California Health Care Improvement Projects (CHIPs)

Creating a County-Wide Group Therapy Network (MCBH)

My project aims to provide access to Countywide therapy groups for adults suffering from severe mental illness. Monterey County Behavioral Health (MCBH) Adult System functions within regional silos composed of 4 different regional clinics in Salinas, Marina, Soledad, and King City. Currently, a behavioral health client can only obtain therapy group services offered by a regional clinic actively serving the client.

My project will create a cohesive network of therapy group services that can be offered to any behavioral health client within the Monterey County adult care system- regardless of which region serves the client. The referral form will be a simple cloud-based excel sheet on Microsoft Teams application. Every MCBH regional office already utilizes the same electronic health record system (AVATAR) and the same billing codes; thus, offering county-wide group therapy services to all Monterey County behavioral consumers is a no-brainer!

By utilizing a network of shared group resources, our adult behavioral health system will achieve the following goals:

1. Strengthen inter-regional collaborations.
2. Provide MCBH client’s a diverse list of available therapy groups across all regions.
3. Leverage the expertise and creativity of our master-level clinical staff/social worker team acrossMonterey County Behavioral Health.

Monterey County residents already view our entire agency as one large entity- it’s time we (MCBH) actually as one cohesive adult care system.

Integrating Behavioral Health and Autism Services into a Medical Health Plan

Patients with Mental Health (MH) conditions have poorer quality outcomes and experience persistent barriers in accessing care than those without MH conditions. Individuals with a Serious Mental Illness (SMI) or Substance Use Disorder (SUD) die over 20 years earlier than individuals without such a diagnosis. People with MH diagnoses incur costs more than those without MH disease. While the current health delivery system is shifting, it often separates Physical and Mental Health care. The solution to improved health outcomes for patients affected by MH conditions is complex, but a proven solution is integrated care. Integrated Care is a team-based approach of PCP and MH providers using systematic methods to provide patient-centered care that addresses issues including MH and SUD, life stressors, and ineffective health care utilization patterns.

In 2014, Medi-Cal health plans became responsible for the Mild-To-Moderate MH (M2M) and Autism Spectrum Disorder (ASD) benefits; this required health plans to oversee the delivery of services and benefits to members with mild-to-moderate mental health conditions. Many health plans chose to delegate these responsibilities to a Managed Behavioral Health Organization (MBHO), and almost 50% of health plans, including Alameda Alliance for Health (AAH), delegate these responsibilities to the MBHO, Beacon Health Options (BHO). Continuing to “carve out” behavioral health responsibility through delegation to an MBHO challenges MediCal Plans to deliver whole-person care envisioned in Cal Aim.

In April 2021, the AAH Board of Governors (BOG) voted to de-delegate M2M and ASD and retook responsibility for improving the health plan to integrate Mental and Physical Healthcare. This CHIP aims to leverage the existing structure of the Alameda Alliance of Health to insource the Mild to Moderate and Autism Spectrum Disorder benefit by March 31, 2023. As a result, AAH will be directly responsible for the 623 ASD and 10,599 members who utilize 96,043 mental health visits. AAH has hired eight staff on the BH team; an additional staff and two consultants will join the team. A further 15 non-clinical staff will be hired to support the transition.

Pursuing Certification as a Certified Community Behavioral Health Center (CCBHC)

Due to the aftermath of COVID-19 and the global pandemic, we are experiencing an unprecedented demand for behavioral health (BH) services. As a Federally Qualified Health Center (FQHC), whole-person care has only been available to patients within the mild to moderate level of impairment, resulting in referrals to county and other specialty mental health clinics for patients that are in crisis, require psychiatry and/or a higher level of care. Unfortunately, current wait times for patients seeking psychiatry and a higher level of care are reportedly between 6-8 months. These entities have also experienced a demand for service and staff shortage issues. To better support patients accessing BH services, I researched a solution to help FHQCs, such as ourselves, expand BH services of various levels of care internally. Certification as a Certified Community Behavioral Health Center (CCBHC) would place our organization in a position to qualify for federal funding under the Substance Abuse and Mental Health Administration (SAMHSA). As an FQHC, securing certification as a CCBHC would reduce the need to refer out, support the continuum care for patients, and provide the funding needed to staff our BH Department with psychiatry, care coordination, peer support, and 24/7 crisis response team.