Behavioral and physical health integration has been a hot topic for the last few years.
Even the Centers for Medicare and Medicaid Services (CMS) have focused its efforts on the space, announcing a new cost control initiative called the States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model), which focuses on enhancing care coordination.
In February, CMS announced The Innovation in Behavioral Health (IBH) Model, which is focused on connecting adults with mental health or substance use disorders to physical, behavioral and social care supports.
Many provider organizations are hammering out exactly how to integrate these services. Still, some, such as home health care provider Innovive, have been doing integration for years. Massachusetts-based Innovive Health provides home health to individuals with serious mental illness (SMI). The company’s goal is to keep high-acuity and high-risk patients at home and out of the hospital.
Behavioral Health Business sat down with Innovive CEO Joe McDonough to discuss the future of integration and the lessons learned along the way in the latest Perspectives podcast.
Highlights from the conversation are below, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.
BHB: The federal government is pushing for the integration of physical and behavioral health care. How do you foresee those changes shaping the future of healthcare?
McDonough: It’s been a long time coming. I’m very grateful that the federal government and its policymakers are looking at our types of patients from a whole-patient perspective. This pilot model, the Innovation in Behavioral Health Model that the federal government is proposing, is a wonderful step in the right direction.
One of the central tenets of this model is that they’re looking at combining a patient’s behavioral health issues, medical issues, really looking at the whole-person– and treating them as such. Oftentimes, these patients could be diagnosed with schizophrenia, but they also may have a concurrent diagnosis of diabetes.
Right now, the care environment for these patients is incredibly fragmented. Often, the psychiatrist and the primary care physician do not talk. So, I think this is a really welcomed step in the right direction from the federal government.
What do you see in terms of the difference in outcomes when integrated care is happening, especially in that serious mental illness population?
One of the things that everyone, I believe, needs to focus on for this population is the community, and really looking at these patients in the lowest-cost care environment where they live. Traditionally, there’s been so much focus spent on the hospital as sort of the starting point for these patients.
We look at the hospital as the failure point. The best way to take care of these patients is in the community and in their own homes.
The fact that the federal government is really focusing on that is a wonderful step in the right direction, because hospitalizations are so costly.
In Massachusetts, for instance, the average hospitalization time for these types of patients is 11.3 days, which costs the state over $38,000 for each hospitalization. It’s not uncommon for these patients when they’re not being treated by any community services, such as home health care, which is what I provide, for them to have 10 to 12 hospitalizations per year, which is a tremendous cost on state Medicaid systems.
Innovive has really been one of the pioneers of this physical and behavioral health integration. What are some of the lessons learned from doing this model for some time?
I think the lessons learned is that you can really get good outcomes by really defragmenting the system.
Just getting all of the stakeholders on the same page is important. For instance, what we do when we admit patients is we communicate with the psychiatrists and will communicate with any kind of specialists that are working with the patients, as well as their primary care physician. And oftentimes patients could have case managers with the Department of Mental Health, or they could have case managers with an ACO that they’re working with.
Getting everyone to work together creates the most optimal outcomes.
