Guest Blog: Better care through integrated Behavioral Health Organizations

By Jeff Thomas, CEO of Frontier Behavioral Health

Published in Frontier Behavioral Health Magazine

Behavioral health conditions, including mental illness and substance use disorders, are widespread among Medicaid’s high-need, high-cost recipients, many of whom also have chronic physical conditions.  As a result, many states across the country are working on new strategies to improve the coordination of physical and behavioral health services for Medicaid populations and other populations within state priorities and available resources.

In 2013 the state of Washington received a $1 million State Innovations Model (SIM) planning grant from the Center for Medicare and Medicaid Innovation (CMMI).  This grant enabled the state over the next year, with significant stakeholder participation, to develop the State Health Care Innovation Plan (SHCIP) that outlined a bold vision for health system change in our state.

The SHCIP was used by the state as the basis for a Round 2 model test grant proposal submitted to CMMI titled “Healthier Washington,” which resulted in the state being awarded in 2014 a five year grant in the amount of $65 million.  This grant is helping to finance key initiatives that invest in Washington’s infrastructure to support system transformation over the next four years.

To help accomplish this, the legislation called for the joint creation of Regional Service Areas (RSA’s) by the Health Care Authority and Department of Social and Health Services for purposes of healthcare purchasing.  The RSA’s, the boundaries of which have shifted some since initially identified in 2014, are required to include contiguous counties, contain at least 60,000 Medicaid beneficiaries, possess and adequate number or healthcare providers, and reflect “natural healthcare service referral patterns.”

As a first step toward the integration of healthcare purchasing, SB 6312 stipulated that administration and purchase of public-funded mental health and substance use disorder (SUD) treatment services be combined under a single, financial risk-bearing Behavioral Health Organization (BHO) for each RSA.  The BHO’s, which will come into effect April 1, 2016, will replace the current system wherein mental health services are overseen by Regional Support Networks (RSN’s), and SUD services are overseen by individual countries.

Spokane County Regional Behavioral Health (SCRBH) will assume responsibility April 2016 for providing substance use disorder treatment, and the mental health services previously overseen by these Regional Support Networks (RSNs).  These services include inpatient and outpatient treatment, involuntary treatment and crisis services, jail proviso services, and services funded by the federal block grants for the Medicaid population.

SB 6312 stipulates that the only entities that can apply to become BHO’s are the current RSN’s.  In other words, it is not a competitive procurement process.  However, the RSN’s are required to submit – and have approved – a comprehensive Detailed Plan that demonstrates their ability to meet all of the state’s contractual requirements to operate as a BHO – which are significantly expanded from current requirements and include various outcome measures such as treatment retention, penetration of Medicaid eligible, timely access to care, hospital readmission, and quality improvement projects.  The SCRBH is currently creating a detailed plan for state approval in January.

The geographic boundaries of the Eastern Washington RSA have significant overlap with those of Spokane County Regional Support Network (SCRSN), with a couple of notable differences.  In addition to Spokane, counties that are currently a part of the SCRSN include Adams, Lincoln, Stevens, Pend Oreille, Ferry, Okanogan and Grant.  All but Grant County will be included within the initial boundaries of the Eastern Washington RSA, with Okanogan also potentially moving to a different RSA at some future point.

Inception of the BHO model will, for the first time on our state, beak down the silos that have separated funding and oversight of mental health and SUD treatment services.  Ultimately, the BHO model is targeted at a set of principles known as the Triple Aim which will direct states to strive to simultaneously improve the health of the population, enhance the experience and outcomes of the patient, and reduce per capita cost of care for the benefit of communities. 

The Triple Aim framework serves as the foundation for organizations and communities to successfully navigate the transition from a focus on healthcare to optimizing health for individuals and populations.  Among the benefits of this model will be a blending of this funding, which will afford BHO’s greater latitude than RSN’s or counties have historically had with regard to how funding is allocated and services funded.

Frontier Behavioral Health is looking forward to working closely with the SCRBH and others in our community to support successful implementation of the BHO model and help achieve the goals established through the Healthier Washington initiative.