Medicaid behavioral health homes

Abstract

OBJECTIVE: Individuals with serious mental illnesses represent a high-need, high-cost population. To address this population's needs under the State Innovation Models Initiative, Maine assisted Medicaid-participating behavioral health providers in changing to behavioral health homes (BHHs). The authors explored BHHs' experiences in transforming care from 2014 to 2017 and investigated changes in utilization, care coordination, and Medicaid expenditures before and after Medicaid-covered individuals enrolled in a BHH.

METHODS: The authors interviewed stakeholders, conducted focus groups with BHH consumers and providers, and used pre-post analyses of Medicaid fee-for-service claims. Program features such as capitated payments, connection to the state's health information exchange, and one-on-one technical assistance altered delivery of behavioral health care.

RESULTS: Interviewees reported some challenges, such as understanding team roles, sharing clinical data, and integrating care with primary care providers. Analyses of data for 7,560 BHH enrollees with serious and persistent mental illness (adults) or serious emotional disturbance (children) indicated no changes in inpatient admissions, 30-day inpatient readmissions, emergency department visits, behavioral health-related expenditures, and professional expenditures after the switch to the BHH model. Total Medicaid expenditures increased by $170 per beneficiary per month. The BHH model did not change several measures of utilization and expenditures, but it was well received by behavioral health providers.

CONCLUSIONS: Medicaid programs experimenting with new care delivery models for individuals with complex conditions may look to the Maine experience for guidance in program design.