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The Policy Ecology of Behavioral Health Homes: Case Study of Maryland’s Medicaid Health Home Program

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Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Behavioral health homes, shown to improve receipt of evidence-based medical services among people with serious mental illness in randomized clinical trials, have had limited results in real-world settings; nonetheless, these programs are spreading rapidly. To date, no studies have considered what set of policies is needed to support effective implementation of these programs. As a first step toward identifying an optimal set of policies to support behavioral health home implementation, we use the policy ecology framework to map the policies surrounding Maryland’s Medicaid behavioral health home program. Results suggest that existing policies fail to address important implementation barriers.

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References

  • Aarons, G. A., Wells, R. S., Zagursky, K., et al. (2009). Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis. American Journal of Public Health,99(11), 2087–2095.

    Article  Google Scholar 

  • Annamalai, A., Staeheli, M., Cole, R. A., & Steiner, J. L. (2018). Establishing an integrated health care clinic in a Community Mental Health Center: Lessons learned. Psychiatric Quarterly,89(1), 169–181.

    Article  Google Scholar 

  • Bandara, S. N., Kennedy-Hendricks, A., Stuart, E. A., et al. (under review). The effect of the Maryland Medicaid Health Home Waiver on Emergency Department and Inpatient Utilization Among Individuals with Serious Mental Illness.

  • Bao, Y., Casalino, L. P., & Pincus, H. A. (2013). Behavioral health and health care reform models: Patient-centered medical home, health home, and accountable care organization. The Journal of Behavioral Health Services & Research,40(1), 121–132.

    Article  Google Scholar 

  • Breslau, J., Leckman-Westin, E., Han, B., et al. (2018a). Impact of a mental health based primary care program on emergency department visits and inpatient stays. General Hospital Psychiatry,52, 8–13.

    Article  Google Scholar 

  • Breslau, J., Leckman-Westin, E., Yu, H., et al. (2018b). Impact of a mental health based primary care program on quality of physical health care. Administration and Policy in Mental Health and Mental Health Services Research,45(2), 276–285.

    Article  Google Scholar 

  • Burns, T., Catty, J., Dash, M., et al. (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: Systematic review and meta-regression. British Medical Journal,335(7615), 336.

    Article  Google Scholar 

  • Centers for Medicare and Medicaid Services. (2018a). Health Homes. Retrieved September 9, 2018, from https://www.medicaid.gov/medicaid/ltss/health-homes/index.html.

  • Centers for Medicare and Medicaid Services. (2018b). Promoting Interoperability. Retrieved October 31, 2018, from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHrIncentivePrograms/.

  • Centers for Medicare and Medicaid Services. (2018c). State-by-State Health Home State Plan Amendment Matrix. Retrieved September 23, 2018, from https://www.medicaid.gov/state-resource-center/medicaid-state-technical-assistance/health-home-information-resource-center/downloads/state-hh-spa-at-a-glance-matrix.pdf.

  • Clemans-Cope, L., Wishner, J. B., Allen, E. H., et al. (2017). Experiences of three states implementing the Medicaid health home model to address opioid use disorder—Case studies in Maryland, Rhode Island, and Vermont. Journal of Substance Abuse Treatment,83, 27–35.

    Article  Google Scholar 

  • Correll, C. U., Solmi, M., Veronese, N., et al. (2017). Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: A large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry,16(2), 163–180.

    Article  Google Scholar 

  • Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist,59(7), 614.

    Article  Google Scholar 

  • Daumit, G., Anthony, C., Ford, D. E., et al. (2010). Pattern of mortality in a sample of maryland residents with severe mental illness. Psychiatry Research,176(2–3), 242–245.

    Article  Google Scholar 

  • Daumit, G. L., Stone, E. M., Kennedy-Hendricks, A., et al. (2018). Care coordination and population health management strategies and challenges in a behavioral health home model. Medical Care,57(1), 79–84.

    Article  Google Scholar 

  • De Hert, M., Van Winkel, R., Van Eyck, D., et al. (2006). Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: A cross-sectional study. Clinical Practic & Epidemiology in Mental Health,2, 14.

    Article  Google Scholar 

  • Druss, B. G., Rohrbaugh, R. M., Levinson, C. M., & Rosenheck, R. A. (2001). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry,58(9), 861–868.

    Article  CAS  Google Scholar 

  • Druss, B. G., von Esenwein, S. A., Glick, G. E., et al. (2017). Randomized Trial of an Integrated Behavioral Health Home: The Health Outcomes Management and Evaluation (HOME) Study. American Journal of Psychiatry,174(3), 246–255. https://doi.org/10.1176/appi.ajp.2016.16050507.

    Article  PubMed  Google Scholar 

  • Gilmer, T. P., Henwood, B. F., Goode, M., et al. (2016). Implementation of integrated health homes and health outcomes for persons with serious mental illness in Los Angeles County. Psychiatric Services,67(10), 1062–1067.

