Medicaid coverage of physical and behavioral health does not improve access to care

Healthcare systems in the United States have gradually adopted the concept that mental health should be treated on an equal footing with physical health, particularly in light of increasing rates of anxiety and depression during and after the COVID-19 pandemic.

To improve access to mental health treatment, many Medicaid programs have required their managed care organizations to fund behavioral health and physical health together. This contrasts with the traditional approach in which behavioral health, including substance use disorder treatment, was “excluded” from typical health care coverage, requiring patients to be covered by a health plan. totally different insurance.

The new approach, known as integrated managed care organizations, was supposed to lead to better access and outcomes for patients.

However, a new study led by Oregon Health & Science University finds that integrating behavioral and physical health has not led to significant changes in access or quality of health services in Washington state .

“It was hoped that this would be an important catalyst,” said lead author John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness. “The idea was that integrating care within managed care organizations would lead to positive changes at the clinical level, and that hasn’t really happened, at least not yet.”

Published today in JAMA Health Forumthe study concludes that administrative change may be necessary but insufficient on its own to improve access, quality, and overall health outcomes for patients.

To achieve these results, McConnell said it may require new training and incentives, including a shift from traditional fee-for-service payment models (in which providers are paid for each medical visit) to alternatives such as those that pay providers for a defined number of patients. covered by the practice as a whole.

Researchers studied changes in Washington state, a pioneer in promoting integrated care models to improve mental health treatment.

The new study evaluated claims-based measures, such as mental health visits; health outcomes, such as reported incidents of self-harm; and overall quality of life, such as rates of arrest, employment, and homelessness among 1.4 million Medicaid patients in Washington state. The analysis followed a phased rollout of financial integration across all 39 Washington counties between 2014 and 2019.

“The surprising result is that nothing has really changed,” McConnell said.

Although researchers were not able to discern statistically significant improvements in access or outcomes for patients in the Evergreen State, McConnell noted that financial integration also did not made things worse. It’s important, he said.

“That probably made it easier,” he said.

In addition to McConnell, co-authors include Sara Edelstein, MPP, Jennifer Hall, MPH, Anna Levy, MPH, Maria Danna, MA, Deborah Cohen, Ph.D., Stephan Lindner, Ph.D., and Jane Zhu, MD. , from OHSU; and Jürgen Unützer, MD, MPH, of the University of Washington.