Embrace integration of behavioral health care

The OlympianFebruary 7, 2014 

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Former professional football player Orlando Huff (center) talks with Maj. April Fritch, chief of the Psychology Residency Program at Madigan Army Medical Center, and Dr. Simon Pincus, chief of Behavioral Health at Madigan at Joint Base Lewis-McChord on Saturday, Jan. 12, 2013. The Legislature is considering two bills this session that would form a legislative task force to evaluate how the state delivers and procures behavioral health services. (TONY OVERMAN/Staff Photographer)

TONY OVERMAN — The Olympian

Along with 25 other states last year, our Legislature agreed to accept federal funds to expand Medicaid, a state-federal program that provides health care to low-income adults and families. So far, the rollout is a success.

Under the Affordable Care Act, household income eligibility for Medicaid was raised up to 138 percent of the federal poverty level ($15,856 for a single adult, and $32,499 for a family of four).

Washington State Community Health Centers (CHC) report that nearly two-thirds of the newly eligible adults expected to enroll by the end of 2015 have already signed up. And more than 50,000 others, mostly children, have received coverage after they discovered from the expansion’s marketing campaign that they were previously eligible.

In Thurston County, more than 6,000 newly eligible people, or 150 percent of the 2015 goal, have signed up to date. Daily line-ups of people hoping to register required the South Sound CHC to hire additional staff, including one person going into community and signing up five to six newly eligible people every day.

That’s a great success story for Washington, along with our relatively smooth launch of the state’s health insurance exchange and online registration portal.

We can bask in that accomplishment for a moment, and serve as a model for the 25 other states that inexplicably declined this opportunity to extend health insurance to millions of low-income people.

But there’s more work to be done.

Washington’s CHCs have recommended a number of reforms. They range from funding technology changes that give Medicaid enrollees a choice in selecting health plans to funding a marketing campaign targeted specifically at the hard-to-reach Medicaid eligible population.

The most important reform, however, is to integrate behavioral health care — both mental health and substance abuse — and physical health care into co-located facilities. Today, these services are separate, often long distances apart, and without sufficient communication between behavioral and physical health care providers.

People with both behavioral and physical health problems get bounced around in the present complex system and often fall through the cracks. These are the people who make the news, often under tragic circumstances.

The Legislature is considering two bills this session that would address that issue.

Although SB 2639 and HB 6312 differ slightly, they both would form a legislative task force to evaluate how the state delivers and procures behavioral health services. Both bills require the task force to report back the Legislature by Jan. 1, 2015.

The first step toward behavioral health integration might be to get the money flowing through a single entity. After that, deeper reforms can occur more smoothly, such as a clinical registry of electronic health records, treating some behavioral health issues such as depression in a primary care setting and certifying lower-level providers to fill the gap resulting from too few psychiatrists statewide.

The Legislature should embrace the concept of integrating behavioral health care and forming a task force to sort through this quagmire of competing interests is the right place to start.

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