How California can build on CalAIM to better integrate physical and behavioral health care
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Kelly, Logan, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, March 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated -- organization & administration Medicaid -- organization & administration Mental Health Services -- organization & administration California
- Genre(s):
- Technical Report
- Abstract:
- A growing number of Medi-Cal members have serious behavioral health conditions, and many of them experience barriers in accessing care and poor health outcomes. The pandemic has exacerbated these challenges, as Californians with low incomes have reported that their mental and emotional health has worsened during the pandemic, and drug overdose deaths have increased by 45%. People with serious mental illness (SMI) and substance use disorders (SUDs) often have co-occurring medical conditions and complex social needs that affect their health and well-being. They experience higher rates of chronic physical conditions, homelessness, and early mortality. Across the country, people with behavioral health conditions receive less preventive care and more acute care. Californians with behavioral health needs often struggle to access treatment, especially in lower income regions of the state. While many residents have co-occurring mental health and SUD needs, only 1 in 13 with dual diagnoses receive treatment for both. In Medi-Cal, physical and behavioral health care services are managed and administered across several separate systems. Medi-Cal managed care plans (MCPs) manage physical health and nonspecialty mental health services, while county behavioral health departments manage both specialty mental health and SUD care, often through separate county programs. County behavioral health agencies have deep expertise in managing and delivering care for populations with serious behavioral health needs, and in managing the broad array of behavioral health funding sources. However, when Medi-Cal members experience complex and interrelated physical and behavioral health conditions, they must navigate multiple systems to find the care they need. Physical and behavioral health providers often do not receive information about the co-occurring needs or treatment plans of their patients, and therefore are constrained in how they can deliver whole-person care. This fragmented care then leads to higher costs--people with serious behavioral health conditions incur greater spending on care, and these costs are largely attributable to increased physical health spending. Clinical integration of care has been shown to improve health outcomes for people with co-occurring physical and behavioral health conditions. In California, many initiatives have been designed to advance clinical integration of care, including Whole Person Care pilots, the Health Homes Program, and the Coordinated Care Initiative, as well as many other initiatives led by counties and providers. CalAIM (California Advancing and Innovating Medi-Cal), which encompasses the CalAIM Section 1115 demonstration and the CalAIM Section 1915(b) waiver as well as related contractual and Medi-Cal State Plan Amendments, represents a significant opportunity to improve how care is delivered and experienced for people with serious behavioral health needs. Some CalAIM behavioral health initiatives are explicitly designed to improve integration between mental health and substance use disorder care, and between physical and behavioral health. Although these initiatives do not change the carve-out of specialty behavioral health services in Medi-Cal, if implemented effectively they could help build a more integrated system of care over the long term. California policymakers have meaningful opportunities to build on the strengths of the specialty behavioral health system while leveraging the promise of CalAIM reforms to address the fragmentation in physical and behavioral systems and ensure that all members can experience the benefits of integrated care. This brief analyzes how relevant CalAIM reforms can build toward greater physical-behavioral health integration. It profiles local innovations and select national exam ples that can inform areas of opportunity for Medi-Cal to advance integration at the interface of MCPs and county behavioral health agencies.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (13 pages)).
- NLM Unique ID:
- 9918573686006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918573686006676