People coping with serious mental illness often spend a large percentage of their lives tangled in a number of care systems: searching for therapy referrals, scheduling physicians’ appointments, picking up prescriptions, finding reliable transportation, even searching for a job or an affordable home.
Untying the tangles of these complicated yet mundane tasks can be hard on anyone. For those already coping with the stress of mental illness, this process can take a serious toll — including, according to Minnesota Department Human Services (DHS) Commissioner Emily Johnson Piper, “multiple chronic health conditions and . . . early mortality.”
In an attempt to counter this problem, DHS has recently certified 17 Minnesota providers to coordinate behavioral health services for clients with serious mental illness. In order to qualify for these highly individualized care services, known as a behavioral health homes, clients must be covered by Medical Assistance, Minnesota’s Medicaid program.
Certified providers — the list is likely to grow to as many as 25 statewide in the next month — will deliver individualized behavioral health home services from a “strength-based” approach, meaning that workers will support clients based on their individual, family and cultural values.
Nathan Moracco, DHS assistant commissioner for health care, said that by focusing on the strengths of individuals and their unique care needs, the approach helps smooth the tangles of care, providing key supports that help make systems work better for individuals.
“This program is highly patient-centric,” he said. “It puts the patient at the center and wraps all the needs around that patient, rather than doing it the old way, forcing a patient to interact with an existing medical structure or system.”
Enhancing existing approaches
To meet certification requirements, behavioral health homes must provide six core federally mandated services for their clients: care management, care coordination, health promotion and wellness, transitional care, patient and family support, and referral to community and social support services.
These are services that many Minnesota providers were already offering to their patients, said Pahoua Yang, Amherst H. Wilder Foundation vice president of community mental health and wellness. Behavioral health home certification — Wilder was among the to earn the designation — means that they can now file for reimbursement. The program helps solidify good intentions, creating a documentable framework on which to build a range of client services.
“Care coordination is already what we do with our clients because it is the right thing to do,” Yang said. “With behavioral health home certification, it is now a sustainable benefit that we will be able to do in a more intentional way in some areas of services rather than piecemealing it together.”
Wilder has named their behavioral health home program Wilder OneCare.
“Through Wilder OneCare,” Yang said, “patients have access to a care coordinator who can help them navigate through multiple needs and multiple specialists and services as well as the other people they may typically need in order to heal and be well. With this program, there is one person helping clients, being the glue to help them get the care they need.”
The program, Yang added, is not about keeping clients in a holding pattern.
“There is a huge focus on recovery,” she said. “It is all about getting people to live the life that they want to lead, to be healthy and happy, for adults to find work and have families, for kids be successful at school.”
New programs, new providers
Fairview Health Services and University of Minnesota Health were also in the first group of organizations certified as behavioral health homes. Chris Beamish, Fairview Behavioral Health Services director of systems clinical integration, said that the designation further improves the quality of care for their patients.
“For us, behavioral health home services is a means to expand and enhance the care we were already providing,” Beamish said.
One way that Fairview is expanding its care model for clients with serious mental illness is by hiring community health workers, specifically trained individuals who provide hands-on community-based care.
The community health worker, Beamish explained, “is a new and exciting role for us. We see this as a position that can ago in people’s homes, accompany them to appointments, help them remember the recommendations their primary care provider made, help them get to pharmacy, pick up medications, break down barriers to help them get to a referral or housing or job opportunity.”
Fairview has also enhanced the role of behavioral health clinician, offering patients eligible for behavioral health home services same-day access to masters-level mental health professionals.
“Behavioral health clinicians talk to patients about stress and other mental health issues,” Beamish said. “They use the same rooms that patients see their primary care provider in, so it helps normalize the experience. Clinician visits are not intended to replace traditional therapy — they are meant to provide support and perhaps bridge a patient until they see the traditional therapist. They are key members of our behavioral health home services team. ”
In the right direction
Moracco sees this expansion and innovation of behavioral health care as a positive move.
“I think the state is heading in a great direction,” he said. “This is where Medicaid is going, and Minnesota is out ahead on this one.”
He’s also appreciative of local providers’ willingness to step forward and apply for the behavioral health home certification program.
“We put out a proposed model and asked for applications,” he said. “A number of providers stepped forward. They’ve been very much a part of helping us build and shape these programs. I think that speaks highly of the health-care providers in the state. They are willing to go on a journey with us to provide better care for their patients.”
In the midst of all that innovation, Moracco said he believes that Minnesota providers haven’t lost sight of the reason behavioral health homes were created in the first place.
“Its about best serving the needs of the client with significant mental health issues,” Moracco said. “That’s still front and center, just as it should be.”