Mental health insurance coverage to broaden soon
Journal of Business - 12/21/2018
Starting Jan. 1, behavioral health services traditionally covered through Medicaid also will be covered by some of the same managed care organizations that currently cover physical health services, says Jeff Thomas, CEO of Frontier Behavioral Health.
Known as Integrated Managed Care, combining behavioral health and physical health coverage under the same health insurance plans offers better opportunities to help patients, asserts Thomas.
Behavioral health includes mental health and substance use treatment, he says.
The change follows the passing of Washington state Senate Bill 6312 in 2014, which requires government-paid medical insurance to integrate behavioral and physical health services under the same health plans by January 2020. The current system has behavioral and physical health services covered by separate managed care organizations, he says.
Currently, five managed care organizations contract with Medicaid to offer its coverage here, says Thomas.
Four of them-Amerigroup, Community Health Plan of Washington, Molina Healthcare, and UnitedHealthcare Community Plan-currently cover physical but not behavioral services. A fifth, Coordinated Care of Washington, specializes in health services for children in foster care, he says.
Spokane County Regional Behavioral Health Organization currently covers behavioral health services, he says.
As of Jan. 1, Amerigroup, Community Health Plan of Washington, and Molina will offer behavioral health coverage, and UnitedHealthcare will no longer contract with Medicaid in the Spokane market, says Thomas. Coordinated Care will still focus on foster care.
Spokane County Regional Behavioral Health Organization will change its name and focus on crisis services.
With that organization taking on its new crisis-based role, Frontier Behavioral Health has contracted with the Spokane County Regional Behavioral Health Organization to replace Spokane's regional crisis line, First Call for Help, with a new 24-hour regional crisis line, says Thomas.
First Call for Help is primarily staffed by volunteers, he says; however, the new regional behavioral health line will be staffed by 24 clinical professionals, all of whom will work for Frontier Behavioral Health.
Frontier Behavioral Health is headquartered at 103 E. First and has 18 offices and service locations and about 700 employees. The organization provides an array of outpatient mental health services for all ages, including case and medication management, crisis intervention, counseling, and community support services.
As Medicaid's current payer system is set up, having patients navigate through two separate health care plans can prevent providers from communicating and providing holistic care for patients who might be struggling with both behavioral and physical health problems, Thomas says.
Combining those coverages under the same managed care organizations opens the door to providing coordinated help for patients with co-occurring conditions, he asserts. However, it doesn't "magically fix" communication issues between providers, he says; instead, it helps facilitate a higher level of care coordination.
As many as two-thirds of people with serious mental illness also have a co-occurring chronic physical health condition, says Thomas, and half of those patients aren't getting all the care they need for those physical issues.
As of now, a patient could seek treatment from Frontier Behavioral Health and have a co-occurring physical illness that their mental health providers aren't aware of, unless the patients tell them, he says.
"We have no way of knowing, because they're paid for by different structures, whether they're even receiving appropriate treatment, or whether their (physical condition) is wildly out of control," he says.
With the new payer system taking effect next year, health care providers will be better equipped to communicate and know if their patients are getting the care they need, he says.
Still, Thomas says, organizations might encounter some bumps during the transition.
"It's a big change," he says. "This has been a structure in place for 30 years, so there's a lot of new relationships that need to be developed and new processes that need to be put in place."
Working with a greater number of organizations adds complexity that Frontier Behavioral Health needs to navigate, he says. Some potential challenges, he says, include accessing information when different providers use different medical software, and communicating with other providers while also respecting patient privacy laws.
Ultimately, though, Thomas envisions Frontier Behavioral Health creating more partnerships with physical health providers to be able to "create a more seamless system of care for the clients we're serving," he says.