Behavioral health is an umbrella term that includes mental health and substance abuse conditions, life stressors and crises, stress-related physical symptoms, and health behaviors. Behavioral health conditions often affect medical illnesses.1 Individuals who are dually eligible for Medicare and Medicaid are more likely than other Medicare beneficiaries to have a mental health diagnosis, with many dually eligible beneficiaries having multiple complex and chronic conditions.2 Approximately 41% of dually eligible adults aged 18 to 64 report experiencing symptoms of a behavioral health condition in the past year, compared to only 16% of adults aged 18 to 64 who are eligible for Medicare only.3 Resources for Integrated Care features practical resources for providers and plans delivering services to dually eligible beneficiaries with behavioral health conditions to help address these disparities. Products and webinars highlight promising practices, lessons learned, and stories from the field to support the delivery of integrated and coordinated care tailored to the needs of this population. Developed with input from a wide range of providers, plans, and other subject matter experts, these resources focus on the following topics:
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Behavioral Health & IDD
It is estimated that 30-35% of individuals with intellectual and developmental disabilities (I/DD) have a psychiatric disorder.4 Resources highlight promising practices for supporting individuals with behavioral health needs and I/DD.
4 National Association for the Dually Diagnosed. Information on Dual Diagnosis. Retrieved from http://thenadd.org/resources/information-on-dual-diagnosis-2/.
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Behavioral Health & Older Adults
One in four older adults experience a mental health condition, yet older adults underutilize behavioral health services.5,6 As the number of Americans aged 65 or older continues to increase, it is important for health plans and providers to implement promising practices that can address the behavioral health needs of older adults.
5 American Psychological Association, Office on Aging. (2017). Older Adults’ Health and Age-Related Changes: Reality Versus Myth. Retrieved from: http://www.apa.org/pi/aging/resources/guides/myth-reality.pdf.
6 U.S. Department of Health and Human Services, Administration on Aging. (2001). Older adults and mental health: Issues and opportunities. Retrieved from https://copgtp.org/wp-content/uploads/2015/08/Older-Adults-and-Mental-Health-Issues-and-Opportunities.pdf.
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Integration with Primary Care
Beneficiaries with behavioral health conditions often receive services delivered by multiple providers in separate care settings, sometimes with little or no coordination. Integrating mental health, substance use, and primary care services produces the best outcomes and is the most effective approach to caring for people with complex behavioral and physical health care needs.7
7 The Academy Integrating Behavioral Health and Primary Care, What is Integrated Behavioral Health? https://integrationacademy.ahrq.gov/about/integrated-behavioral-health.
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Navigation Services
Navigation links people (and their natural supports) with essential health and community services and coordinates care and services across siloed mental, behavioral, and physical health care delivery systems, leading to greater holistic and person-centered care. Navigators may provide health education and coaching, advocacy, care coordination, health assessment, and outreach services to support individuals with behavioral health conditions as well as chronic or complex medical conditions.
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Peer Supports
Peer support staff promote recovery and resilience by providing support and encouragement through lived experiences. Providers and health plans serving individuals with behavioral health needs may benefit from integrating peer supports into their service delivery.
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Self-Management
Self-management support increases individuals’ skills and confidence in managing their health problems and is a key part of providing care to individuals with behavioral health conditions. Self-management has been demonstrated to increase individuals’ satisfaction with health care, reduce the cost of care, and improve health outcomes for persons with a variety of chronic health conditions.8
8 Lorig, K.R., et al. (2001). Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care, 39(11):1217-23.
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Substance Use
Dually eligible individuals have an increased risk of developing substance use conditions, with at least 60% of dually eligible individuals having three or more chronic conditions and 41% of dually eligible individuals having at least one mental health condition.9 This increases the risk of substance use conditions among dually eligible individuals.
9 Centers for Medicare & Medicaid Services. “Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees.” September 2014. Retrieved from: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/Dual_Condition_Prevalence_Comorbidity_2014.
1 The Academy Integrating Behavioral Health and Primary Care, Agency for Healthcare Research and Quality. (2020). What is Integrated Behavioral Health? Retrieved from https://integrationacademy.ahrq.gov/about/integrated-behavioral-health.
2 Medicare-Medicaid Coordination Office. (2020). [Fact Sheet] People Enrolled in Medicare and Medicaid. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf.
3 Medicare-Medicaid Coordination Office. (2012). [Fact Sheet] Medicare-Medicaid Enrollee Information National 2012. Retrieved from: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/NationalProfile_2012.pdf.
