Title : How to align National Health Care Policy Goals with patient care: A Mechanism to improve population health
Background: The Arizona Medicaid program recently completed a six-year program (2016-2022) to integrate behavioral health services and primary care for patients. The overall goal is to reduce care fragmentation for patients needing treatment for mental health conditions and substance use disorders. A Quality Improvement Collaborative (QIC) was implemented to help providers achieve secondary and tertiary prevention targets. The audience will gain knowledge in the quality improvement (QI) strategies, methods, and techniques implemented to improve behavioral health and primary care integration.
Methods: This is a prospective study using secondary and tertiary prevention strategies to improve behavioral health and primary care integration. We developed a QIC that included representatives from over 400 clinic locations across Arizona. The intervention group organizations participated in a monthly QIC meeting that included performance feedback, technical assistance, and application of QI methods and techniques. The QIC focused on the performance for evidenced-based secondary and tertiary prevention interventions. The performance was assessed using key quality metrics, such as clinic follow-up after hospitalization for mental illness.
Data Analysis: Data were analyzed using frequency distributions, cross tabulations, trend analysis, and difference-in-difference analysis.
Results: Comparing national Medicaid health maintenance organization performance with Arizona participant performance, the difference-in-differences findings for the follow-up after psychiatric hospital in 7-days and 30-days indicates improved performance for the cohort. The national performance on the 7-day follow-up after hospitalization after a psychiatric hospitalization in 2017 was 37% and in 2021 was 39%. Whereas the performance of the participants was 44% in 2017 and 62% in 2021, a 16-point difference (228%). For the 30- day follow-up after hospitalization after a psychiatric hospitalization, the national performance was 58% in 2017 and 59% in 2021. Whereas the performance of the participants was 67% in 2017 and 80% in 2021, a 19- point difference (211%).
o Reduce Fragmentation between acute and behavioral health care.
o Increase efficiencies in service delivery for member with behavioral health needs by improving integration at the provider level
o Improve health outcomes for members with physical health and behavioral health needs.
Conclusion: There is substantial fragmentation in the health care system for providing care to patient populations needing mental health services and care for substance use disorders. The results from this study suggest that primary care and behavioral health integration can be accomplished on a large-scale level using QI techniques. Audience members will learn quality improvement strategies to help promote an efficient behavioral health and primary care integration.