Mapping gaps and redundancies in behavioral health care: Community mental health and Medicaid clients
Many individuals who receive Community Mental Health (CMH) services in Washtenaw County have complex health and social service needs. They may receive a variety of services – physical and behavioral health services, care coordination, care management, and social support services – provided by both their CMH and by their Medicaid health plan (MHP). These services, however, are often not coordinated and may be difficult to navigate.
Washtenaw County Community Mental Health (WCCMH), Blue Cross Complete (BCC), and the Center for Health and Research Transformation (CHRT) will undertake an integration program. The proposed program will identify gaps in care and redundancies in services so that care can be better coordinated, offering the client a system that can be navigated easily and provide an overall improvement in care.
CHRT will identify shared clients of Washtenaw County Community Health and the Blue Cross Complete Medicaid health plan. The population will include adults with serious mental illnesses, children with serious emotional disturbances, and anyone receiving substance use disorder services through WCCMH. In addition, CHRT will include individuals with mild to moderate mental health concerns. CHRT will explore the overall care experiences of all of these clients and will work with partners to map the current service environment, to identify areas where community mental health and Medicaid health plan services overlap, and to highlight any gaps where clients do not receive all the care they need.
Once the mapping is complete, a second phase may be initiated. During that phase, CHRT would work with partners to design organization-specific implementation plans guided by the opportunities identified during the mapping process. These plans would define integration goals and specific actions toward each goal, and would identify targeted outcomes from better integration and timelines to assess the desired outcomes such as better coordination of varied services through increased data sharing, improved understanding of partner organizations’ roles and service delivery, and attention to gaps in needed services. The program would also include modeling potential financial savings associated with program efficiencies.
Key informant interviews will generate data about each organization’s processes for assessing eligibility, enrollment, conducting needs assessments, providing physical and behavioral health services, case management and care coordination, and other relevant aspects of care such as the engagement of peers and of community health workers. In addition, the interviews will identify data sharing and data analysis opportunities to help the WCCMH and BCC to maximally integrate care for their shared clients. A set of recommendations will be developed to guide implementation efforts for the second phase of this program.