Improving Care Coordination Across Behavioral Health Settings: The Role of Payment and Delivery Innovations for Adults with Serious Mental Illness

About This Grant

PROJECT SUMMARY For the 20 million individuals with serious mental illness (SMI), limited access to evidence-based and coordinated treatments is associated with poor medical outcomes, higher costs, and devastating societal impacts, including suicide. Outpatient treatment plays an important role during the high-risk period following hospital discharge. However, only about 50% of discharged patients receive any outpatient follow-up within 30 days with lack of pre-crisis engagement with mental health care being the most important predictor of follow-up treatment. Outpatient mental health specialty clinics are a frequent source of treatment for patients who use hospital-based services, but many clinics do not offer the full continuum of evidence-based specialty mental health services, nor do they have the ability to share electronic medical records with other providers. More generally, little is known about existing patterns in hospitals’ formal and informal relationships with these clinics. New payment and delivery models that target specialty mental health clinics, such as the Certified Community Behavioral Health Clinic (CCBHC) program, have the potential to improve clinical capacity to deliver integrated and coordinated care for patients with SMI. Our proposal is designed to better understand these relationships and their effects on follow-up care for patients to inform future care coordination strategies between hospitals and specialty behavioral health clinics. Specifically, we propose to use Medicaid administrative claims from multiple states and a quasi-experimental approach to (1) assess whether CCBHC implementation was associated with changes in follow-up care after hospital-based treatment and (2) whether patterns of follow up care after hospital-based treatment improved for patients with no prior mental health treatment engagement. This will be supplemented by a mixed methods study in Texas, an early CCBHC adopter state with 44 CCBHCs, to assess organizational strategies that mediate the relationship between CCBHC and follow-up care. This grant is responsive to NOT-MH-24-270, “Notice of Special Interest: Impact of Financing and Payment Mechanisms to Improve Behavioral Health Access, Utilization and Outcomes,” and will provide information on outcomes targeted by federal and state agencies, and help to bridge the gap between those who need treatment and those who receive treatment. The significance of this study lies in its focus on how to optimize delivery systems to improve mental health treatment and outcomes for those with SMI.