The Community’s Money -

A consistent barrier in financing integrated healthcare services is that organizations think of the funding in a siloed way. It’s not uncommon to hear “this is my money” or “our money.” With this old approach to financing, the outcomes often need to benefit the organization and sometimes even the individuals within an organization. Success with financing integrated care requires a paradigm shift that involves putting the consumers’ and community’s best interest first. Agencies and organizations are stewards of the public money. It is a behavioral healthcare organization’s responsibility to make behavioral health resources available to the community as part of a package of services. This approach to financing integrated healthcare results in creative, effective service packages that meet everyone’s needs.

Generating the Will -

In these difficult financial times it seems natural to hunker down and wait for things to improve. Now, more than ever is the time to be creative and to stretch mental health resources to the maximum and assist consumers in their path to recovery. It may seem counter-intuitive but now may be when change is most possible and most effective. Now is the time to get the most creative financial minds together with the most conservative financial minds and hammer out exactly what is possible with the funding that is received. Partnering and collaboration are often keys to making money go further. This is particularly true in integrated healthcare where shared resources improve consumer outcomes while enhancing the bottom line of all the partners.

Advocating for State Level Medicaid Changes -

Medicaid regulations are made state by state in this country. This is both a blessing and a curse. A blessing in that there is often more ability to influence state policy rather than federal policy and a curse because the same work has to be done 50 times! A number of states already allow for billing two services on one day. It is possible to get a copy of that policy work in one state and work with another state to implement it.

Tips for Financing Mental Health Services Right Now -

Two series of codes are already approved for commercial, Medicare and Medicaid billing: SBIRT (Screening, Brief Intervention, Referral and Treatment) and the Health and Behavior Assessment/Intervention (96150-96155). The Health and Behavior Assessment/Intervention codes can be used to bill a behavioral health service ancillary to a primary care diagnosis. This would include providing services regarding chronic care management such as diabetes care, cardiac support, and consulting and assistance with COPD management. SBIRT can be billed in the primary care setting for screening for substance use/abuse.

In Wisconsin, case/care management services are billable for primary settings working with individuals with a serious mental illness. In Michigan the Primary Care Association has negotiated a memorandum of understanding that allows for FQHCs to bill two services in one day (www.mpca.net). In states where two services rendered on one day by one provider are not billable, programs have found innovative ways to collaborate that allow both partners to bill, using two provider numbers to provide the services. They key here is creative, collaborative thinking that maximizes the current financing options. Improving the health status of those we serve requires all of us to come to the table and work within existing financing structures to find solutions rather than use financing as way to delay discussions.

In states where capitation is used, it often provides the flexibility for local decision-making regarding services and funding. Don’t be afraid to expand thinking about creative ways to secure better outcomes by integrating staff into primary care setting to provide mental health services. Often, it requires no new approvals for mental health centers to provide community based services. In fee for service states, review the regulations and find any way you can to bill for services at a primary care site. You’ll generate better health outcomes and support your organization’s bottom line.

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- The integration of primary care services in behavioral health settings: The Healthcare Collaborative Project brings together behavioral health and primary care organizations offering a bi-directional approach for care. The need for behavioral health services in primary care is widely accepted. But the integration of primary care services in behavioral health settings remains controversial despite the fact that individuals with serious mental illness appear to have the worst mortality rates in the public health system. Therefore, mental healthcare organizations are actively pursuing single points of accountability to enhance continuity of care for this underserved population.

- Cost-based-plus financing that supports service excellence: People want and deserve quality services but quality services depend on skilled staff. Low salaries have created – and are perpetuating – a recruitment, retention, and quality crisis for behavioral healthcare. We need a workforce of skilled staff delivering nationally recognized practices within organizations that live by the rule “If you don?t measure it, you can?t improve it.”For mental healthcare organizations, healthcare reform is an opportunity to bring “parity” to public mental health services by ending the second class status of community mental health and addiction providers in America?s safety net.

- Federal mental health funding stream dedicated to mental health and integrated treatment services for the uninsured: The uninsured have exceptionally high rates of untreated mental illnesses with co-occurring addiction disorders and there is no safety net. State plans to cover the uninsured have all but disappeared and federal universal coverage plans may well be incremental. We have large numbers of individuals with treatable mental illnesses and addictions in our overburdened emergency rooms, in jails, and on the streets with no access to services that can engage them, treat them and return them to work. We must stop denying our economy productive taxpayers and wasting human lives.

- Eligibility for social security disability for people with addiction disorders: Addiction has come a long way from the days when it was perceived as merely a failure of will. Today, there is growing public awareness and acceptance of addiction as a chronic, relapsing condition that requires continual monitoring and management, as do other chronic illnesses like diabetes, asthma, and hypertension and yes, mental illness. If we accept addiction as a chronic illness then we must advocate that people with addiction disorders be eligible for disability support.

- Funds to support investments by behavioral healthcare organizations in information technology: We talk about information technology and service transparency, but behavioral healthcare organizations that move forward to automate their clinical systems get no support, funding, or technical assistance. We and those we serve cannot continue to be marginalized. Healthcare reform and economic recovery will depend upon the expansion of information technologies and behavioral health providers must be included.

- Expansion of research-based education and prevention practices: There are mental health and addiction prevention and education programs that work. These include research-based prevention initiatives that reduce the risk of childhood serious emotional disturbance by treating maternal depression, the Nurse-Family Partnership Program that has an array of consistent positive effects across multiple trials, and Mental Health First Aid – an evidence-based mental health literacy program. Now we must adequately fund and support the spread of these interventions to communities across the country.