Integration of behavioral health services within CCOs
For integration to take hold within a healthcare system, transformation efforts cannot focus exclusively on the provider network. The CCO itself needs to be organized in such a way that an informed behavioral health perspective is always at the table when conducting planning, policy development, financial modeling, and other critical elements of CCO operations. Behavioral health experts and expertise need to be woven into the fabric of the CCO itself.
IBHI has experience working with managed care entities, both large and small, to assess their capabilities and to make and monitor changes that position the organization to be successful in a rapidly changing healthcare environment. Prior to the start of the CCO's, ABHA, the predecessor of IBHI, developed an AMHA-authorized pilot with Pacific Source Community Solutions (PSCS) to test the concept of putting both behavioral health care and physical health care under one health plan umbrella. This is a brief summary of that work:
- The funding ABHA would have received for mental health services for its three Central Oregon counties was rerouted to PSCS. ABHA then became a subcontractor of PSCS, functioning as PSCS's at-risk manager for both mental health and chemical dependency services
- ABHA and PSCS management teams met regularly to plan, monitor, and coordinate the implementation of the pilot
- The ABHA Executive Director, Seth Bernstein assisted the Regional CCO in developing and operationalizing core concepts of integration at the Plan level
- ABHA staff provided technical assistance to providers in many areas including clinical documentation, auditing, utilization & quality management, as well as evidence-based clinical interventions
- The ABHA Quality Manager, Sandy Minta, represented the behavioral health perspective at Regional QM meetings and assisted in the redesign of QM processes and structures so that they encompassed behavioral health and physical health concerns and opportunities
- The ABHA Operations Manager, Valerie Davis, participated in regular meetings with PSCS and PhTech to coordinate encounter data submission and claims payment issues
- ABHA's Central Oregon Utilization Manager, Leslie Neugebauer, worked with their PSCS counterparts to begin to develop integrated UM processes
- IBHI and PSCS held meetings with primary care providers to identify and solve operational impediments to coordinating care with behavioral health specialty providers
- IBHI and PSCS began the development of a work plan that would lead to the development of region-wide behavioral health integration in primary care
- ABHA staff participated on an OHA sub-committee that was designed to identify barriers, conflicting requirements, etc. regarding the integration of the mental health (AMH) and physical health (DMAP) contract requirements so that they could be folded into a single CCO contract
Since that time, all CCOs have made efforts to achieve organizational integration. (Many of the staff noted above have gone on to play prominent CCO roles.) Such efforts are ongoing. Together with business partners such as PhTech, IBHI stands ready to provide assistance to CCOs in continuing their evolution as integrated health plans .