1115 BEHAVIORAL HEALTH WAIVER PROJECTS: AN OVERVIEW Molly Lopez, PhD Stacey Stevens Manser, PhD Texas Institute for Excellence in Mental Health School of Social Work University of Texas at Austin
Acknowledgements • This project was supported through a grant by The Meadows Foundation. • Texas HHSC provided guidance on database structure and facilitated communication with RHPs (HHSC did not sponsor or request the project). • We want to thank Regional Health Partnerships for reviewing elements of the database for accuracy.
The Why… • The interest is great: • Most significant funding increase for behavioral health services in Texas in decades • The projects chosen by regions provides insight on the needs of local areas • Provides for local innovation and development of best practices • It will be critical to demonstrate good return on investment • TIEMH’s goal was to document characteristics of the projects undertaken in the state and to provide a useful database to Meadows, HHSC and other stakeholders. • A report summarizing findings is available here: • http://sites.utexas.edu/mental-health-institute/publications-and-reports/
The How… • Behavioral health projects were identified initially by HHSC and then additional projects added based on key word searches. • Reviewers with behavioral health knowledge were trained on data definitions and coding and reviewed initial proposals to reach adequate reliability. • All proposals were scored and then received a secondary review for reliability by a lead investigator. • RHPs were provided a subset of data elements to review for accuracy.
The What… • Data is focused on the 395 CMS approved projects. • Providers may be doing more than is reflected in the brief proposal and additional specification may have occurred during the planning year. • Some data elements are more subjective. They are coded when reasonable assumptions could be made.
Proportion of 1115 Projects with Behavioral Health Component % of All Plans Total # of BH with BH RHP Partnership Projects Component Total BH Year 2-5 72,631,848 Anchor: University of Texas Health Science Center - Tyler 24 25.3% 1 88,409,458 Anchor: University of Texas Medical Branch at Galveston 30 40.0% 2 466,983,943 3 Anchor: Harris County Hospital District 46 30.1% 76,429,216 4 Anchor: Nueces County Hospital District 22 25.3% 104,893,535 5 Anchor: Hildago County (South Texas) 18 52.9% 233,777,884 6 Anchor: University Health System (San Antonio) 35 30.7% 216,131,309 7 Anchor: Healthcare District (Austin) 37 56.1% 50,009,524 8 Anchor: Texas A&M Health Science Center (Round Rock) 25 67.6% 126,622,617 9 Anchor: Dallas County Hospital District 21 18.3% 232,185,601 10 Anchor: JPS Health Network (Ft. Worth) 26 25.5% 20,677,393 11 Anchor: Palo Pinto General Hospital (Mineral Wells) 10 31.4% 68,410,788 12 Anchor: Lubbock County Hospital District 20 23.3% 8,768,370 13 Anchor: McCulloch County Hospital District (Brady) 11 31.4% 24,238,242 14 Anchor: Medical Center Health System (Odessa) 6 12.0% 61,159,723 15 Anchor: University Medical Center of El Paso 8 15.1% 36,092,630 16 Anchor: Coryell Memorial Hospital (Gatesville) 15 46.9% 18,207,725 17 Anchor: Texas A&M Health Science Center (College Station) 8 27.6% 63,579,282 18 Anchor: Collin County (Collin, Grayson & Rockwall) 16 69.6% 11,753,709 19 Anchor: Electra Hospital District 10 27.0% 27,087,094 20 Anchor: Webb County Indigent Health Care Services (Laredo) 7 50.0% $2,008,049,890 All All RHPs 395 30.9%
Approved RHP Projects by Category and Goal Number Percent Category 1 Projects: Infrastructure 191 48.4% Goal Number and Description 1.12 Enhance service availability to appropriate levels of BH care 58 30.4% 1.13 Development of BH crisis stabilization services 49 25.7% Expand specialty care 29 15.2% 1.9 1.11 Implement technology assisted services to support or deliver 21 11.0% BH services Introduce, expand, or enhance telemedicine/health 18 9.4% 1.7 1.14 Develop workforce enhancement initiatives to support access to 6 3.1% BH providers in underserved areas 1.10 Enhance performance improvement and reporting capacity 5 2.6% Expand primary care capacity 4 2.1% 1.1 Implement a chronic disease management registry 1 0.5% 1.3
