Behavioral Health

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.[1] In addition, enrollment in both Medicare and Medicaid is associated with worse clinical outcomes and beneficiary experience measures.[2]

Resources for Integrated Care features practical resources for providers and plans providing services to dually eligible beneficiaries with behavioral health conditions to help address these disparities. These 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:

  • Behavioral Health Integration: 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.[3] 
  • Navigation and Care Coordination Services: Navigation refers to the function of linking clients and their families with essential health and community services, and aims to assist clients in identifying and overcoming barriers to care. Navigators may provide health education and coaching, advocacy, care coordination, health assessment, and outreach services to support clients with behavioral health conditions as well as chronic or complex medical conditions.
  • Self-Management Support: Providers that support self-management help clients with chronic conditions become active participants in their own care and encourage clients to make informed decisions about their health. Self-management empowers clients and promotes improved health outcomes.
  • Peer Supports: Peer support staff are individuals in recovery from a mental illness, substance use condition, or co-occurring condition who have been trained to use their lived experience to assist others in recovery. Thoughtful integration of peer support staff into an organization is critical for this role to achieve its promise.

Behavioral Health And My Organization

You may find it helpful to begin your exploration of RIC resources by completing one or more of the organizational self-assessment tools featured below. These tools are designed to support systematic evaluation of current processes and potential next steps. 

Behavioral Health Integration Capacity Assessment Tool (BHICA) Self-Management Support in Behavioral Health – Organizational Assessment Tool Navigation Services in Behavioral Health – Organizational Assessment Tool
  • Assess organizational ability to integrate primary care and behavioral health services
  • Evaluate organizational processes in relation to three approaches for integrating care: coordinating care; co-locating care; or building primary care capacity in-house
  • Assess organizational capacity for delivering self-management support to clients managing serious mental illness or substance use conditions
  • Review a quality assurance process that facilitates ongoing organizational improvements in self-management support
  • Assess organizational capacity for delivering navigation services to clients managing serious mental illnesses
  • Connects identified gaps to tangible next steps in the form of a customized action plan
References
[1] Medicare-Medicaid Coordination Office. (2018). [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.
[2] Office of the Assistant Secretary for Planning and Evaluation. (2016). Report to Congress: Social Risk Factors and Performance under Medicare’s Value Based Purchasing Programs. Retrieved from https://aspe.hhs.gov/pdf-report/report-congress-social-risk-factors-and-performance-under-medicares-value-based-purchasing-programs.
[3] SAMHSA-HRSA Center for Integrated Health Solutions. What is Integrated Care? Retrieved from: http://www.integration.samhsa.gov/resource/what-is-integrated-care.
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