This article is sponsored by Relias. In this Voices interview, Behavioral Health Business sits down with Relias Senior Clinical Effectiveness Consultant Rola Aamar, PhD to learn the ABCs of CCBHCs: Certified Community Behavioral Health Clinics. These clinics provide a comprehensive suite of mental and behavioral health services to vulnerable populations. Dr. Aamar walks through the steps that behavioral health organizations can take to become a CCBHC and explains the impact these organizations can then make.
Behavioral Health Business: Dr. Aamar, you’ve been with Relias since February 2018, and in a new role since October. You have a vast academic experience. What are the career experiences that you most draw from in your current role?
Dr. Rola Aamar: I transitioned in October to a new team called the “Solutions Group,” which comprises experts from across the health care industry. As the senior clinical consultant for clinical effectiveness, I work one-on-one with behavioral health organizations to improve their service delivery, patient and clinical outcomes and their operations at an organizational level.
As you can probably imagine, I bring every aspect of my clinical experiences into my day-to-day role. Whether it’s program management and administration, client engagement and supervision or measuring outcomes and evaluating program effectiveness, all of those clinical experiences help on both the internal and client-facing planes.
This type of clinical and field experience is not just limited to our solutions group — it is fairly standard throughout Relias as a whole. Relias intentionally incorporates clinical experts, whether they’re MDs, PhDs, nurses, therapists, social workers and so on. Every department in our organization has clinical experts, ensuring the quality and efficacy of the products and services that we provide.
Tell us about Relias. Who does it serve, and what is its mission?
Dr. Aamar: Relias is a tech company that specializes in education solutions and software for health care and human service providers. We help 11,000 client organizations and 4.5 million caregivers across the health care continuum elevate their performance to improve clinical, organizational and financial outcomes. Our mission is at the core of how we serve our clients, which is to measurably improve the lives of the most vulnerable members of society and those who care for them.
The Certified Community Behavioral Health Clinics, or CCBHC, is a new provider type in Medicaid designed to provide a comprehensive suite of mental and behavioral health services to those in need. The NCBH is now pursuing a significant expansion goal to add more of these in the US. Why is their availability so important to at-risk populations including seniors?
Dr. Aamar: Relias and National Council have a long partnership focused on supporting behavioral health organizations in the delivery of quality services in evidence-based practices. The National Council has been a leader in advocating for the expansion of CCBHCs across the country. Through that advocacy for expansion grants, CCBHCs have grown substantially since the original eight state Medicaid demonstration.
There are now 340 CCBHCs across the U.S., which is tremendously important due to the scope of services CCBHCs provide. Specifically, there are nine services that CCBHCs are required to provide, either directly or through formal partnership with DCOs or Designated Collaborating Organizations. The expansion of the scope of services in an integrated fashion is at the core of what CCBHCs do and why they’re so valuable.
At the top of the list in those nine services are crisis mental health services, including 24-hour mobile crisis. These services help redirect patients out of emergency departments and into crisis services. CCBHC services also include screening, assessment and diagnosis, which are at the core of outpatient care, patient-centered treatment planning, which ties back into the core purpose of outpatient services, and services for members of the armed forces and veterans.
Ultimately, this boils down to providing vulnerable populations with consistent access to timely services, regardless of their ability to pay. Thanks to a strong focus on care coordination, the CCBHC can ensure that individuals receive necessary services from a variety of providers, thus promoting whole person care. The CCBHC funding model also helps alleviate some of the financial strains that behavioral health providers often experience, which allows them to expand their staff and services, streamlining operations to improve the quality and effectiveness of care.
CCBHCs are grant-funded through SAMSHA, and they are awarded funding to offer a full round of services in primary care and behavioral health, with a heavy focus on suicide prevention. For those who receive the grant, what are the top three most important ways to use that funding?
Dr. Aamar: Funding use varies from organization to organization, and it depends heavily on what the provider needs to meet the six program requirements for certification. CCBHCs go through a needs assessment, which helps them determine the top areas of focus. The six areas required for certification are staffing, availability and accessibility of services, care coordination, scope of services, quality recording and other types of reporting and organizational authority, governance, and accreditation.
