A Holistic Approach to Improving Health Care

07 May 2014
Although health care providers have long recognized that many of their patients have both behavioral and physical health needs, there has been a complete disconnect in how this comprehensive care is provided and paid for. Data from the National Comorbidity Survey Replication indicated that 34 million American adults, or 17 percent of the adult population, had comorbid mental and medical conditions within a 12-month period. While evidence-based treatments and programs exist for improving care for this population, they are not routinely used. Now, with health reform, millions of uninsured patients with mental health disorders are transitioning to the formal health system, in particular the Medicaid program, making efforts to improve quality of care for this population an even higher priority.
Addressing this priority, the Aligning Forces for Quality (AF4Q) initiative in Maine, led by Maine Quality Counts (QC), in partnership with the Maine Health Management Coalition (MHMC) and the Dirigo Health Agency’s Maine Quality Forum (MQF), is working with MaineCare to support the implementation of Behavioral Health Homes (BHH) by coordinating the Behavioral Health Homes Learning Collaborative.
“We are taking Maine’s experience and success with its patient-centered medical home (PCMH) efforts and integrating a similar structure to our BHH initiative,” said Anne Conners, program director of QC’s BHH Learning Collaborative. “Our primary objective is to help the BHHs succeed. This is an exciting time to bring mental health issues to the table, and we are very hopeful that this collaborative will help BHHs improve the health status of our entire community and serve as a beacon to other communities looking to implement similar programming.”
BHHs are a partnership between a licensed community mental health provider (the “behavioral health home organization,” or BHHO) and one or more primary care practices. The teams work together, leaving no stone unturned, to manage the physical and behavioral health needs of individuals with significant behavioral illnesses. Each patient receives a personal care plan and continuous help from team members and resources. Both organizations receive a per-member, per-month payment for services provided to the eligible and enrolled member. BHHs use data to identify members who need additional support to manage their care, as well as provide feedback to providers on both utilization and key quality benchmarks. They are also population based, integrated, and outcomes oriented.
“This advanced model of care focuses on the ‘whole patient’ and is long overdue,” said Catherine Ryder, executive director at Tri-County Mental Health Services, a participating BHHO.
The BHHs have five key goals:
  1. Reduce Inefficient Health Care Spending
  2. Improve Chronic Disease Management
  3. Promote Wellness and Prevention
  4. Promote Recovery and Effective Management of Behavioral Health Conditions
  5. Promote Improved Experience of Care for Consumers/Families
The initiative officially launched in April 2014. QC’s BHH Learning Collaborative will include up to 35 BHHOs that will provide BHH services and care coordination to patients. Goals of the BHH Learning Collaborative include working with BHHs to improve care coordination for members and their partnering PCMH/PCP. Its structure will mirror that of the existing PCMH/HH Learning Collaborative. It will offer customized programming to facilitate collaborative learning across BHHOs and will likely include direct quality improvement support, daylong learning sessions, and monthly webinars focused on specific improvement areas. Information will be reinforced through newsletters and other communication.
“Using a more holistic approach by advancing the integration of behavioral and physical health care will help improve overall health care quality and reduce costs,” said Lisa Letourneau, MD, MPH, project director of AF4Q Maine.