HHS has recently awarded $54.6 million dollars in Affordable Care Act mental health services funding to 221 health centers nationwide. The ability to increase service capacity is welcome news since it is widely acknowledged that primary care has become the nation’s de facto mental health provider.
Every primary care presentation has a behavioral component and psychological distress drives primary care utilization. A variety of studies have concluded that 70% of all healthcare visits have primarily a psychosocial basis (Strosahl, 1998; Fries, et. al., 1993; Shapiro, et. al., 1985). Additionally, the highest utilizers of healthcare commonly have untreated/unresolved behavioral health needs (Von Korff, et. al., 1992; Katon, et. al., 2003). Therefore, primary healthcare is behavioral healthcare.
Even with increased mental health funding to community health centers, collaboration is still key for successful behavioral health initiatives, and Community Mental Health Centers (CMHCs) are the perfect partner. Integrated behavioral health within an FQHC is a problem focused, brief intervention. Working in tandem with the CMHC allows for seamless follow up for those with more chronic mental health needs, ensuring continuity of care and improved patient outcomes.
The partnership is not without challenges, however. There are many considerations when bringing together two systems that have been historically autonomous and, except for referral arrangements, largely isolated from one another.
While FQHCs have a federal mandate and substantial funding to provide care regardless of a patient’s ability to pay, CMHCs are not funded at that same level. Most CMHCs must prioritize care for those with severe and persistent mental health illnesses first, unless others with less severe mental illnesses have health insurance coverage. As a result, the uninsured with mild to moderate mental illness have often been referred to the local FQHC. Consequently, depending on the diagnosis and health care coverage, there are different doors to services that can create a significant barrier to integrated care. Close collaboration removes this barrier.
One of the biggest challenges to overcome is the fragmented payment system. Unfortunately, integrated care often involves the type of care coordination and provider collaboration that takes time and is not always billable through conventional fee-for-service systems. In addition, the disparate payment streams of the entities and different state laws require careful navigation.
The necessary exchange of health information is also a key integration challenge. Many organizations have chosen electronic health records to meet the specific needs of their respective organizations, resulting in incompatibilities that making a shared record impractical.
Despite the challenges, the benefits to collaboration far outweigh any barriers. With appropriate due diligence and laser focus on the aligned missions and shared client population, it’s a no brainer.
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