Healthcare systems in the United States have gradually embraced the concept that mental health should be treated as equal to physical health, especially considering the increased prevalence of anxiety and depression during and after the COVID-19 pandemic.
To improve access to mental health treatment, many Medicaid programs have required their managed care organizations to collectively cover behavioral and physical health. This is in contrast to the traditional approach where behavioral health, including the treatment of substance use disorders, was „carved out“ of typical health insurance – forcing patients to secure coverage through a completely different insurance plan.
The new approach, known as integrated managed care organizations, was believed to lead to better access and outcomes for patients.
However, a new study from the Oregon Health & Science University shows that the integration of behavioral and physical health has not led to significant changes in access or quality of healthcare services in the state of Washington.
„There was hope that this would be a significant catalyst. The idea was that integrating care in managed care organizations would bring about positive changes at the clinical level, and that has not really happened – at least not yet.“
John McConnell, Ph.D., lead author, Director of the OHSU Center for Health Systems Effectiveness
Published today in JAMA Health Forum, the study concludes that while administrative change is necessary, it alone is not sufficient to improve access, quality, and overall health outcomes for patients.
According to McConnell, new training and incentives may be necessary to achieve these results, including a departure from traditional payment models where providers are paid a fee for service to alternatives that pay providers for a certain number of patients covered by the practice overall.
Researchers examined changes in the state of Washington, which was a pioneer in promoting integrated care models to improve mental health treatment.
The new study assessed claim-based measures such as mental health visits; health outcomes, such as reported incidents of self-harm; and overall quality of life, such as arrest, employment, and homelessness rates among 1.4 million patients covered by Medicaid in the state of Washington. The analysis tracked the phased introduction of financial integration across 39 Washington counties between 2014 and 2019.
„The surprising result was that nothing really changed,“ said McConnell.
Although the researchers were unable to find statistically significant improvements in access or outcomes for patients throughout the Evergreen State, McConnell noted that financial integration also did not worsen the situation. He emphasized the importance of that.
„It likely simplified things,“ he said.
The co-authors include Sara Edelstein, MPP, Jennifer Hall, MPH, Anna Levy, MPH, Maria Danna, MA, Deborah Cohen, Ph.D., Stephan Lindner, Ph.D., Jane Zhu, MD, of OHSU; and Jürgen Unützer, MD, MPH, of the University of Washington.
Oregon Health & Science University
McConnell, KJ, et al. (2023). Access, utilization, and quality of integrating behavioral health in Medicaid Managed Care. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2023.4593.