CMSA Today - Issue 4, 2015 - (Page 15)

Behavioral Health Law & the ACA Integrating Behavioral Health Services into Mainstream Medicine New Federal Parity Law Driving Change BY GARRY CARNEAL, JD, MA P art of a case manager's job is to support their patients through the health care continuum. However, one dynamic that case managers have to contend with in this role is the lack of integration between the general medical system and the specialist behavioral treatment system, both from a clinical and financial perspective. Over the past several decades, mental health and substance use disorder (Mh/SuD) treatments have been carved out or not covered at the same level as medical or surgical treatments. To address this disparity, Congress adopted the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MhPAEA). This federal law, along with numerous state laws, is leveling the playing field for how insurers cover behavioral health care alongside mainstream medicine. thE bEhavioral hEalth ChallEngE Behavioral health problems such as anxiety, depression, and addiction issues are among the most common and disabling health conditions worldwide. They often coincide with chronic medical conditions and can significantly impact health outcomes. The challenge for case managers, then, is to build customized care treatment plans for the populations that they serve which address both the physical ailments and psychosocial challenges associated with each patient. A primary goal for most case managers is to lower the longterm costs associated with individuals who have both physical and psychological problems. Typically, earlier and more proactive interventions can lower costs and reduce clinical complications overtime. To date, we have not been able to successfully implement this strategy because of the systematic fragmentation that dominates key areas of the delivery system. thE intEgrAtion opportunity As briefly mentioned before, the key problem in the delivery of Mh/SuD care today is the lack of coordination and integration between the general medical system and the specialist behavioral treatment system. Despite the difficulties, it is time to tear down the barriers and build bridges where we can. This is because many patients with mental health and addiction problems receive all of their care in the general medical system. Conversely, many people with serious behavioral health problems that are treated primarily within the specialty Mh/SuD system do not have their medical conditions recognized or treated appropriately. Multiple effective interventions currently exist that can address these integration, communication, and coordination failures; however, these specialized, evidenced-based programs have not been fully implemented and made available to all patients. A recent article captures the challenge and opportunity to integration: Frameworks are needed that encompass all levels of the system, from financing and organization of care to linkages between service sectors, and that detail how these factors affect care delivery, including individual-level coordination of care, treatment engagement, and treatment continuation. Just as important, research and policy must be informed by the real-world contingencies and pragmatics of service delivery, incorporating both practice-based evidence and evidence-based practices (EBPs). Without a relevant theoretical framework, we risk a piecemeal approach that is much less likely to produce significant changes in the system or results that can be integrated in a coherent manner.1 Issue 4 * 2015 CMSA TODAY 15

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2015

Integrating Behavioral Health Services into Mainstream Medicine
Cleveland Clinic Integrated Care Model
The Importance of Collaboration
Adult and Pediatric Integrated Case Management
Corporate Collaboration

CMSA Today - Issue 4, 2015