    Article  Google Scholar 

  • Golembiewski, E. H., Askelson, N. M., Bentler, S. E., et al. (2015). Evaluation of the Integrated Health Home (Ihh) Program In Iowa: Qualitative interviews with site administrators. Iowa City: University of Iowa Public Policy Center.

    Book  Google Scholar 

  • Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006). From silos to bridges: Meeting the general health care needs of adults with severe mental illnesses. Health Aff (Millwood),25(3), 659–669.

    Article  Google Scholar 

  • Janssen, E. M., McGinty, E. E., Azrin, S. T., et al. (2015). Review of the evidence: Prevalence of medical conditions in the United States population with serious mental illness. General Hospital Psychiatry,37(3), 199–222.

    Article  Google Scholar 

  • Johnson, J., Hall, L. H., Berzins, K., et al. (2018). Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International Journal of Mental Health Nursing,27(1), 20–32.

    Article  Google Scholar 

  • Krupski, A., West, I. I., Scharf, D. M., et al. (2016). Integrating primary care into community mental health centers: Impact on utilization and costs of health care. Psychiatric Services,67(11), 1233–1239.

    Article  Google Scholar 

  • Lluch, M. (2011). Healthcare professionals’ organisational barriers to health information technologies—A literature review. International Journal of Medical Informatics,80(12), 849–862.

    Article  Google Scholar 

  • Maragakis, A., & RachBeisel, J. (2015). Integrated care and the behavioral health home: A new program to help improve somatic health outcomes for those with serious mental illness. The Journal of Nervous and Mental Disease,203(12), 891–895.

    Article  Google Scholar 

  • Maryland Department of Health. (2018). Maryland Chronic Health Homes. Retrieved September 26, 2018, from https://mmcp.health.maryland.gov/Pages/Health-Homes.aspx.

  • Massechusetts Executive Office of Health and Human Services. (2018). MassHealth Medicaid Section 1115 Demonstration. Retrieved October 31, 2018, from https://www.mass.gov/files/documents/2018/06/27/1115%20MassHealth%20Demonstration%20STC%206-27-18.pdf¸.

  • McGinty, E. E., Baller, J., Azrin, S. T., et al. (2015). Quality of medical care for persons with serious mental illness: A Comprehensive Review. Schizophrenia Research,165(2–3), 227–235.

    Article  Google Scholar 

  • McGinty, E. E., Kennedy-Hendricks, A., Linden, S., et al. (2018). An innovative model to coordinate healthcare and social services for people with serious mental illness: A mixed-methods case study of Maryland’s Medicaid health home program. General Hospital Psychiatry,51, 54–62.

    Article  Google Scholar 

  • McGinty E. E., Stone E. M., Kennedy-Hendricks A., et al. (under review). The effect of the Maryland Medicaid Health Home Waiver on Quality of Care for Diabetes and Cardiovascular disease among individuals with serious mental illness.

  • Missouri Department of Health. (2017). Missouri CMHC Healthcare Homes: Progress Report 2016. Retrieved March 20, 2018, from https://dmh.mo.gov/mentalillness/docs/cmhchch2016report.pdf.

  • Murphy, K. A., Daumit, G. L., Stone, E., et al. (2019). Physical health outcomes and implementation of behavioural health homes: A comprehensive review. International Review of Psychiatry,30, 224–241.

    Article  Google Scholar 

  • Murphy K., Daumit G. L., Stone E. M., et al. (under review) Effect of the Maryland Medicaid Behavioral Health Home Program on Cancer Screening in People with Serious Mental Illness.

  • North Carolina Health Information Exchange Authority. (2018). About the NC HIEA. Retrieved October 31, 2018, from https://hiea.nc.gov/about-us/about-nc-hiea.

  • Ohio Departmet of Medicaid. (2015). Health Homes Performance Measures: Comprehensive Evaluation Report. Retrieved March 20, 2018, from http://mha.ohio.gov/Portals/0/assets/Initiatives/HealthHomes/OH-SFY2015_O2A-Health-Homes-Performance-Measures_FINAL.pdf.

  • Olfson, M., Gerhard, T., Huang, C., et al. (2015). Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry,72(12), 1172–1181.

    Article  Google Scholar 

  • Parks, J., Svendsen, D., Singer, P., et al. (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council,25(4), 1–87.

    Google Scholar 

  • Pescosolido, B. A., Medina, T. R., Martin, J. K., et al. (2013). The “Backbone” of Stigma: Identifying the Global Core of Public Prejudice Associated With Mental Illness. American Journal of Public Health,103(5), 853–860. https://doi.org/10.2105/AJPH.2012.301147.

    Article  PubMed  PubMed Central  Google Scholar 

  • Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implementation Science,3(1), 26.

    Article  Google Scholar 

  • Scharf, D. M., Breslau, J., Hackbarth, N. S., et al. (2014a). An examination of New York State’s integrated primary and mental health care services for adults with serious mental illness. Rand Health Quarterly,4, 3.

