Benjamin F. Miller, PsyD, is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is responsible for integrating mental health across all three of the Department's core mission areas: clinical, education, and research. He is also the Associate Director of Research and Primary Care Outreach for the University of Colorado Denver's Depression Center. Dr. Miller received his doctorate degree in clinical psychology from Spalding University in Louisville, Kentucky. Dr. Miller is a co-principal investigator and co-creator of the National Research Network's Collaborative Care Research Network.
Policy is not a static construct, but rather a dynamically interacting set of efforts that conclude in a decision being made. This decision is often the best decision that can be made at that time, but as with most things, sometimes politics get in the way of good policy; sometimes, financial limitations and implications often trump sound policy. Most of the time, however, policy is a delicate balance of politics and financing while simultaneously trying to meet the community's needs.
Now, for a minute let's apply this philosophy to mental health and primary care integration.
On the surface, policies that address mental health and primary care are inadvertently bifurcated. Separate mental and medical systems often force different policies to be addressed depending on "whose team you are on." When it comes to integration, there needs to be a coming together of the mental health and physical health teams to address policies in tandem. This is often harder than it sounds, but three key components can make building integrated policy more successful:
1) A neutral convener
2) A foundation or financial partner (funder)
3) An academic partner
Why these three you may ask - well the answer is much simpler than you might imagine. First, without someone who doesn't play for any team (neutral convener), bringing together the two teams, there is usually a standstill. Each side stakes its claim, and then debates where the lines should be drawn. A challenging place to start! The neutral convener who can invite various stakeholders to the table to have a meaningful dialogue around often complicated and political issues, is worth his or her weight in gold!
Second, having a philanthropic foundation support the initiative can help demonstrate to policy makers that the proposed policy around integration has "legs." People tend to pay more attention to integration efforts when there is a funder who is interested and could possibly support the endeavor. In fact, the funder does not have to be different from the neutral convener; in some cases it may be ideal if the convener and the funder are the same entity.
Finally, having an academic partner at the table allows for the research, measurement and dissemination of efforts around policy. The field has been remiss in not joining together and collecting some of the same data to help make the case for integration.
Could this be a policy triple threat?
Because states often adopt different strategies to address these problems, there appears to be an opportunity for states to learn from one another. What happens when states share innovative ideas? What happens when they agree to sit at the same table and begin to work on some of the same issues?
Would this lead to change?
In order to change policy to better allow for the integration of mental health with physical health, the field needs as much help as possible. Bringing together the aforementioned three components is a start, but may not be entirely sufficient. Regardless, it is time for us all to move to support mental health integration and begin to change the healthcare field.
What do you see as the essentials in moving policy for integration?
by Becky Hayes Boober, PhD, Program Officer, MeHAF
Dr. Ben Miller asks if states can learn from one another as they develop policies to support integrated behavioral health and primary care. Having just hosted Dr. Miller and a delegation of integrated care leaders from Colorado, we can answer with a solid "yes!"
In early September I had the pleasure of working with the Colorado group during their visit as they explored strategies MeHAF has used to sustain our 43 Integration Initiative grantees and more than 100 integrated care practice sites. The synergy of ideas flowing back and forth was stimulating. I strongly suspect we learned as much - or more-from them than we shared.
Colorado's delegation represented important yet diverse interests in integrated care policy work: state Medicaid officials, philanthropic foundations, and academicians - all travelling and learning together on behalf of their state. This diverse group could weigh-in across the spectrum of issues as we examined ideas to create policies sensitive to the "delicate balance of politics and financing while...meet[ing] the community's needs," as described by Dr. Miller.
Key integrated care leaders in Maine generously shared their time over a packed three days. We met with DHHS leadership, including the Commissioner, Deputy Commissioner, and Directors. We examined specific Medicaid policy and reimbursement strategies with MaineCare officials. We gathered ideas and insights from grantees, who shared data that build a business case for integrated care. We also met with the Integration Initiative Policy Committee, HIT and healthcare leadership development representatives, leaders of both the Patient Centered Medical Home pilots and the Maine Primary Care Association and patient and family advocates.
In a short period of time we identified ways in which states can work together and benefit through:
I would love to hear any other ideas that could work across state borders!
So, what did Maine get out of the visit?
Firstly, the questions raised by our peers from Colorado will help us focus on priorities. Secondly, we learned new ideas. For example, they are so committed to integrated care that they have a designated state staff position: Director of the State Demonstration to Integrate Care for Dual Eligible Individuals. Finally, we made new friends and deepened previous relationships with colleagues around the country who are as excited as we are to have people receive integrated care that promotes better health outcomes.
We look forward to an ongoing dialogue with our friends from Colorado and other states who want to compare notes.
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