Physical and Mental Health Integration

Background

Mental health is a key driver of Medicaid spending. The June 2015 Medicaid and CHIP Payment and Access Commission’s Report to Congress noted that approximately one-in-five Medicaid enrollees lived with a diagnosed mental health condition or substance use disorder. A 2015 report released by the Government Accountability Office showed that over half of the Medicaid-only enrollees in the top five percent of expenditures had a mental health condition, and one-fifth had a substance use disorder. These conditions often co-occur; 71 percent of those high-expenditure enrollees with a substance use disorder also lived with one or more co-occurring mental health condition.

Mental health also drives healthcare utilization. According to the Agency for Healthcare Research and Quality, individuals with mood disorders or schizophrenia and other psychotic disorders represented the top two most common diagnoses for re-hospitalizations among Medicaid beneficiaries in 2011. Individuals with mental health needs often have comorbid physical health conditions that require medical attention; more than half of the Medicaid-enrollees in the top five percent of expenditures who had asthma or diabetes also had a behavioral health condition. Furthermore, individuals with co-morbid physical and behavioral health conditions often have worse health outcomes. Although individuals with mental health conditions have some of the greatest health care needs (including complex polypharmacy regimens), the health care system is often too fragmented to effectively and efficiently serve them. Behavioral health needs often go undiagnosed or untreated in the primary care setting, and primary care physicians also have a more difficult time referring their patients to mental health services compared to other specialty services.

Given the prevalence of mental health conditions in the Medicaid population, the high level of Medicaid spending on behavioral health care, and the adverse impact that uncoordinated care can have on people’s health, initiatives to integrate physical and mental health are a top priority for Medicaid agencies. Integrated care approaches have been shown to improve health outcomes for individuals with behavioral health conditions. Effective integrated care can also enhance patient engagement and activation, which has been shown to be associated with increased treatment adherence, improved patient satisfaction, better quality of life, and increased mental and physical health.

Program Support Available to State Medicaid Agencies

Under this IAP program priority area, targeted program support will be available to up to ten Medicaid agencies interested in expanding and/or refining existing physical and mental health integration efforts in their states. IAP will work with states to support integration across varied settings (e.g., primary care, community mental health centers, school-based health centers), for different populations (e.g., adults and children, individuals with serious mental illness), and/or a variety of evidence-based models of integrated care (collaborative care, co-location, primary care-oriented, etc.) Through this effort, IAP will provide states with technical support to improve or expand diverse integration approaches, including data analytics, payment and delivery system reforms, and measurement.

It is not expected that each state will focus on the same integration approaches however; selected states will share common interests and goals that align with IAP’s goals for this priority program area:

  • Improve the behavioral and physical health outcomes and experience of care of individuals with a mental health condition;
  • Create opportunities for states to link payments with improved outcomes for beneficiaries with these co-morbid conditions;
  • Expand and/or enhance existing state physical and mental health integration efforts to:
    • Customize for specific populations; and/or,
    • Spread integration efforts to new areas of the state; and/or,
    • Spread integration efforts to new types of health professionals;
  • Identify and spread innovations to the field that improve and expand physical and mental health integration initiatives in various settings and for various populations.

The type of program support will be refined to meet specific needs of the selected states and will include:

  • Strategic planning support
  • In-person workshop(s) tailored to state needs
  • Individualized technical support
  • State-to-state virtual workshops

Additional Information on PMH Opportunities:

Additional information can be found in the Program Overview and the Information Session Slides. States interested in this type of program support are asked to review the State Selection Factors and submit an Expression of Interest Form by January 29, 2016.

CMS is interested in feedback pertaining to IAP PMH activities. Direct questions via email with the subject line "PMH Integrations" to the IAP mailbox: MedicaidIAP@cms.hhs.gov.

References