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Medicaid and Health Insurance

Behavioral Health and Primary Care Integration

States are leading initiatives to better address the needs of Medicaid enrollees with behavioral health needs, particularly those with severe mental illness and substance use disorders and related challenges such as homelessness and incarceration. One of the priorities for state health system transformation is establishing better integration of behavioral health and primary care services and coordination of services across the continuum of care for those populations.

The National Governors Association Center for Best Practices (NGA Center) is working with states on a number of issues pertaining to behavioral health and primary care integration with a focus on achieving the three-part aim of improved outcomes, better quality of care and reduced costs. Those issues include information (data) exchange to support quality care coordination, delivery system and payment reforms to incentivize best practices (including pursuing new flexibility to modify state Medicaid programs, for example through waivers and state plan amendments), quality measurement and workforce capacity building.

A focal point of the NGA Center work with states is in establishing or scaling up cost-effective programs for Medicaid enrollees with complex care needs. Many of those individuals have unmet behavioral health and social service needs that are better served outside of costly health care settings. [add link here to complex care subpage]

Social Determinants of Health and Well-Being

The vast majority of factors that contribute to health and well-being are socioeconomic and behavioral in nature. Therefore, payment and care delivery reform will be most effective and most efficiently managed when coordinated with policies in the public health, social support services, education, employment and community development domains. Integrating policies and programs across those sectors increases the prospect for improved health and overall well-being in our communities. To do this, states could develop sustainable funding streams, complementary processes and common outcomes to support full integration of those services.

Governors are uniquely situated to look across their states in their entirety and can coordinate action among state agencies, communities and stakeholders including payers and providers towards a common vision of improved population health. Many governors are actively engaged in aligning multiple health delivery system reform efforts with broader population health strategies and are exploring economically sustainable models.

The NGA Center and state, federal and national expert partners, are assisting governors in using the convening, payment, and programmatic levers at their disposal to innovate as they address social determinants of health.