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Health Care Reform Primary Care and Behavioral Health Integration
John O’BrienSenior Advisor on Health FinancingSAMHSA
Affordable Care Act
• Major Drivers– More people will have insurance coverage– Medicaid will play a bigger role in MH/SUD than ever
before– Focus on primary care and coordination with specialty
care– Major emphasis on home and community based services
and less reliance on institutional care– Preventing diseases and promoting wellness is a huge
theme
Person Served by SSAs/SMHAs
• 12 M visits annually to ERs by people with MH/SUD• Individuals with schizophrenia have one of the
highest rates of smoking (58%–88%) • Cardiovascular mortality was 6.6 times higher among
SMI clients than the general population• 70% of SMI had at least 1 chronic health conditions,
45% have 2, and almost 30% have 3 or more.
Primary Care And Coordination
• Individuals with SMI die on average at the age of 53 years old• Barriers include stigma, lack of cross-discipline training, and
access to primary care services• Have elevated (and often undiagnosed) rates of:
– hypertension, – diabetes, – obesity – cardiovascular disease
• Community-based behavioral health providers are unlikely to have formalized partnerships with primary care providers
Primary Care And Coordination
• Readmissions– 20% of Medicare patients are readmitted within
30 days after a hospital discharge– Lack of coordination in “handoffs” from hospital is
a particular problem – More than half of these readmitted patients have
not seen their physician between discharge and readmission
Affordable Care Act Opportunities
• Grants for mental Illness with co-occurring primary care conditions (SAMHSA)
• Health Homes (CMS and SAMHSA)• Prevention Trust Fund and Primary care and
Behavioral Health Integration (SAMHSA)• Community health teams (CMS/Medicare)
SAMHSA Grant Program
To improve the physical health status of people
with serious mental illnesses (SMI) by supporting community-based efforts to coordinate and integrate primary health care with mental health services in community-based behavioral health care settings
SAMHSA Grant Program
• To better coordinate and integrate primary and behavioral health care resulting in:– improved access to primary care services– improved prevention, early identification and
intervention to reduce the incidence of serious physical illnesses, including chronic disease
– increased availability of integrated, holistic care for physical and behavioral disorders
– better overall health status of clients
SAMHSA Grant Program
FY 2010• $28 million to help 56 community behavioral
health agencies • $5.3 million national resource center (co-
funded by SAMHSA/HRSA/HHS)
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• Facilitate screening and referral for primary care prevention and treatment needs
• Provide and/or ensure that primary care screening/assessment/ treatment and referral be provided in a community-based behavioral health agency
• Develop a registry/tracking system for all primary care needs and outcomes
• Offer prevention and wellness support services (>10% of grant funding)
• Build processes for referral and follow-up for needed treatments that are not appropriately provided in a primary care setting
PBHCI: Services Delivery
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Baseline Descriptive Information• Personal/family history of: diabetes, hypertension, cardiovascular disease;
substance use; tobacco use• Medication history/current medication list, with dosages• Social supports Health Outcome Indicators (by individual)• Weight/Height/Body Mass Index Blood pressure • Blood glucose or HbAiC Lipid profile
PBHCI: Data Collection and Performance Outcomes (<20% of grant funds)
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Services Outcome Indicators •The number of mental health consumers receiving primary care services•The number of mental health consumers screened for:
•hypertension; •obesity; •diabetes; •co-occurring substance use disorders; and•Tobacco product use
PBHCI: Data Collection and Performance Outcomes (<20% of grant funds)
Training and Technical Assistance Center
In partnership with HHS/Health Resources and Services Administration
• Purpose– to serve as a national training and technical assistance
center on the bidirectional integration of primary and behavioral health care and related workforce development
– provide technical assistance to PBHCI grantees and entities funded through HRSA
Training and Technical Assistance Center (TTA)
TTA will: • Increase the number of individuals trained in specific behavioral health
related practices; • Increase the number of organizations using integrated health care
service delivery approaches; • Increase the number of consumers credentialed to provide behavioral
health related practices; • Increase the number of model curriculums developed for bidirectional
primary and behavioral health integrated practice; and, • Increase the number of health providers trained in the concepts of
wellness and behavioral health recovery.
Health Homes
• Section 2703– Enhanced integration of primary and specialty care for
individuals with: • At least two chronic conditions• One chronic condition and be at risk for another, or • Serious and persistent mental illness
– Chronic conditions include:• mental health condition, • substance use disorder, • asthma, • diabetes, • heart disease, and • being overweight, BMI < 25.
Health Homes
• Health homes (several new services):– Comprehensive Care Management– Care Coordination and Health Promotion– Patient and Family Support– Comprehensive Transitional Care– Referral to Community and Social Support Services
• Timing– States can submit plans for effective dates as early as
1/2011