    Google Scholar 

  • Scharf, D. M., Eberhart, N. K., Hackbarth, N. S., et al. (2014b). Evaluation of the SAMHSA primary and behavioral health care integration (PBHCI) grant program. Rand Health Quarterly,4, 6.

    PubMed  PubMed Central  Google Scholar 

  • Scharf, D. M., Eberhart, N. K., Schmidt, N., et al. (2013). Integrating primary care into community behavioral health settings: Programs and early implementation experiences. Psychiatric Services,64(7), 660–665.

    Article  Google Scholar 

  • Scharf, D. M., Schmidt Hackbarth, N., Eberhart, N. K., et al. (2016). General medical outcomes from the Primary and Behavioral Health Care Integration grant program. Psychiatric Services,67(11), 1226–1232.

    Article  Google Scholar 

  • Schuster, J., Nikolajski, C., Kogan, J., et al. (2018). A payer-guided approach to widespread diffusion of behavioral health homes in real-world settings. Health Affairs,37(2), 248–256.

    Article  Google Scholar 

  • Shortell, S. M., Colla, C. H., Lewis, V. A., et al. (2015). Accountable care organizations: The national landscape. Journal of Health Politics, Policy and Law,40(4), 647–668.

    Article  Google Scholar 

  • Stewart, R. E., Adams, D. R., Mandell, D. S., et al. (2016). The perfect storm: Collision of the business of mental health and the implementation of evidence-based practices. Psychiatric Services,67(2), 159–161.

    Article  Google Scholar 

  • Stewart, R. E., Marcus, S. C., Hadley, T. R., Hepburn, B. M., & Mandell, D. S. (2018). State adoption of incentives to promote evidence-based practices in behavioral health systems. Psychiatric Services,69(6), 685–688.

    Article  Google Scholar 

  • Stone, E. M., Chen, L. N., Daumit, G. L., et al. (2019). General medical clinicians’ attitudes toward people with serious mental illness: A scoping review. The Journal of Behavioral Health Services & Research. https://doi.org/10.1007/s11414-019-09652-w.

    Article  Google Scholar 

  • Struijs, J. N., Drewes, H. W., Heijink, R., et al. (2015). How to evaluate population management? Transforming the Care Continuum Alliance population health guide toward a broadly applicable analytical framework. Health Policy,119(4), 522–529.

    Article  Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2016). SAMHSA PBHCI Grantees by HHS Regions. Retrieved December 11, 2018, from https://www.integration.samhsa.gov/SAMHSA_PBHCI_Grantees_Cohort_I-IX.pdf.

  • Tepper, M. C., Cohen, A. M., Progovac, A. M., et al. (2017). Mind the gap: Developing an integrated behavioral health home to address health disparities in serious mental illness. Psychiatric Services,68(12), 1217–1224.

    Article  Google Scholar 

  • The Code of Maryland Regulations. (2018). Health Homes. Retrieved September 26, 2018, from http://www.dsd.state.md.us/comar/SubtitleSearch.aspx?search=10.09.33.

  • The Commission on Accreditation of Rehabilitation Facilities. (2018). Core Treatment Program Standards—Health Home (HH). Behavioral Health Standards Manual.,42, 23.

    Google Scholar 

  • The Joint Commission. (2018). Behavioral Health Home Certification. Retrieved September 26, 2018, from https://www.jointcommission.org/accreditation/behavioral_health_home.aspx.

  • Thornicroft, G., Rose, D., & Kassam, A. (2007). Discrimination in health care against people with mental illness. International Review of Psychiatry,19(2), 113–122. https://doi.org/10.1080/09540260701278937.

    Article  PubMed  Google Scholar 

  • Ubbink, D. T., Guyatt, G. H., & Vermeulen, H. (2013). Framework of policy recommendations for implementation of evidence-based practice: A systematic scoping review. British Medical Journal Open,3(1), e001881.

    Google Scholar 

  • Vancampfort, D., Correll, C. U., Galling, B., et al. (2016). Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: A systematic review and large scale meta-analysis. World Psychiatry,15(2), 166–174.

    Article  Google Scholar 

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Funding

NIMH K01MH106631 (PI: McGinty) and NIMH R24MH102822 (PI: Daumit).

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Authors and Affiliations

  1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Elizabeth M. Stone, Alene Kennedy-Hendricks & Emma E. McGinty

  2. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Gail L. Daumit

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  1. Elizabeth M. Stone
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  2. Gail L. Daumit
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  3. Alene Kennedy-Hendricks
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  4. Emma E. McGinty
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Correspondence to Elizabeth M. Stone.

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Stone, E.M., Daumit, G.L., Kennedy-Hendricks, A. et al. The Policy Ecology of Behavioral Health Homes: Case Study of Maryland’s Medicaid Health Home Program. Adm Policy Ment Health 47, 60–72 (2020). https://doi.org/10.1007/s10488-019-00973-8

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