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.
