Mental health services in the Medicaid space faces two major issues: a lack of long-term services, and a need for better integration with physical health. Anya Rader Wallack asks Arkansas Medicaid Medical Director William Golden and CareMore Health System CEO Sachin Jain if they see any promising fixes to either issue.
Arkansas is knocking down regulatory barriers that have blocked the co-location of behavioral health in primary care, says Golden. “We think that the opportunities for a mom to take a kid to their primary care office and not have to go to a mental health clinic — the potential for a proactive intervention when a kid is having some issues at school, but not necessarily at full-blown crisis — is enormous. And, frankly, I think it’s going to be cost-saving for the system.” He adds that many states, including Arkansas, unfortunately have a “behavioral health industrial complex” in terms of influencing policy, which slows progress in more severe behavioral health levels. “But we really think that the primary care community is extremely interested in having capacity in their office or in their neighborhood to have those kinds of services available for the moderately to mildly behavioral health–challenged patient.”
“Nationally, we continue to have a very draconian view of mental health that’s grounded in the stigma that’s been associated with mental health since the origins of the field,” adds Jain. “You have a traditional health care system and then you have a behavioral health care system, and there’s lots of talk about integration and connectivity and cross-walking, but ultimately, the reality is that they are two different systems.” A lot of this stems from medical school, says Jain — not all physicians are trained to view internal medicine through the lens of behavioral health. He explains that CareMore, a company focused on chronic disease management, is working to revise its behavioral health approach so that every employee is trained in behavioral health, rather than just the specialists.
“We need to recognize the interconnectedness between behavioral health issues and diabetes management and cardiovascular disease, and just about every other disease process has a behavioral health lens and component to it,” says Jain. It makes sense, for example, to include diabetes management within the walls of the dentist’s office and optometrist’s office. “We have these very hard lines that we draw that are artificial and, frankly, unnecessary in a modern health care system that I think will be the key to dealing with our supposed primary care shortage, which I don’t think really is a shortage,” adds Jain. “I think it’s just a very narrow definition of who delivers what in the current systemic context.”
From the NEJM Catalyst event New Risk, New Business Models held in Boston, October 6, 2016.