Where’s the Behavior in Healthcare?

A couple of recent articles have reminded me of how important behavioral components will be in our new healthcare marketplace. My only question is whether and how behavioral health providers will position themselves to take advantage of the restructuring of our healthcare system.

A couple of days ago, I received a newsletter from SAMHSA and the National Council for Community Behavioral Health through the SAMHSA-HRSA Center for Integrated Health Solutions. The focus of this newsletter was the necessary core clinical features for the creation of a Behavioral Health Home.

I am not sure exactly what a Behavioral Health Home is, but SAMHSA has been working to be sure behavioral health services are included in the Health Home concept and implementations. It is very likely that integration of healthcare services will occur with behavioral health services being provided as part of a larger health system.

Today’s email announced June workshops on finance and billing integration.

Billing for Integrated Health Services
When: Tuesday, June 12, 2012, 2:00-3:30 pm EDT
Presenter: Kathleen Reynolds, Senior Consultant, SAMHSA-HRSA Center for Integrated Health Solutions, and Vice President, Health Integration and Wellness Promotion, National Council for Community Behavioral Healthcare

Financing integrated healthcare is one of the key challenges encountered by organizations during implementation of services. This webinar will feature the state based Interim Billing and Financial Worksheets developed by the SAMHSA-HRSA Center for Integrated Health Solutions.

The worksheets identify the major CMHC and Health Center CPT codes used for billing integrated health services and their availability for use in each of the 50 states. The webinar will address the core aspects of billing for integrated health services and assist participants in successfully using the worksheets to maximize billing opportunities for integrated health services.

If your organization would like to overcome financing barriers and better understand billing rules and regulations, this webinar will help you to:

  • Learn about financial viability and sustainability of integration efforts through appropriate and accurate billing for services.
  • Understand how state Medicaid programs determine the types of services, codes, and individuals credentialed to provide services, resulting in unique billing rules and regulations in each state.
  • Get familiar with CPT codes that can be used to bill for services and the discipline and credentials required by the public funding source (i.e., Medicare, Medicaid) to bill for the codes.

Register today. The webinar is free, but space is limited.

Preparing for Bidirectional Integration: Lessons from the Field
When: Thursday, June 14, 2:00–3:30 pm EDT
Presenters: David Lloyd, Founder, MTM Services; Anthony Zipple, President/CEO, Seven Counties Services; Frank Berry, CEO, View Point Health

Significant practice changes lie ahead for community behavioral healthcare as parity, coverage expansion, and new practice paradigms make integration of care the expectation, not the exception. In July 2011, the SAMHSA-HRSA Center for Integrated Health Solutions launched the Integrated Health Provider Learning Collaborative program. The program engaged 15 organizations to help answer one question — how can community mental health and addictions treatment organizations shift their practices to support bidirectional integration?

During this 9-month program, participating sites learned how to nurture three primary values required for community behavioral health organizations to serve as partners in new service delivery models — be accessible, be efficient, and produce measurable outcomes. They share their experiences on this webinar.

If your organization is interested in preparing for bidirectional integration, this webinar will help you to:

  • Learn how to assess readiness levels for integration.
  • Get a firsthand view of integration challenges and accomplishments from two of the collaborative participating sites.
  • Identify key areas of change in service delivery models, administrative processes, and culture shifts to get ready to integrate with community partners.

Register today. The webinar is free, but space is limited.

Traditional mental health problems will certainly be addressed in this integrated manner, particularly in the public sector. Simultaneously, physical problems that involve significant behavioral components are likely to be treated using integrated care.

An article in Fierce Health Payer newsletter talked about insurance carriers developing anti-obesity programs.

“Is there coverage [for obesity] is yesterday’s conversation,” Karen Ignagni, president of America’s Health Insurance Plans, told KHN. “Today’s conversation is how to design coverage to encourage people to use it and continue using it.”

UnitedHealth, for example, is considering offering a version of the Diabetes Prevention Program, which is an intensive weight-loss intervention, for overweight and obese adults. “Doctors are in short supply,” so the insurer wants to introduce intensive behavioral change programs through the community rather than doctor offices, Deneen Vojta, senior vice president of UnitedHealth’s Center for Health Reform & Modernization, told KHN.

Read more: Insurers launch more anti-obesity programs – FierceHealthPayer http://www.fiercehealthpayer.com/story/insurers-launch-more-anti-obesity-programs/2012-05-16#ixzz1wU9hmuzH
Subscribe: http://www.fiercehealthpayer.com/signup?sourceform=Viral-Tynt-FierceHealthPayer-FierceHealthPayer

While some insurers will focus partially on use of physical treatments and surgeries to facilitate weight loss, it seems to me that this is an ideal arena for behavioral health specialists. Cognitive and behavioral changes are crucial to weight loss. Who is better prepared to facilitate these changes than mental health providers?

Where is your organization currently in considering the evolution of healthcare services to incorporate behavioral health? Do you currently operate a practice that works with physicians on physical care? Are you part of a community health center with integrated general health and behavioral health components? Please share your experiences.

0 thoughts on “Where’s the Behavior in Healthcare?

  • Thanks for your comments, Vince. I think many private practitioners are in the same position you are. Unless they do a very health-oriented practice, they see themselves continuing to function quite separately from general healthcare.

    The picture is not the same in the public arena. At this time, about 60% of the funding for all mental health and substance abuse services comes from public, not private, sources. Of the people receiving such services, a large percentage have serious physical illnesses as well.

    It is possible that changes brought about by the Affordable Care Act and the Wellstone-Domenici Parity Act will result in more individuals having private insurance and receiving behavioral health services in the private arena.

    This study by the Kaiser Family Foundation has some very interesting information about how behavioral health services are paid for:


    It might be interesting to you and others to take a look. Thanks for sharing your thinking.

  • Vince Bellwoar says:

    Just some random thoughts…
    We have looked at this from a number of angles. What does integrated care really mean? I have seen pilot programs attempting to create some form and the results are not impressive. Sure, there are patients who would benefit from having a mental health practitioner in a PCP office, but the concept doesn’t seem to work for the great majority of patients who seek mental health services. The practical aspects of service delivery get in the way. Is the PCP office going to designate one room as the “psychologist’s office.” Is the psychologist supposed to remain available to deal with a patient that the PCP just saw–and now wants to walk that patient down the hall to see the psychologist? Not going to happen. A good psychologist will end up having his/her schedule fairly booked with weekly appointments. But maybe the integrated care model is to have a psychologist not really do “therapy” or any type of extensive treatment beyond a few sessions. Take the e.g. above re obesity. While it is easy to argue for the benefits of psychological interventions to treat obesity, and a psychologist could create a package of sessions to treat obesity (or smoking cessation), there typically needs to be an individualized approach as well.
    We treat a lot of patients each week in our practice, about 1200 sessions a week. About 80% of these patients do not have a concomitant physical disorder and so they would see their PCP quite infrequently. Meanwhile, they come to our practice the same time each week for an average of 10 sessions. Are these patients supposed to go to their PCP offices instead?
    SO, when discussing integrated care (integrating mental health with primary care services) aren’t we really talking about those patients who have a physical disorder that is caused or worsened by a mental health disorder, such as high BP, sleep issues, obesity, etc? Why not refer these patients to the psychology group that is already well established instead of hiring a masters-level therapist and paying them via the PCP practice?

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