DHCS 1115 Waiver Behavioral Health Integration Technical Workgroup

DHCS 1115 Waiver Behavioral Health Integration Technical Workgroup Presented by Louise Rogers, May 19, 2010

DUALS WITH MENTAL INLLNESS AND SUBSTANCE USE l l l l Prevalence of mental illness and substance use High cost, high risk, poor outcomes Fragmented benefit in most counties: Medicare, Medicare HMOs, Medi-Cal HMOs, Medi. Cal specialty mental health, Drug Medi-Cal Difficulty participating in Medicare Lag in payments Paucity of providers Paucity of services

COSTS WITH AND WITHOUT MENTAL HEALTH CONDITION Cost Without Mental Health Condition Cost With Mental Health Condition All Adults (with and without MH conditions) $1913 $3454 Heart Condition $4697 $6919 High Blood Pressure $3481 $5492 Asthma $2908 $4028 Diabetes $4172 $5559 From Carter Center Nov 2009 Presentation citing Robert Graham Center for source of data. Larry Green author.

SAN MATEO COUNTY EXPERIENCE AS A COHS FOR DUALS l Health Plan contracts with and delegates responsibility for Care. Advantage to County Behavioral Health bills Health Plan for Medicare portion of benefit and specialty mental health Medi-Cal for Medi-Cal portion. l PROS: reduces fragmentation improves provider network capacity improves services timely payment increases federal funds ü ü ü l ü CONS: BH must meet various federal health plan requirements for Advantage plans which are not identical to Medi-Cal requirements

HIGHLIGHTS FROM BHI TWG l l ü ü ü Integrating behavioral health in treatment of chronic conditions reduces overall health care costs There are best practices that should be addressed for integrated care with any group of enrollees: care management data management and information exchange engagement of consumers performance measures and financial incentives governance clear designation of person centered health care home

4 QUADRANTS MODEL