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Published in: Administration and Policy in Mental Health and Mental Health Services Research 1/2020

01-01-2020 | Care | Original Article

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

Authors: Elizabeth M. Stone, Gail L. Daumit, Alene Kennedy-Hendricks, Emma E. McGinty

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 1/2020

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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.
Literature
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist,59(7), 614.CrossRef Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist,59(7), 614.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference Lluch, M. (2011). Healthcare professionals’ organisational barriers to health information technologies—A literature review. International Journal of Medical Informatics,80(12), 849–862.CrossRef Lluch, M. (2011). Healthcare professionals’ organisational barriers to health information technologies—A literature review. International Journal of Medical Informatics,80(12), 849–862.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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. 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.
go back to reference 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.PubMedPubMedCentral 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.PubMedPubMedCentral
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference 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.CrossRef 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.CrossRef
go back to reference The Commission on Accreditation of Rehabilitation Facilities. (2018). Core Treatment Program Standards—Health Home (HH). Behavioral Health Standards Manual.,42, 23. The Commission on Accreditation of Rehabilitation Facilities. (2018). Core Treatment Program Standards—Health Home (HH). Behavioral Health Standards Manual.,42, 23.
go back to reference 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. 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.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
The Policy Ecology of Behavioral Health Homes: Case Study of Maryland’s Medicaid Health Home Program
Authors
Elizabeth M. Stone
Gail L. Daumit
Alene Kennedy-Hendricks
Emma E. McGinty
Publication date
01-01-2020
Publisher
Springer US
Keyword
Care
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 1/2020
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-019-00973-8

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