Connecticut
Behavioral Health
Homes
IMPROVING THE EXPERIENCE IN CARE… IMPROVING HEALTH
OUTCOMES… REDUCING HEALTH CARE COSTS
A survey of mortality data of eight states
concluded that, on average, Americans with
major mental illness die 14 to 32 years
earlier than the general population.
Source:
Thomas Insel on September 6, 2011 http://www.nimh.nih.gov/about/director/2011/nohealth-without-mental-health.shtml
The gap between life expectancy in
patients with a mental illness and the
general population has widened since
1985.
http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widensbetween-those-mental-illness-and-general-population
Comparative Mortality Risks
Behaviors and/or Disorders
Reduction in Life Expectancy
• Recurrent Depression
• 7-11 years
• Bipolar Disorder
• 9-20 years
• Schizophrenia
• 10-20 years
• Drug and Alcohol Abuse
• 9-24 years
• Heavy Smoking
• 8-10 years
Source:
Mental illness threat to life expectancy similar to heavy smoking
28 May 2014 - 8am PSThttp://www.medicalnewstoday.com/articles/277388.php
Connecticut Life Expectancy:
Gender
Life Expectancy
Avg. Life Expectancy
– for those with MI
Male
77.69
45.69 - 63.69
Female
82.44
50.44 - 68.44
Total
80.18
48.18 - 66.14
Source: http://www.worldlifeexpectancy.com/usa/connecticut-life-expectancy
DMHAS Persons Served: Ages
Most of the risk associated with reduced
life expectancy can be attributed to
physical illness such as cardiovascular and
respiratory diseases and cancer (80% of
deaths).
http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widensbetween-those-mental-illness-and-general-popula
Researchers suggest that efforts to
reduce the gap in life expectancy
should focus on improving physical
health.
http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widensbetween-those-mental-illness-and-general-population
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Behavioral Health Home (BHH):
• an innovative, integrated healthcare service delivery
model for people diagnosed with SPMI
• emphasizes care coordination services
• Is recovery-oriented, person and family centered
• A model which promises better patient experience and
better outcomes than those achieved in traditional
services.
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Origin
• In 2010, the Patient Protection and Affordable Care Act
(ACA) established a “health home” option under Medicaid
that serves enrollees with chronic conditions.
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Connecticut BHH Eligibility
 SPMI:
Schizophrenia and Psychotic Disorders;
Mood Disorders;
Anxiety Disorders;
Obsessive Compulsive Disorder;
Post-Traumatic Stress Disorder; and
Borderline Personality Disorder
 Medicaid Eligibility
 Medicaid claims > $10k/year
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Connecticut’s
BHH Service Population
 Medicaid population with SPMI (2013): 58,055
 BHH eligible and enrolled at an LMHA: 6549
 Eligible and over 60 years of age: 903.76 (13.8%)
 BHH eligible and to receive outreach and
engagement: 19,000
 Over 60 years of age: 3230 (17%)
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The Goals of Health
Homes align with the aim
of the Affordable Care Act
(ACA)
• Improved experience in care
• Improved health outcomes
• Reduction in health care costs
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GOAL 1:
Improve Quality By Reducing
Unnecessary
Hospital Admissions And Readmissions
• Decrease the readmission rate within 30 days of an acute
hospital stay
• Decrease the rate of ambulatory care-sensitive
admissions
• Reduce ambulatory care-sensitive emergency room visits
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GOAL 2:
REDUCE SUBSTANCE USE
• Increase the number of tobacco users who received
cessation intervention
• Increase the percentage of adolescents and adults with a
new episode of alcohol or other drug dependence (AOD)
who initiated AOD treatment or engaged in AOD treatment
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GOAL 3:
IMPROVE TRANSITIONS OF CARE
• Increase the percentage of those discharged from an
inpatient facility for whom a transition record was
transmitted for follow-up care within 24 hours of discharge
• Increase the percentage of individuals who have a follow
up visit within 7 days of discharge from an acute
hospitalization for mental health
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GOAL 4:
IMPROVE THE PERCENT OF INDIVIDUALS WITH
MENTAL ILLNESS WHO RECEIVE
PREVENTIVE CARE
• Improve BMI education and health promotion for enrolled
individuals
• Early intervention for individuals diagnosed with
depression
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GOAL 5:
IMPROVE CHRONIC CARE DELIVERY FOR
INDIVIDUALS WITH SPMI
• Increase the percentage of individuals with a diagnosis of
hypertension (HTN) whose blood pressure (BP) is
adequately controlled
• Increase the percentage of individuals with asthma and
who were dispensed a prescription for medication
• Increase the percentage of adults with diabetes, whose
Hemoglobin HbA1c is within a normal range
• Increase the percentage of adults with coronary artery
disease (CAD) whose LDL is within a normal range
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GOAL 6:
INCREASE PERSON-CENTEREDNESS AND
SATISFACTION WITH CARE DELIVERY
• Increase general satisfaction with care including:
• access to care;
• quality and appropriateness of care;
• participation in treatment; and
• cultural competence.
