Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working With Managed Care Delivery Systems
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Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working With Managed Care Delivery Systems

Integrated Care Resource Center Technical Assistance Brief
Published: Aug 31, 2017
Publisher: Washington, DC: Centers for Medicare & Medicaid Services, Medicare-Medicaid Coordination Office
Health Delivery System Reforms Disability Mental Health and Substance Use Medicaid and CHIP Medicare State Health Policy
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Authors

Melanie Au

Claire Postman

James Verdier

Key Findings

The following are lessons from state experiences with behavioral and physical health integration models:

  • States can drive integration by combining operational and oversight functions.
  • State leadership is crucial to improve information sharing. States can require information sharing agreements, build the “backbone” for information sharing through Health Information Exchanges, and fill information gaps.
  • States should seek to balance prescriptiveness with flexibility, particularly in the area of care management and coordination, when setting plan contract requirements.
  • Misalignment of the recovery model of care in behavioral health systems and the medical model of care in physical health systems can be the most difficult challenge to overcome during integration at the state, health plan, and provider levels.

A growing number of states are integrating physical and behavioral health services for beneficiaries dually eligible for Medicare and Medicaid. These beneficiaries not only have complex needs, but must also navigate between separate programs (Medicare and Medicaid) and care delivery systems (physical and behavioral health) for their services. This brief explores the experience of six states that have achieved varying levels of behavioral health and physical health integration or collaboration for dually eligible beneficiaries within a managed care environment. States are implementing their models of integration through contracts with Medicare-Medicaid Plans or Medicaid managed care plans that are aligned with Medicare Advantage Dual Eligible Special Needs Plans. Regardless of the model chosen, the essential components of integration or coordination are the same, including combining the cultures of behavioral and physical health, information sharing, designing care management and coordination, provider training, and program monitoring and quality improvement. States can encourage the development of these components irrespective of the integration model.

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