Integrated care is a big topic in Washington and across the nation and has a long history. In 1963 President John F. Kennedy signed the Community Mental Health Centers Construction Act. It provided federal funding to create community-based mental health facilities. These community-based mental health centers, like BHR, were tasked with treating people in the community rather than in a confined hospital setting. This funding became known as a “carve out” in that it was not a part of the normal federal funding to health care but rather specifically for the provision of community-based care for substance use disorders and major mental illness.
By 1977 only 650 community health centers (CMHCs) were in operation. That was less than half of what was needed to accommodate care in the community. With this and following legislative efforts to deinstitutionalize those with mental illness we saw a significant increase in the number of mentally ill people in jails. Today, BHR’s Community Integration and Outreach team works to create jail diversion programs to allow community-based treatment rather than incarceration.
Integrated care has taken on great momentum across the country with the concept of integration of all care needs for those struggling with mental illness and substance use disorders. The concept is that treating all aspects of care for a person achieves better health goals. We know that people with mental illness are less likely to receive care for their health issues and die at a higher rate than the population as a whole.
Where does that leave us today? In January of 2020 the Medicaid “carve out” is coming to an end and behavioral health care will receive funding under the same umbrella as other Medicaid health services. This is a move from our traditional payer, the Behavioral Health Organizations (BHOs) to Managed Care Organizations (MCOs). This “carve in” only accomplishes a financial integration. There are many community-wide efforts to also assure treatment integration as well. BHR is a part of these treatment integration efforts on many fronts while we prepare for the payment change. For example, BHR’s clients in Olympia have access to medical and dental services through our partnership with Valley View Health Center on our campus at Martin Way. The transition does require changes in many of our administrative operations. We are working hard to minimize the effects for our service providers and our clients as we are always focused on providing as much of our resources to client care as possible.
Laurie Tebo, CEO