Human Services and Behavioral Health Integration: A Model for Whole-Person Medicaid Managed Care.

A comprehensive, whole-person approach to individuals' health care can be achieved by aligning, integrating, and coordinating health services with other human services. HealthChoices, Pennsylvania's managed Medicaid program, delegates responsibility for Medicaid-funded behavioral health service management to individual counties or multicounty collaboratives. County administrators' programmatic and fiscal oversight of Medicaid-funded services allows them to create synergies between behavioral health and other human service delivery systems and to set priorities on the basis of local needs. This model supports access to community-based care, integration of general medical and behavioral health services, and programs that address social determinants of health.

Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission.

PURPOSE OF STUDY: To examine the effectiveness of a care management intervention to decrease readmissions and to better understand clinical and social determinants associated with readmission. PRIMARY PRACTICE SETTING: Inpatient mental health (MH) and substance use disorder (SUD) facilities, nonhospital SUD withdrawal management and rehabilitation facilities. METHODOLOGY AND SAMPLE: The authors identified 3,950 Medicaid-enrolled individuals who received the intervention from licensed clinical staff of a behavioral health managed care organization; 2,182 individuals were eligible but did not receive the intervention, for treatment as usual (TAU). We used logistic regression to examine factors associated with readmission. Determinants of readmission were summarized through descriptive tests. RESULTS: The intervention was associated with lower readmissions to SUD facilities compared with TAU (6.0% vs. 8.6%, p = .0002) and better follow-up to aftercare. Controlling for clinical differences between groups, regression results found increased odds of readmission for male gender (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.16-1.52, p < .0001) and dual MH and SUD diagnoses (OR: 1.52; CI: 1.29-1.79, p < .0001). Prior inpatient and case management services were also associated with increased odds for readmission. In the regression model, the intervention was not associated with decreased odds for readmission. Individuals with readmission (n = 796) were more likely to report being prescribed psychotropic medication and having housing difficulties and less likely to report having a recovery plan than those without readmission. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Characteristics of Medicaid populations with hospitalization may contribute to readmission, which may be mitigated through care management intervention.

Increased likelihood of psychiatric readmission with Medicaid expansion vs legacy coverage.

OBJECTIVES: To compare patterns of psychiatric hospitalization and readmission within 30 days for Medicaid expansion (expansion) vs previously insured (legacy) samples. STUDY DESIGN: Retrospective analysis using Medicaid behavioral health service claims. METHODS: We identified 24,044 individuals with hospitalizations in calendar years 2017 and 2018 within the network of a behavioral health managed care organization in Pennsylvania. Logistic regression was used to examine factors associated with readmission. RESULTS: Individuals covered under expansion (n = 7747) vs legacy (n = 16,297) were older and more likely to be male and European American, with higher rates of cooccurring mental health (MH) and substance use disorder (SUD) diagnoses, as well as lower rates of MH and SUD services in the 30 days prior and any prior MH hospitalization. A higher proportion of individuals with expansion vs legacy status were readmitted (11.3% vs 9.0%; P < .0001). Controlling for factors associated with readmission, regression showed an increased likelihood of readmission for expansion vs legacy status (adjusted odds ratio [AOR], 1.23; 95% CI, 1.12-1.35; P < .0001). Increased risk for readmission was also found across populations for male patients (AOR, 1.12; 95% CI, 1.02-1.22; P = .0124), those with prior MH hospitalizations (AOR, 1.65; 95% CI, 1.51-1.81; P < .0001) or other behavioral health services (AOR, 1.14; 95% CI, 1.03-1.26; P = .0142), those with longer hospitalization episodes (AOR, 1.01; 95% CI, 1.00-1.01; P < .0001), and those with cooccurring SUD (AOR, 1.58; 95% CI, 1.44-1.74; P < .0001). CONCLUSIONS: Individuals with coverage through Medicaid expansion compared with legacy coverage have an increased risk of psychiatric readmission and may warrant targeted interventions that also address service utilization and cooccurring SUD.

Payer-Provider Partnership to Identify Successful Retention Strategies for the Behavioral Health Workforce.

BACKGROUND: High staff turnover rates are a burden for behavioral health providers because they may negatively impact staff morale, quality of care, and clinical outcomes as well as increase costs. The Staff Assessment and Retention (STAR) Project is a partnership between a behavioral health managed care organization and community-based providers designed to: 1) share information on research-based approaches, 2) identify strategies that providers find successful yet feasible, and 3) develop a learning community around research-based, community-informed strategies to increase staff retention. METHODS: Participants from 87 community-based behavioral health providers completed a survey about successful strategies and barriers to staff retention, current retention and turnover rates, and ratings of commonly used strategies supported by research. Results were shared and discussed across the partnership through a learning community including a webinar co-facilitated by two participating providers. RESULTS: Successfully demonstrated but less utilized strategies included use of exit and stay interviews, training in best practices, availability of electronic records and other technology, and flexible work schedules. Providers reported the type of employment offered (full or part time, benefits, competitive wage; reported in 17% of responses), ability to offer trainings and staff development (13%) and using staff feedback (10%) were most important to retention. CONCLUSIONS: The partnership demonstrated that providers desire a vehicle for sharing ideas and problem-solving issues related to the behavioral health workforce. The endorsement by several community-based providers of lower-utilized strategies known to improve retention would not be realized across the community without the collaboration of the payer-provider partnership.

Value of psychiatric rehabilitation in a behavioral health medicaid managed care system.

OBJECTIVE: The present study was designed to describe individuals receiving psychiatric rehabilitation (PR) service and investigate program outcomes and factors associated with progress in a multisite, descriptive evaluation across Pennsylvania. METHOD: Through an outcomes-monitoring process integrated into routine service delivery, survey responses from 408 individuals participating in PR were summarized. Linear mixed models were used to examine change over time in self-reported progress ratings in rehabilitation domains and factors associated with progress. RESULTS: Significantly lower utilization of inpatient psychiatric service was observed in the 12 months after initiating PR versus the 12 months before service (15% vs. 24%; p = .002). Peer and case management service increased after initiation of PR. Specifying a domain as a goal in the service plan was associated with higher progress ratings in the learning (ß = .75, p < 0001), working (ß = 1.06, p < .0001), and physical wellness (ß = 1.27, p < .0001) domains. Average hopefulness rating was positively and significantly associated with self-reported progress in all domains. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current investigation provides some evidence that individuals participating in PR decrease utilization of inpatient service. This finding and the goals and activities reported in domains over time support the added value of PR as a Medicaid-reimbursable service to managed care efforts to promote rehabilitation outcomes and recovery for individuals with psychiatric disabilities. (PsycINFO Database Record

In managed behavioral health care, a seat at the table is not enough.

TOPIC: The involvement of individuals in recovery and their families has helped drive change in the behavioral health field. Medicaid managed care organizations (MCOs) can promote meaningful involvement by empowering stakeholders at every level of the organization. PURPOSES: Roles for self-identified service recipients, including membership on boards, advisory committees, and grievance committees; in research and evaluation; in employment at all levels of the MCO; and in individual interactions with providers--as well as the impact of this involvement on individuals and the organization--is explored. SOURCES USED: Research on the implications of service user involvement is reviewed and actual practice at an MCO is highlighted. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Research on the benefits to organizations of service user involvement is scarce. However, based on their experiences, the authors believe it is not only the right thing to do, but the smart thing to do. They challenge the field to join them in involving service users and seeking ways to measure the impact of this empowerment on managed behavioral health care.