California State University, Northridge Certificate in LGBTQ+ Health

The Behavioral Health Sector and Physical Health Services Models

Individuals with serious mental illness (SMI) are known to have significant co-morbid medical conditions and as such greater medical costs though only a tiny fraction of that overall costs can be attributed directly to mental health services.1 It is well established that approximately 50% of total Medicaid expenditures accrue in those individuals with behavioral health diagnoses but spending increases up to 75% when these individuals have a co-morbid chronic physical condition.2,3

There are many models that aim to integrate physical and behavioral health (BH) services and itModels that integrate care to treat people with mental health and medical comorbidities have proven effective. Despite their effectiveness, however, these models are not in widespread use. is increasingly apparent that these models reduce fragmentation of services and promote true person-centered care for adults with behavioral health and comorbid health conditions. There is sufficient evidence that shows that integrating physical health services into the traditional public behavioral health treatment sector leads to improved care and reduced costs. Mental health professionals are best suited to align treatment options and interventions in order to manage these comorbid health conditions. Despite the effectiveness of these models, however, they are not in widespread use.4,5

The Coordinated Behavioral Care (CBC: www.cbcare.org) Independent Practice Association (IPA: www.cbcare.org/ipa/what-is-an-ipa/) Network of providers, throughout the five boroughs, offers a comprehensive, person-centered and holistic and integrated health care network to New Yorkers with serious behavioral health disorders and/or complex medical needs by bringing together primary health, behavioral health, care coordination, recovery, and supportive housing and social service interventions in all five boroughs. CBC connects individuals in the community using a variety of traditional BH services as well as a number of practice-based and evidence-based care transition and crisis service models, which fill identified, critical community-based service gaps.

CBC and the Network are at the forefront of developing, implementing and/or establishing multiple models of integrated care that are innovative and characteristic of CBC’s Network provider’s core mission to deliver care to individuals in the mode person-centered manner possible. As part of CBC IPA’s clinically integrated array of services these are a few of the CBC Network’s models/services:

Among the most promising models of integrated care is the Certified Community Behavioral Health Clinic (CCBHC), part of the 2014 Excellence in Mental Health Act that allocated over $1 billion to community-mental health services. This program mandated nine broad categories of services with a unique and promising federal reimbursement methodology based on a Prospective Payment System (PPS) ensuring that these organizations were compensated for the actual cost of care delivered. Within the CBC Network, Services for the UnderServed (www.sus.org), Catholic Charities Neighborhood Services (www.ccbq.org), New Horizon Counseling Center (www.nhcc.us) and Samaritan Daytop Village (www.samaritanvillage.org) are all designated as CCBHC.

An innovative model of improving the physical and mental health of vulnerable New Yorkers, comes from CUCS’s (www.cucs.org) Janian Medical Care (www.cucs.org/wellness/janian-medical-care/). Whether it is at a park bench, shelter or housing residence, Janian’s health care practitioners are delivering integrated and individualized medical and mental health care to both homeless individuals and those that have transitioned into permanent housing. Janian’s staff provide primary care that is integrated with the psychiatric care in 58 settings serving homeless and formerly homeless people, including in street outreach programs, shelters, safe havens, and supportive housing. Janian also has two full time street medicine teams working with outreach teams in Manhattan and in Brooklyn and Queens, bringing care to people who for whatever reason can’t make good use of the mainstream medical system.

Another existing model of integrated care can be found in the collaboration between The Bridge (TB: www.thebridgeny.org) and Ryan Health (www.ryanhealth.org) while Bridge clients make use of all Ryan Health’s Article 28 diagnostic and treatment centers, the centerpiece of the collaborative relationship between the two agencies are the co-located primary care services at TB’s 108th Street Clinical Hub and the mobile van that provides services to TB Safe Haven shelter location and a cohort of ACT clients in The Bronx. The Bridge’s 108th Street Clinical Hub is home to an Article 31 Outpatient Mental Health Clinic, a PROS program, and two Article 32 OASAS programs – an Outpatient Clinic and Outpatient Rehabilitation. The on-site primary care and referral to specialty care offered by the co-located Ryan Clinic, which is available regardless of ability to pay, is staffed by a physician and a licensed nurse practitioner. This means that all these recipients have one-stop access to comprehensive, integrated behavioral and physical healthcare. Integration of care is facilitated by the ability of staff to provide a ‘warm hand-off’ to clients by walking them over between service providers, especially when adherence to appointments has been an issue. Staff work in close proximity and there is daily formal and informal sharing of clinical information, need for follow up, referral for service to address acute and chronic conditions. In addition, during a weekly ‘huddle’, there is an opportunity to review situations that require a higher level of interagency cooperation to achieve positive health goals. Staff from both programs have access to data related to medical testing, admission and discharge from hospitalization, medications, and utilization of services can be shared, while safeguarding jointly served recipients personal health information.

OHEL Children’s Home & Family Services (www.ohelfamily.org), offers CHAMPS (Coordinated Health & Mental Health Programs & Services: www.ohelfamily.org/?q=content/champs-wellness-program), a Primary and Behavioral Health Care Integration (PBHCI) SAMSHA grant funded program. The program is based on a chronic care model, incorporated into a primary care system and delivered within a behavioral health setting. Through an integrated model of medical and behavioral health care, patients with serious mental illness who have or are at risk of poor health, are provided with services to connect them to and keep them in primary health care, link them to specialty services and engage them in wellness programs and health promotion and education. CHAMPS is co-located in both OHEL’s outpatient mental health clinic and the medical clinic. CHAMPS staff provides its’ clients with a diverse array of integrated individual and group wellness services and programming. The program provides screening and diagnosis of medical problems, educating clients about the nature of the disorder and self-management, access to treatment/therapies and integrated wellness programming supported by trained Peer Specialists.

CBC offers a comprehensive, person-centered and holistic health care network to New Yorkers with serious behavioral health disorders and/or complex medical needs by bringing together primary health, behavioral health, care coordination, recovery, and supportive housing and social service interventions in all five boroughs. CBC connects individuals in the community using a variety of traditional BH services as well as a number of practice-based and evidence-based care transition and crisis service models, which fill identified, critical community-based service gaps. The CBC IPA Network of community-based providers have been promoting integrated behavioral and health care services for decades, many in unique and innovative manners that are responsive to the needs to the populations they serve and true examples of person-centered care. CBC’s goal is to further inventory and evaluate these physical health services and models being delivered throughout the five boroughs in traditional BH settings. CBC is developing program evaluation models that can better study the impact of these services on the individuals in terms of utilization, outcome and costs with the hope of further disseminating and replicating these practice-based innovations across the CBC Network and New York City.

For more information please contact Sara Sezer, MPA, Special Assistant to the CEO and CBC Project Manager at ssezer@cbcare.org, or at (646) 930-8801.

References

  1. Goodell S, Druss BG, Walker ER. Mental Disorders and Medical Comorbidity. Robert Wood Johnson Foundation: The Synthesis Project, February 2011. Available at: http://www.rwjf.org/en/library/research/2011/02/mental-disorders-and-medical-comorbidity.html
  2. Report to Congress on Medicaid and CHIP, Medicaid and CHIP Payment and Access Commission, June 2015
  3. Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations, Center for Health Care Strategies, December 2010
  4. Integration of Behavioral and Physical Health Services in Medicaid, MACPAC

5.            Ward MC, Druss BG. Treatment Considerations in Severe Mental Illness Caring for the Whole Patient. JAMA Psychiatry July 2019 Volume 76, Number 7, 759-760

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