A couple of weeks ago, my colleague Sarah Threnhauser talked about the different types of integration models – integrated service delivery system and integrated care coordination (see All Integration Is Not The Same). Today, I want to focus on integrated service delivery systems – the model for delivering clinical care and treatment to consumers – not the management of care. And specifically, how the Substance Abuse and Mental Health Services Administration (SAMHSA) is helping community behavioral health providers implement integrated service delivery through its Primary Behavioral Health Care Integration (PBHCI) grant program.
Created in 2009, the PBHCI program awards grant funds to behavioral health organizations to co-locate primary care services for individuals with serious mental illness (SMI) or substance use disorders who are at-risk for chronic conditions. The idea is that consumers are most likely to access care and feel comfortable accessing care where they have their primary contact with the health care system. Between 2009 and 2015 a total of over $128 million was awarded to 142 organizations. In 2015, SAMHSA plans to award an additional $40 million+ to 102 organizations. Thus far in 2015, 16 grantees have been awarded a total of about $9.9 million (see Primary and Behavioral Health Care Integration RFA No. SM-15-005).
As part of the specifications of the PBHCI program grant in 2015, awardees must implement the two core requirements:
- Co-locate primary care provided by primary care professionals at the site of the behavioral health organization
- Provide medically necessary referrals to consumers from specialty care professionals or other coordinators of care
Additionally, behavioral health organizations must serve as health homes and provide the six core requirements (see Behavioral Health Homes For People With Mental Health & Substance Use Conditions: The Core Clinical Features). Organizations are also encouraged to achieve meaningful use standards for health information technology, participate in the Million Hearts Initiative, and implement wellness programs for consumers.
The program intends for integrated physical and behavioral health care to extend beyond the four-year grant cycle and make a lasting change in the organization and the consumer’s care. SAMHSA specifically states that funds from the PBHCI program are to be used to support consumers without public or private insurance or to provide services not covered by an individual’s insurance. Additionally, by the second year of the program, organizations must submit a sustainability plan to SAMHSA detailing how the program will continue when the grant cycle ends.
So far, the results of the program has been mixed. In partnership with the RAND Corporation, SAMHSA conducted an evaluation of the early grantees in 2013; the evaluation process looked at the clinical and structural approaches of implementing integrated care, health outcomes, and what model features lead to better outcomes. As the results were inconclusive, perhaps the most useful results are the health outcomes. A review of three grantees compared to control clinics with little to no primary care integration found improvement on some, but not all health outcomes. Health outcomes that showed improvement included diastolic blood pressure, total cholesterol, LDL cholesterol, and fasting plasma glucose. Health outcomes that did not show improvement included systolic blood pressure, body mass index, HDL cholesterol, glycated hemoglobin, triglycerides, and self-reported smoking. Further improvements in physical health symptoms did lead to an improvement in behavioral health symptoms, which showed no improvement over the course of the program (see Evaluation Of The SAMHSA Primary & Behavioral Health Care Integration (PBHCI) Grant Program: Final Report).
For more on primary behavioral health care service integration models, check out these resources in the OPEN MINDS Industry Library – Integrated Care – Advice From Execs Making It Work and Making Integrated Service Delivery A Financial Possibility. And, for more information on the SAMHSA PBHCI grant program, be sure to check out, What Is The SAMHSA Primary & Behavioral Health Care Integration Grant Program?: An OPEN MINDS Market Intelligence Report. The report answers a number of questions, including:
- What is SAMHSA’s Primary & Behavioral Health Care Integration Program?
- How much has been spent on integration grants and who are the grant winners?
- What have been the results of the grant program?
This report is free to all OPEN MINDS Circle premium members, and can be purchased in the OPEN MINDS e-Store for $495.