the six criteria and also identifies practices that Learning Collaborative members are implementing that partly or entirely fulfilled each criterion. Rather than defining a strict set of practices that may only work in specific conditions, we focus on the technical assistance needed to operationalize the basic principles of integration. Implied in this approach is that there are many models that fulfill the criteria for integration, and that weak points in a model can be strengthened by borrowing practices from others and carefully incorporating them into the existing framework of service delivery.


Perspectives on Data Exchange (May 2017)
From early planning conversations that set the stage for the Learning Collaborative to recent planning to test new methods for hospital transitional care, data exchange has consistently emerged as a major challenge to implementing integrated models and improving services for people with mental illness and substance use disorder. This policy brief lays out challenges and potential solutions to data exchange in an integrated environment.


Policy Lessons on Integration for Illinois (June 2017)

Distilling feedback and insight from Learning Collaborative members,  this paper offer our broad perspective on the policy needs for integration, focusing on three key areas related to integrated primary care and behavioral health in Illinois: 1)Building capacity by reforming regulations and reimbursement; 2) Supporting data systems and information exchange, and; 3) Developing an adequate workforce for integrated care.


As we launch this initiative, Health & Medicine welcomes feedback and questions from the community as well as inquiries about joining the Learning Collaborative. Please contact Renae Alvarez, Director of the Center for Long-Term Care Reform, at 312-372-4292 x35 or ralvarez@hmprg.org.

Health & Medicine wishes to thank Blue Cross and Blue Shield of Illinois for their generous support of this project.

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