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GOAL 7:
INCREASE CONNECTION
TO RECOVERY
SUPPORT SERVICES
• Decrease the number of individuals who experienced
homelessness and increase housing stability
• Increase the number of individuals who become involved
in employment and/or educational activities
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CT BHH Designated Providers
 DMHAS Local Mental Health Authorities (LMHAs)
and contracted LMHA affiliate providers (Affiliates)
will serve as designated providers of behavioral
health home services.
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It has been argued that for those individuals
who have relationships with behavioral
health organizations, care may be best
delivered by bringing primary care,
prevention, and wellness activities onsite
into behavioral health settings.
•Source: SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS, MAY
2012
Mental Health Practitioners have
an Opportunity to Impact
Life Expectancy
 preventing suicides,
 discouraging risky behavior,
 encouraging a healthy lifestyle, and
 general primary medical care.
Reviewed by John M. Grohol, Psy.D. on July 13, 2010
http://psychcentral.com/news/2010/07/13/life-expectancy-in-mentalillness/15502.html
CT Behavioral Health Home
Core Services
• Comprehensive care management
• Care coordination
• Health promotion
• Comprehensive transitional care
• Patient and family support
• Referral to community support services
Comprehensive Care
Management
• Assessment of service needs
• Development of a treatment and recovery
plan development in conjunction with the
individual
• Assignment of health home team roles
• Monitoring of progress
Care Coordination
• Implementation of the treatment and
recovery plan in collaboration with the
individual to include linkages
• Ensuring appropriate referrals,
coordination and follow-up to needed
services and supports
• Ensuring access to medical, behavioral
health, pharmacological and recover
support services
Health Promotion
• Health education specific to an
•
•
•
•
individual’s chronic condition(s)
Assistance with self-management
plans
Education regarding the importance of
preventative medicine and screenings
Support for improving natural
supports/social networks
Interventions which promote wellness
and a healthy lifestyle
Comprehensive Transitional Care
• Specialized care coordination
focusing on the movement of
individuals between or within
different levels of care
• Care coordination services
designed to:
• Streamline plans of care
• Reduce hospital admissions
• Interrupt patterns of frequent hospital
Emergency Department use
Patient and Family Support
• Services aimed at helping individuals
to
• Reduce barriers to achieving goals
• Increase health literacy and knowledge
about chronic conditions
• Increase self-management skills
• Linking individuals to resources which
support their highest level of wellness
and functioning within their families and
communities
Referral to Community Support
Services
• Ensuring access to a myriad of
formal and informal resources which
address social, environmental and
community factors
• Assistance in overcoming access or
service barriers;
• increasing self-management skills;
• improving overall health
BHH Next Steps
• PNP LMHAs to begin providing BHH Core Services to +/-
3500 persons fall 2014
• State-Operated LMHAs to begin providing BHH Core
Services to +/- 3000 persons winter 2014
• Implementation of an IT system to collect and report BHH
Core Services and Outcome Measures early 2015
• Submission of a final State Plan Amendment allowing CT
to be eligible to receive enhanced rate of Medicaid
reimbursement for BHH services
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Questions?
Cheryl.Stockford@ct.gov
860 418-6749
www.ct.gov/dmhas/BHH