A Different Kind of Home under Construction: Behavioral Health Homes for the Seriously Mentally Ill
Over the past few years, health care reform has been buzzing with discussions about health homes. This new way of delivering health care is generating much enthusiasm among policymakers, payers, and practitioners. The goal, after all, is laudable: higher quality and lower cost, integrated care for more people.
How do we provide care for our sickest patients at a cost we can bear? What does it mean to truly integrate care?
At Beacon Health Options, we had the opportunity to apply our behavioral health expertise in support of this movement when we won a contract as the administrative services organization (ASO) for behavioral health homes in Connecticut. This contract was different work than what we had done before, and with it came new challenges. In brief, there were many lessons learned about a process filled with surprises, which led to the publishing of “Under Construction: One State’s Approach to Creating Health Homes for Individuals with Severe Mental Illness.” The article was recently published in AIMS Public Health, an international, peer-reviewed open access journal, and written by Andrea Auxier, PhD, Bonnie Hopkins, PhD, and Anne Reins, all of Beacon Health Options.
As it turns out, the article has been popular, which isn’t surprising since it tackles topics that keep health care leaders awake at night: How do we provide care for our sickest patients at a cost we can bear? What does it mean to truly integrate care?
These questions need to be addressed, especially for those living with a serious mental illness (SMI), a population with high rates of physical health problems that often go undetected and untreated. What we learned in Connecticut is that the answers will vary according to each unique effort to do so. In brief, there is no one overarching solution.
A concept is one thing, reality is another
In the case of “health homes,” concept collides with reality. While the concept of the “health home” has become a persistent one because the care it provides is intended to be local, person-centered and integrated, it remains an entirely new form of health care delivery where the devil lies in the details. Therefore, creating this kind of system can be both invigorating and daunting, as this is largely uncharted territory. What goes on behind the scenes requires commitment from a lot of people, who together, work to iron out the glitches. And there are always glitches.
Like building an actual house, creating a health home requires teamwork, perseverance, and the ability to course-correct, all while acknowledging the local environment.
The upside is that challenges often beget opportunities, such as in the example of the behavioral health home (BHH). BHHs provide an important testing ground for the effectiveness of integrated care, specifically for individuals with serious mental illness.
Generally, health homes include attention to physical, behavioral and social needs, which are routinely approached as separate and unrelated. Therefore, they are a natural extension of the realization that, while the medical/behavioral split is pervasive in health care delivery models, it does not exist in actual people. As it turns out, our experience in Connecticut taught us that concept is easier than reality. Like building an actual house, creating a health home requires teamwork, perseverance, and the ability to course-correct, all while acknowledging the local environment.
Local problems, local solutions
In Connecticut, the Medicaid behavioral health system initiated the development of a behavioral health home model to serve anyone diagnosed with SMI and annual Medicaid claims exceeding $10,000. Supported by an administrative services organization known as the Connecticut Behavioral Health Partnership, the initiative hopes to:
- Improve the individual care experience and population health
- Reduce per capita health care costs
- Achieve high-quality integrated health care
- Support behavioral health practices by increasing primary care resources
- Decrease unnecessary inpatient hospitalization and emergency room visits
- Improve individuals’ quality of life
While these are worthwhile goals, the Connecticut experience illustrates there are local hurdles, many of them unanticipated, that must be worked through, such as member identification and enrollment and PCP engagement. These challenges highlight there is not a one-size-fits-all solution for successfully integrating care. Moreover, navigating these challenges and developing the solutions to meet them, generates opportunities for health home models to strengthen over time. Because people are not one-size-fits-all, health homes – or any other variation of integrated care – cannot be one-size-fits-all, either.
Therein lies the overall challenge for local health care markets. In the words of the Delphic inscription, “know thyself.” It’s a tall order.