Integrating Physical and Behavioral Health Care: Promising Medicaid Models

Many individuals receiving care for behavioral health conditions also have physical health conditions that require medical attention, and the inverse is also true. Unfortunately, our physical and behavioral health care systems tend to operate independently, without coordination between them, and gaps in care, inappropriate care, and increased costs can result. This brief examines five promising approaches currently underway in Medicaid to better integrate physical and behavioral health care. They can be arrayed along a continuum that ranges from relatively modest steps to coordinate care between the two systems, to more ambitious efforts to implement a single integrated system of care.

1. Universal Screening.Integrated care begins with screening patients for conditions in addition to the ones they present for. A number of evidence-based tools are available for primary care providers to use to screen for behavioral health disorders easily. Routine screening for common medical conditions among adults with behavioral health conditions can be accomplished by providing behavioral health practitioners with basic equipment like a scale, a blood pressure cuff, and a stethoscope, along with training in how to use them. Early identification of conditions helps to prevent or mitigate their progression.
2. Navigators. Even when individuals get screened for other conditions and referred for care, obtaining the recommended services can be challenging. Many Medicaid programs are deploying a new cadre of “navigators,” who may be nurses, social workers, or trained paraprofessionals, to help Medicaid beneficiaries navigate the health care system. Navigators’ functions can range from simply helping individuals to seek care, to interacting with their health care providers on their behalf, to improving home and community-based support for their clients. Navigators also foster patient engagement.
3. Co-location. Geographic distance between physical and behavioral health provider settings can itself be a significant barrier to coordinated care. Community health centers are leaders in the “co-location” of physical and behavioral health care at the same site. Medicaid’s system of prospective, cost-based payment for health centers supports this model because the costs of licensed behavioral health practitioners can be included in the calculation of health centers’ prospective rates.
4. Health Homes. A growing number of states are using the Medicaid “health home” option, established by the ACA, to advance the integration of physical and behavioral health care for Medicaid beneficiaries with serious mental illness. Health home services, which are eligible for a 90% federal match for two years, include comprehensive care management, transitional care, referral to community and social services, and other services to foster integrated care for people with complex conditions and needs. Community mental health centers are one natural choice to be designated health home providers for Medicaid beneficiaries with serious mental illness.
5. System-Level Integration of Care. System-level integration of services and fiscal accountability underpins truly person-centered, holistic care and represents the most advanced model on the integration continuum. A fully integrated system for Medicaid beneficiaries is one that directly provides and is at financial risk for the entire complement of acute physical and behavioral health services covered by Medicaid.