Approved RHP Projects by Category and Goal Number Percent Category 2 Projects: Program Innovation or Redesign 204 51.6% Goal Number and Description Provide an intervention for a targeted BH population to prevent unnecessary services in 90 54.4% 2.13 other settings 2.15 Integrate primary and BH care services 49 24.0% 2.18 Recruit, train, and support consumers of MH services to provide peer support services 15 6.4% 2.19 Develop care management function that integrates PH and BH needs of individuals 13 6.4% 2.17 Establish improvements in care transition from the inpatient setting for MH/SA patients 9 4.4% Establish/expand a patient care navigation program 8 3.9% 2.9 2.2 Expand chronic care management models 4 2.5% Provide virtual psychiatric and clinical guidance to PCPs delivering BH care 4 2.0% 2.16 2.6 Implement evidence-based health promotion programs 2 1.0% Enhance/expand medical homes 1 0.5% 2.1 2.3 Redesign primary care 1 0.5% 2.4 Redesign to improve patient experience 1 0.5% 2.7 Implement evidence-based disease prevention programs 1 0.5% 2.8 Apply process improvement methodology to improve quality/efficiency 1 0.5% 2.12 Implement/expand care transitions programs 1 0.5% Note: BH=behavioral health; MH=mental health; SA=substance abuse/use
Populations of Focus for Behavioral Health Projects Populations Number of Projects Percent* Targeted Age General adult population excluding children 235 59.5% General adult population and children 124 31.4% Children only 29 7.3% Older adults (65 and older) 11 2.8% Adolescents (12 to 17) 6 1.5% Transition age young adults (18 to 25) 2 0.5% Early childhood (0 to 5) 4 1.0% Behavioral or Specialty Populations Severe mental illness 263 66.6% Serious emotional disturbance 98 24.8% General mental health (non-SMI/SED) 129 32.7% Substance use problems 101 25.6% Medical populations 75 19.0% Intellectual or developmental disabilities 38 9.6% Autism 26 6.6% Homeless population 18 4.6% Criminal justice population 26 6.6% Veterans 7 1.8% High utilizers of emergency care 3 0.8% (not specific to BH)
Settings for Care Service Setting # of Projects Percent* Local Mental Health Authority (LMHA) 303 76.7% General Medical Hospital 59 14.9% Primary Care Clinic (non-FQHC) 54 13.7% General Medical Hospital – Psychiatric Unit 15 3.8% Federally Qualified Health Clinic (FQHC) 13 3.3% Mental Health Clinic (non-LMHA) 11 2.8% School 10 2.5% Psychiatric Hospital 8 2.0% Substance Abuse Clinic (non-LMHA) 8 2.0% Homeless Shelter/Facility 7 1.8% County Health and/or Human Services 4 1.0% County Jail 3 0.8% Inpatient Detoxification Facility 3 0.8% Ambulatory Detoxification Clinic 2 0.5% Mobile Clinic 2 0.5% Note: *Total is >100% reflecting collaborations between more than one provider or service setting.
Types of New Staff / Providers Identified Number Staffing Percent of Projects Licensed Mental Health Practitioner (Psychologist, LPC, LMSW, 115 38.0% LCSW) Psychiatrist(s) 77 25.4% Nurse(s) 61 20.1% Administrative staff 60 19.8% Qualified Mental Health Practitioner 55 18.2% Peer Specialist 38 12.5% Physician(s) (non-psychiatrist) 31 10.2% Licensed Chemical Dependency Counselor 30 9.9% Advanced Nurse Practitioner 28 9.2% Community Health Worker or Promotoro/a 13 4.3% Certified Behavior Analyst 10 3.3% Patient Navigators or Care Coordinators 10 3.3% Health Information Technology or data analysis staff 7 2.3% Telepresenters 6 2.0% Law enforcement professionals 5 1.7% University faculty 5 1.7% Family Partner (parent peer support provider) 4 1.3%
Evidence-Based / Promising Practices • 43.8% ( n =173) of projects identified an EBP or promising practice. • 19.1% ( n =33) stated the practice would be selected during the initial planning year. • The 10 most commonly identified practices were: Cognitive Behavioral Therapy Cognitive Processing Therapy Supported Employment Applied Behavior Analysis Motivational Interviewing Wellness Recovery Action Planning Wraparound Planning Illness Management and Recovery Screening, Brief Intervention, and Referral to Treatment Collaborative Care
Integrated Care # of Project Focus Percent* Projects Mental health only 238 60.3% Co-occurring behavioral health and physical health 139 34.9% Co-occurring mental health and substance use 82 20.8% Unspecified behavioral health 65 16.5% Substance use disorders only 63 15.9% Co-occurring intellectual or developmental disorders and 33 8.4% behavioral health Intellectual or developmental disorders only 14 3.5% Co-occurring intellectual or developmental disorders and 8 2.0% physical health Project Focus # of Percent Project Focus # of Percent Projects Projects Co-occurring MH/SA N=82 Co-occurring BH/PH N=139 15 18.3% 34 24.5% Q1 (Low MH/Low SA) Q1 (Low BH/Low PH) 44 53.7% 87 62.6% Q2 (Hi MH/Low SA) Q2 (Hi BH/Low PH) 21 25.6% 39 28.1% Q3 (Low MH/Hi SA) Q3 (Low BH/Hi PH) 44 53.7% 43 30.9% Q4 (Hi MH/Hi SA) Q4 (Hi BH/HI PH) Note: Some projects serve more than one quadrant.
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