Session #D4a
Saturday, October 18, 2014
Claiming a Seat at the Table: Strategies to
Promote Behavioral Health Integration in
Healthcare Reform
Becky Hayes Boober, PhD, Senior Program Officer
Maine Health Access Foundation
Rick Ybarra, MA, Program Officer
Hogg Foundation for Mental Health
Collaborative Family Healthcare Association 16th Annual Conference
October 16-18, 2014
Washington, DC U.S.A.
Faculty Disclosure
We have not had any relevant
financial relationships
during the past 12 months.
Learning Objectives
At the conclusion of this session, participants will be able to:
• Explain three strategies for including behavioral health in
planning for health care reform.
• Articulate Triple Aim benefits for embedding integrated
behavioral health/primary care into new health care
system structures, such as Accountable Care
Organizations and managed care systems.
• Identify at least one policy opportunity in their home
states and select relevant strategies to use to address
that opportunity.
HEALTH REFORM RACE
In the next 30 seconds, list the names (or other
identifier) of as many health reform initiatives as
you can recall.
 Example: Affordable Care Act
 Can be local, county, regional, state, national,
international
 GO!

History of Integrated Health Care in TX
 Multi-year,
multi-site grant program begun in
2006 implementing collaborative care model
 Statewide conference in 2008; Resource guide
published
 Multi-year learning community begun in 2009
 Office of Minority Health / Hogg collaboration
(2012). Lit review, consensus report on
eliminating health disparities through IHC, and
funders report published
 2012-2015 planning and implementation grants
Key Policy Opportunities in Texas
• 2011: 82nd Leg. Session. HB 2196 Report of Integration
of Health and Behavioral Health Workgroup
– first state to establish a legislatively mandated
workgroup on integration
– Hogg influential in developing a track record in IHC
– Workgroup submitted final report with nine
recommendations
– new relationships proved instrumental in influencing
state health policy
Strategies: after report submitted to the Leg, TX HHSC
sought a waiver under section 1115 of the SSA to
expand Medicaid managed care in TX; approved by
CMS December 2011
Key Policy Opportunities in Texas
• 2011 Texas Healthcare Transformation and Quality
Improvement Program, 1115 Demonstration Waiver
– Strategies: CFHA 2012 Policy Summit 17 of 20
regional health partnerships (RHPs) attended; each
charged with planning for health care delivery best
suited to their communities; CFHA Policy Fellow one
year appointment to follow-up with RHPs, provide
TA, connect RHPs to SMEs, develop policy briefs;
approx 396 Delivery System Reform Incentive
Payment (DSRIP) BH projects funded by the 1115
waiver; 140 of those projects planned to integrate
physical and behavioral health care
• 2013: 83rd Leg. Session. SB 58 IHC workgroup
– Strategies: Hogg Foundation executive director chairs
committee
Key Policy Opportunities in Maine
MeHAF 42 grants: clinical practice and systems
transformation, 150+ partner organizations
 6-year Integrated Care learning community
 State Integrated Care Policy Committee
 Anthem Pilot
 PCMH Pilots—All payers, including Medicare
 Health Homes, Behavioral Health Homes, CCTs
 State Innovation Model initiative
 KeepMEHome (House Speaker Eves)

RESULT
Over
45% of primary
care practices in Maine
have some level of
integrated care! And
growing.
Strong state
champions!
HOW? TIPS WE LEARNED
Be
at the table.
Be strategic.
Be opportunistic.
Know the real issue and not
just the surface system.
Show and Tell.
If you’re not at the table…
You are on the menu!
MORE TIPS: BFFS
 Identify
and nurture your champions.
 Be a friend.
 Mid-level officials
 Administrative staff (gatekeepers)
 State and other systems and political
leaders
 Communicate in their language, value
system.
 Have neutral party (i.e., funders) convene
policy committee.
MORE TIPS
 Be
specific and realistic with your Asks.
 Time the requests right.
 Let decision-makers know when what
they did makes a positive difference.
 Don’t expect immediate results. Stay in it
for the long haul—at least 10 years.
 Recognize the Adaptive System, Collective
Impact nature of embedding Integrated
Care.
The Triple Aim
Be at the Table!
Celebrate small wins
in a BIG way!
YOUR OPPORTUNITIES
Think
of an opportunity you
have to be able to influence the
expansion and/or sustainability
and support of integrated care.
What is one step you can take
within the next 2 weeks?
Learning Assessment
Discussion / Q&A
Bibliography / Reference
Linkins, K.W., Frost, L., Boober, B.H., and Brya, J. (2013). Moving from
partnership to collective accountability and sustainable change: Applying a
systems-change model to foundations’ evolving roles. Foundation Review, 5:2,
52-66.
Gratham, S., Boober, B.H., McKinney, A., Truesdell, N., Coakley, E., and Ward,
M. (2014). “Working toward collaborative care” in Case studies in organizational
behavior and theory for health care. Ed. Borkowski, N. and Deckard, G.
Burlington, MA: Jones & Bartlett Learning.
D. Bachrach, S. Anthony, and A. Detty, State Strategies for Integrating Physical
and Behavioral Health Services in a Changing Medicaid Environment, The
Commonwealth Fund, August 2014.
Sanchez, K., Frost, L.E., and Held, M.L. (2013). Assessing the Legacy of a
Legislative Workgroup for Bidirectional Integration of Services. Journal of
Behavioral Health Services & Research, 2013, 1-10.
Center for Health Care Strategies (CHCS). Improving Health Care Quality and
Equity: Considerations for Building Partnerships Between Provider Practices
and Community Organizations. Robert Wood Johnson Foundation Primer/Brief.
April 2013.
CONTACT US:

Rick Ybarra, Program Officer
Hogg Foundation for Mental Health; Austin, TX
 512-471-9154
 rick.ybarra@austin.utexas.edu


Becky Hayes Boober, Senior Program Officer
Maine Health Access Foundation; Augusta, ME
 207-620-8266 ext. 114
 bhboober@mehaf.org

SESSION EVALUATION
Please complete and return the
evaluation form to the classroom monitor before leaving
this session.
Thank you!