Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes

• DOI: 10.1377/hlthaff.2015.1263
• Publication Date: 2016-08-08T19:57:39Z
• Authors: Robin M. A. Clarke; Jessica Jeffrey; Mark Grossman; Thomas Strouse; Michael Gitlin; Samuel A. Skootsky
• Keywords: Adult; Male; Mental Health Services; Outcome Assessment; Databases, Factual; 8.1 Organisation and delivery of services; Health Services Accessibility; Health Reform; Organization and Delivery of Care; Databases; Hospital; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Health Services and Systems; Health Sciences; Behavioral and Social Science; Outcome Assessment, Health Care; Health services and systems; Humans; Financing Health Care; Program Development; Factual; Primary Care; Aged; Retrospective Studies; Emergency Service; Academic Medical Centers; Accountable Care Organizations; Mental Disorders; Health Services; Middle Aged; United States; Policy and administration; 3. Good health; Health Care; Good Health and Well Being; Mental Health/Substance Abuse; Applied Economics; Public Health and Health Services; Health Policy & Services; Female; Emergency Service, Hospital; Health and social care services research; Program Evaluation

Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services. We developed an evidence-based, all-payer collaborative care program called Behavioral Health Associates (BHA), operated as part of UCLA Health, an integrated academic medical center. Building BHA required several innovations, which included using our enterprise electronic medical record for behavioral health referrals and documentation; registering BHA providers with insurance plans' mental health carve-out products; and embedding BHA providers in primary care practices throughout the UCLA Health system. Since 2012 BHA has more than tripled the number of patients receiving behavioral health services through UCLA Health. After receiving BHA treatment, patients had a 13 percent reduction in emergency department use. Our efforts can serve as a model for other ACOs seeking to integrate behavioral health care into routine practice.