Traveling the Roadmap to Behavioral Health Integration

Last month, the U.S. Department of Health and Human Services (HHS) published a Roadmap for Behavioral Health Integration (roadmap) to ensure that all people have equitable access to evidence-based, culturally appropriate, person-centered care. To develop the roadmap, HHS determined the most prevalent barriers to behavioral health integration and identified best practice policies to overcome them. In addition to the barriers and best practices, the roadmap shares new programming and funding opportunities to advance the three core pillars laid out in President Biden’s Strategy to Address our National Mental Health Crisis. Below, I have provided an overview of each pillar with the associated roadmap actions and further considerations to promote the overarching mission.

Pillar 1: Strengthening System Capacity.  The roadmap acknowledges the need for adequate behavioral health, more clinicians, a community-based workforce to facilitate integrated care, and a more diverse workforce to address the needs of a diverse patient population. To address these needs, HHS introduces several new initiatives: creating opportunities to engage a more diverse workforce, such as the Minority Fellowship Program; developing more remote work opportunities for crisis counselors through 988 staffing; and bolstering the infrastructure for integration by promoting strategies such as Certified Community Behavioral Health Clinic (CCBHC) model implementations and introducing billing codes to reimburse for activities influencing integrated care.

While these programs could potentially help create new educational pathways or clinic infrastructure, they do not address how to strengthen the current system. The roadmap notes that the Centers for Medicare & Medicaid Services (CMS) “will authorize Medicaid coverage and reimbursement of inter-professional consultations and, as a longer-term strategy, test payment models that leverage behavioral health integration to support the delivery of whole-person care.” This is a step in the right direction; however, HHS could take it one step further by building on the Health Resources and Services Administration (HRSA) 2021 Health Workforce Plan to increase salaries and greater access to loan forgiveness for master-level clinicians to improve retention. At a systems level, HHS could allocate care transformation start-up funding and offer targeted technical assistance to build initial workflow, technology, and other requirements to integrate care in current practice settings.

Pillar 2: Connect Americans to Care. The roadmap focuses on the gap between services offered and an individual’s ability to access that care, including affordability and proximity to services. The roadmap focuses on connecting siloed or disparate systems to achieve shared goals to increase access to care for individuals involved with the justice system, provide services to individuals with housing insecurity, and engage head start providers to provide trauma-informed services to children and families. Including each of the individual organizations in the strategy is essential; however, the greatest value can be achieved by creating a comprehensive, integrated network across service lines. Establishing many “front doors” helps people initially access the system and keeping a consistent record of care and support is vital to ensure individuals continue to receive appropriate services as their needs evolve and they transition to various providers. Implementers can look toward integrated care networks such as the Addiction Centered Medical Home Model and the U.S. Department of Veterans Affairs ‘s(VA) Primary Care Mental Health Integration (PC-MHI) and Behavioral Health Interdisciplinary Program as examples of connecting traditionally siloed organizations.

Pillar 3: Support Americans by Creating Healthy Environment. Referencing a history of limited investments in “culturally relevant, person-centered, and evidence-based promotion and preventive services,” the roadmap focuses on promoting the implementation and adoption of wellness and prevention interventions. Specifically, the roadmap includes opportunities to build on prior research with cited outcomes in prevention activities across various areas such as reproductive health and sexual risk education, trauma-informed programs, and behavioral health care infrastructure for infants and school-aged children. To sustain positive results and meet the goals outlined in the presidential strategy, the roadmap could incorporate key performance indicators and evaluation methodology to measure individual outcomes and program impact.

The HHS roadmap lays out distinct strategies to address the three critical pillars of President Biden’s strategy, which will undoubtedly create pathways to serve individuals in integrated care settings. The evolving strategy must identify how these interventions cater to individuals across different time horizons. A balance of short-term and long-term strategic approaches will support individuals with needs today and provide capacity for the future. Additionally, the roadmap should consider how disparate systems can start to work together to form a network of care that wraps around all the needs of a patient and measures the impact ensuring no one is following through the cracks.