Again, it’s going to vary heavily from organization to organization, but where funding may be used is in areas such as hiring and training. It often includes new service lines that the organization will be providing, such as peer support services. It might include building or growing the reporting infrastructure so that they can report on both program and quality outcomes. It could include investment in technologies that help streamline care coordination, data management or documentation of services and patient outcomes.
Many CCBHCs seek out technical assistance to stand up their program and ensure the staff and their DCOs are set up for success during the four-month implementation period.
What are the most exciting and important outcomes we’re seeing for those treated by CCBHCs?
Dr. Aamar: There have been many exciting benefits and outcomes since CCBHCs have been implemented. The first of which is that CCBHCs consistently report an increase in the number of patients they serve. Given that the purpose of the CCBHC model is to increase access to services, this is a crucial outcome.
Along with that, CCBHCs have reported a substantial decrease in wait time for both initial visits and follow-up visits, which are particularly important for individuals seeking addiction treatment or crisis services. The sooner patients have access to care after they seek out services, the more likely they are to continue their needed services.
Third, there have been increases in hiring and retaining staff, which is an important outcome across CCBHCs. There’s a staff shortage in the mental health workforce, and rural areas have seen a significant shortage among psychiatrists and other prescribers. This directly impacts the speed and frequency with which patients have access to services. CCBHCs have been able to increase their staff, increase salaries and provide more comprehensive training in an effort to support staff retention.
The decrease in hospitalizations and ED visits is another important success metric in behavioral health. Through increased funding for care coordination and comprehensive outpatient services, CCBHCs showed a significant decrease in both ED visits and hospitalizations for the populations that they serve.
What do behavioral health organizations need to focus on to become a CCBHC?
Dr. Aamar: To become a CCBHC, behavioral health organizations have to focus on the SAMHSA certification criteria. There are six certification criteria that I mentioned earlier. They’re often referred to as program requirements. The behavioral health organization has to show that they either currently meet the requirements or can meet the requirements within the four-month implementation timeframe from the date that the award is granted.
That’s what they need to be focused on in order to become a CCBHC. SAMHSA outlines these program requirements in great detail in their certification criteria checklist.
What does Relias do to help behavioral health organizations become a CCBHC — and how does Relias support them afterward?
Dr. Aamar: Relias serves over 120 CCBHCs across the country by providing them with education solutions that not only satisfy CCBHC certification criteria but also support CCBHCs in continuously improving care delivery and financial outcomes. Leveraging our online training solution, organizations can improve knowledge on topics like trauma-informed care, person-centered care and culturally sensitive care, which are all CCBHC training requirements.
It also includes topics like employee wellness, developing leadership and so on. Access to quality training is a crucial part of the first certification criteria under staffing. Additionally, Relias solutions allow CCBHCs to efficiently track and report on staff training and licensure, which are required for the fifth certification criteria: reporting.
No one knew what to expect in 2021. What has been the biggest surprise to you in the behavioral health industry this year, and what impact do you think that will have on the industry for the remainder of the year?
Dr. Aamar: I don’t know if I would call them the biggest surprises, but there are definitely three major lessons learned. First is the increased visibility around the need for mental health. Second is in the area of innovation. Behavioral health organizations were challenged to innovate quickly throughout the pandemic in order to continue providing the services their populations needed. Behavioral health organizations rose to the challenge, especially when it came to implementing things like telehealth services and the safety protocols needed to keep their patients and staff safe.
Finally, we’ve seen an increase in funding through grants for behavioral health organizations. This includes an increase in funding for CCBHCs, technological innovation and innovation of behavioral health organizations. These technology grants are offering things like iPads and telehealth infrastructure. While there’s still room to grow in behavioral health funding, these are important first steps as we move into 2021 and organize our post-pandemic behavioral health priorities.
Relias is honored to be a partner to CCBHCs as they work towards increasing access to services and patient-centered quality care. We see the value that CCBHCs bring to the behavioral health field. We believe that the CCBHC service delivery model will have long-term positive effects on the lives of vulnerable populations.
Editor’s note: This interview has been edited for length and clarity.
Relias’s goal is to provide CCBHCs and their staff members with the knowledge necessary to succeed, doing so through its training solution and delivering sustainable best practices to drive high quality, culturally sensitive care. To learn more, visit relias.com/industry/CCBHC.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].