Claiming a Seat at the Table: Strategies to Promote Behavioral Health Integration in

Healthcare Reform

Becky Hayes Boober, PhD, Senior Program Officer Maine Health Access Foundation

Rick Ybarra, MA, Program OfficerHogg Foundation for Mental Health

Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, 2014 Washington, DC U.S.A.

Session #D4aSaturday, October 18, 2014

Faculty Disclosure

We have not had any relevant financial relationships

during the past 12 months.

Learning Objectives

At the conclusion of this session, participants will be able to:

• Explain three strategies for including behavioral health in planning for health care reform.

• Articulate Triple Aim benefits for embedding integrated behavioral health/primary care into new health care system structures, such as Accountable Care Organizations and managed care systems.

• Identify at least one policy opportunity in their home states and select relevant strategies to use to address that opportunity.

HEALTH REFORM RACE

In the next 30 seconds, list the names (or other identifier) of as many health reform initiatives as you can recall.

Example: Affordable Care Act Can be local, county, regional, state,

national, international GO!

History of Integrated Health Care in TX

Multi-year, multi-site grant program begun in 2006 implementing collaborative care model

Statewide conference in 2008; Resource guide published

Multi-year learning community begun in 2009 Office of Minority Health / Hogg collaboration

(2012). Lit review, consensus report on eliminating health disparities through IHC, and funders report published

2012-2015 planning and implementation grants

• 2011: 82nd Leg. Session. HB 2196 Report of Integration of Health and Behavioral Health Workgroup – first state to establish a legislatively mandated

workgroup on integration– Hogg influential in developing a track record in

IHC– Workgroup submitted final report with nine

recommendations– new relationships proved instrumental in

influencing state health policy

Strategies: after report submitted to the Leg, TX HHSC sought a waiver under section 1115 of the SSA to expand Medicaid managed care in TX; approved by CMS December 2011

Key Policy Opportunities in Texas

• 2011 Texas Healthcare Transformation and Quality Improvement Program, 1115 Demonstration Waiver – Strategies: CFHA 2012 Policy Summit 17 of 20

regional health partnerships (RHPs) attended; each charged with planning for health care delivery best suited to their communities; CFHA Policy Fellow one year appointment to follow-up with RHPs, provide TA, connect RHPs to SMEs, develop policy briefs; approx 396 Delivery System Reform Incentive Payment (DSRIP) BH projects funded by the 1115 waiver; 140 of those projects planned to integrate physical and behavioral health care

• 2013: 83rd Leg. Session. SB 58 IHC workgroup– Strategies: Hogg Foundation executive director

chairs committee

Key Policy Opportunities in Texas

Key Policy Opportunities in Maine

MeHAF 42 grants: clinical practice and systems transformation, 150+ partner organizations

6-year Integrated Care learning community State Integrated Care Policy Committee Anthem Pilot PCMH Pilots—All payers, including Medicare Health Homes, Behavioral Health Homes, CCTs State Innovation Model initiative KeepMEHome (House Speaker Eves)

RESULT

Over 45% of primary care practices in Maine have some level of integrated care! And growing.

Strong state champions!

HOW? TIPS WE LEARNED

Be at the table.Be strategic.Be opportunistic.Know the real issue and not just the surface system.

Show and Tell.

If you’re not at the table…

You are on the menu!

MORE TIPS: BFFS

Identify and nurture your champions. Be a friend.

Mid-level officialsAdministrative staff (gatekeepers)State and other systems and

political leaders Communicate in their language, value

system. Have neutral party (i.e., funders)

convene policy committee.

MORE TIPS

Be specific and realistic with your Asks.

Time the requests right. Let decision-makers know when what

they did makes a positive difference. Don’t expect immediate results. Stay

in it for the long haul—at least 10 years.

Recognize the Adaptive System, Collective Impact nature of embedding Integrated Care.

Convening

Strategic

Partnerships

Celebrate small wins in a BIG way!

Look for

opportunitie

s

The Triple Aim

Leverage your

influences

BFFs

Long Term View

Be at the Table!

YOUR OPPORTUNITIES

Think of an opportunity you have to be able to influence the expansion and/or sustainability and support of integrated care.

What is one step you can take within the next 2 weeks?

Learning Assessment

Discussion / Q&A

Bibliography / ReferenceLinkins, K.W., Frost, L., Boober, B.H., and Brya, J. (2013). Moving from partnership to collective accountability and sustainable change: Applying a systems-change model to foundations’ evolving roles. Foundation Review, 5:2, 52-66. Gratham, S., Boober, B.H., McKinney, A., Truesdell, N., Coakley, E., and Ward, M. (2014). “Working toward collaborative care” in Case studies in organizational behavior and theory for health care. Ed. Borkowski, N. and Deckard, G. Burlington, MA: Jones & Bartlett Learning. D. Bachrach, S. Anthony, and A. Detty, State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment, The Commonwealth Fund, August 2014.

Sanchez, K., Frost, L.E., and Held, M.L. (2013). Assessing the Legacy of a Legislative Workgroup for Bidirectional Integration of Services. Journal of Behavioral Health Services & Research, 2013, 1-10.

Center for Health Care Strategies (CHCS). Improving Health Care Quality and Equity: Considerations for Building Partnerships Between Provider Practices and Community Organizations. Robert Wood Johnson Foundation Primer/Brief. April 2013.

CONTACT US:

Rick Ybarra, Program Officer Hogg Foundation for Mental Health; Austin, TX 512-471-9154 rick.ybarra@austin.utexas.edu

Becky Hayes Boober, Senior Program Officer Maine Health Access Foundation; Augusta, ME 207-620-8266 ext. 114 bhboober@mehaf.org

SESSION EVALUATION

Please complete and return theevaluation form to the classroom monitor before

leaving this session.

Thank you!