The Certified Community Behavioral Health Clinic (CCBHC) model means more money for behavioral health providers, better outcomes for patients and lower costs for the health care system overall.
While the model was originally only accessible to providers located in select states participating in the CCBHC Medicaid demonstration, these days, providers nationwide can become CCBHCs with the help of grant funding from the Substance Abuse and Mental Health Services Administration (SAMHSA).
The thought of implementing the model — which requires providers to offer a comprehensive set of services to people with complex needs — can be intimidating. But doing so is worth the time and effort it takes to put it into practice, according to Melissa Jillson, vice president of integrated health care at Liberty Resources Inc., which was awarded a CCBHC expansion grant in 2020.
Headquartered in Syracuse, New York, Liberty serves patients across New York, Texas and, most recently, New Jersey. It treats more than 22,000 people per year and provides behavioral health treatment; early intervention and developmental disability offerings; family services; community-based services; and integrated care.
Some of those services are new and come courtesy of Liberty’s CCBHC rollout, for which Jillson served as the project manager.
“What CCBHC has meant for us and what excites me most is integration,” she said recently during a webinar hosted by the health care research and consulting firm Health Management Associates (HMA). “We have been talking about integration for years within our organization, and it just felt like we couldn’t get the momentum to really make any forward progress.”
That is, until Liberty adopted the CCBHC model, which requires and rewards integration. In fact, it helped push Liberty toward a new medical record system to allow for better care coordination and improved communication overall.
“It’s really helped us to improve our communication across our services,” Jillson said. “It’s forced us to really look at how we collaborate with each other, and as a result, we’ve created several different methods for case conferencing or addressing client concerns or issues, so that has been a nice value-add to the agency.”
Adopting the CCBHC model has also allowed Liberty to expand its staff — something it wouldn’t have been able to afford without the grant funding. The money helped Liberty hire additional peer workers, targeted case managers and psychosocial rehab providers, in addition to other types of clinicians.
In turn, Liberty can serve more clients, better — including those in desperate communities.
“Although it’s still a work in progress, we are definitely having an active dialogue with our marketing department [about] how … we best outreach these clients,” Jillson said. “Our HR is even involved now. … We’re digging deep and thinking about processes, policies and procedures through HR to ensure they’re equitable and culturally competent — and even thinking creatively about how we diversify our workforce so that it’s truly representative of the clients that we’re serving.”
Adopting the CCBHC model
The CCBHC model was created back in 2014 to provide resources to clinics looking to ramp up their service offerings for uninsured and underinsured individuals. It started as a Medicaid demonstration, which will continue to operate in select states through at least September 2023.
Under the demonstration, providers get higher reimbursements in return for offering a set of comprehensive care services for individuals with complex needs. Some of those services include primary care and 24-hour crisis care, as well as comprehensive outpatient mental health and SUD treatment.
Meanwhile, behavioral health providers who aren’t located in demonstration states can become CCBHCs by applying for special grants from SAMHSA, with the main difference being that the grant money is capped and runs out after a certain amount of time.
CCBHCs have been shown to improve access and reduce wait times for patients, in addition to improving overall outcomes.
In fact, according to research from the National Council for Mental Wellbeing, behavioral health providers reported a 17% boost in patients served after becoming CCBHCs. Additionally, 50% of CCBHCs provide same-day access to patients, while the national average wait time for behavioral health services is about 48 days.
On top of that, SAMHSA data released as part of President Trump’s 2021 budget showed CCBHC patients saw huge reductions — more than 60% — in both hospitalizations and emergency department visits. Plus, they saw employment rates increase and overall mental health improve.
Still, it’s not all smooth sailing for providers who implement the model.
“Although we are able to add capacity, we’ve definitely had some challenges with recruitment due to workforce shortages,” Jillson said, noting that COVID-19 also posed implementation challenges for Liberty. “That’s definitely had a negative impact on our ability to improve access.”
As such, she recommends grant recipients start the hiring process as soon as they learn they’ve chosen as an awardee.
Jillson also advises providers to get organized before their CCBHC grant begins. That means designating a startup team and process to help implement the model. That team should include employees from all areas of the organization, from clinical to HR to IT.
Additionally, all employees should be extensively trained on the model. Because rather than just another grant program, it’s an organizational identity, Jillson said.
After implementation of the CCBHC grant begins, providers have four months to build capacity to become a CCBHC. That consists of building out services and preparing a number of other grant deliverables.
Some of those include a behavioral health disparities impact statement; one’s annual goals and budget; an attestation statement; and any other requirements mandated in the special terms and conditions section of the grant.
National outcome measure surveys (NOMS) are another important deliverable mandated in the CCBHC rulebook. CCBHCs have to be able to give NOMS to clients upon admission, as well as in six-month intervals thereafter.
At first, Liberty tried to outsource that process.
“The lesson learned was that we should have our clinicians more engaged in the NOMS-collection process because they are having more of that direct, frequent [patient] contact,” Liz Krell, assistant director of process optimization at Liberty, said during the webinar. “[Even with] our peers and our targeted case managers that are reaching out [for reassessments and] who are engaged with the clients as well, [patients] would rather do it with their clinician that they have an established relationship with.”
Finally, Jillson and Krell recommend providers implementing CCBHC grants develop a peer advisory board to ensure they’re meeting the needs of clients while also pointing out areas that could be improved. They said that the board meet monthly and that providers should ask specific questions so they’re not met with “a bunch of crickets,” according to Jillson.