Behind the efforts to expand access to mental health care in Massachusetts

Behind the efforts to expand access to mental health care in Massachusetts

in one of his last acts as Governor Charlie Baker established 25 new community behavioral health centers across the state and launched a 24-hour Behavioral Health helpline it was a culmination of nearly two years of work on what his administration called roadmap for Behavioral Health reform aimed at increasing access to Mental Health Services and easing Reliance on emergency rooms for care I was able to visit one of the new centers yesterday to see how these kinds of facilities work and now for a look at what kind of response they’ve been seeing so far I’m joined by Kathy mcgeew senior vice president of the behavioral health network which operates a community behavioral health center in Springfield and vicar degravio the third President of the Riverside Community Care which runs the center in Milford and the one I visited yesterday in Norwood Kathy Mugu and Victor degravio the third thank you so much for joining us thanks for having us so I want to begin with asking you just to tell me a little bit about these centers Kathy can you tell me what kind of care is offered at a community behavioral health center how is it different from what happens now yes I’m thrilled to be able to share this so at the Behavioral Health Net we Behavioral Health Network we call ours bhn well-being and the idea is it’s a One-Stop shop for Whole Health Wellness care for individuals with substance use and mental health challenges so what’s different is that when you one thing is that there is no wait for care so when you are looking for services we get to serve you immediately the second is in the past we only had one tool in the toolbox which was therapy and now we have lots of tools in the toolbox we have peers and Recovery coaches and community health workers that are looking at things like housing and food and transportation so what you need we’re able to address the way we like to say it is stop in when you’re ready and we’ll meet you there I mean it’s it’s basically like uh like urgent care but but for mental health correct exactly and figure there’s there’s three different kinds of care that are provided here right it’s not just sort of that Urgent Care walking in the door there are three components exactly so one component is this what we call lower case cbhc which is traditionally outpatient services then there’s the mobile crisis service which is we have teams of individuals that will go out and respond to individuals who are in crisis in their homes in their schools and then we have what’s called crisis stabilization which is a 24 7 level of care where individuals who don’t need to be in a hospital and acute inpatient setting but maybe need to be someplace for four to five days so they can be stabilized and kept safe the CCs is is the third component so it’s three legs of the stool we’ve had a real problem in this state and I think it’s it’s a national issue with just not having enough resources available to help people who are dealing with mental health and Behavioral Health crises I I spoke to one parent of a of a teen who spent two weeks in an emergency room waiting for an inpatient bed to open up and that’s been a problem for some time is is this going to help is it going to address that problem we hope so we hope so um I’m not sure it’s going to solve the problem entirely but the idea of this Urgent Care capacity that Kathy spoke about the mobile crisis teams hopefully we’re going to intervene with folks whether it’s a child an adolescent or an adult before they have to go to the emergency room and before they need acute inpatient stays so if we can get to folks earlier we can one of the great things about this model is we can wrap supports around these individuals that we never have been able to do before and hopefully keep them safe and keep them healthy in their communities and stop them from ever having to go to the emergency department what kind of supports were we talking about Beyond just sort of the usual therapy sure so as Kathy mentioned right so therapy traditionally that was the only tool in the toolbox now we have individuals with lived experience certified peer Specialists recovery coaches we have Kia coordination but we also have enhanced medical capacity as well so we have phlebotomy Services we have increased nursing so that we can address some of these folks if they have low level medical needs as well and just treat them much more holistically than saying okay we’ll provide you Therapy Services but you’ve got to go over here for your blood work and then you’ve got to go someplace else for your medical care so it’s the idea of treating people holistically in an environment that’s respectful in in in in in in in makes them feel welcome and and Kathy one of the things that’s different about this is how that’s paid for right uh can you speak to me a little bit about and tell us about the the bulk sort of payment of this uh if you have mass health yes so individuals with Mass health and as well health New England commercial has um joined this so folks with both of those insurances are eligible for the service so it’s called bundle payment but it’s based on the same activities that we will have used in the past so an individual therapy code or a Psychiatry evaluation and management visit but instead of triggering just the payment for that service it triggers a much higher rate which is called a bundled payment and so we if the expectation is that for that bundle payment the providers have this whole range of other services that are not necessarily unit rate billable right so I mean the the idea there is it’s more than just it’s being paid for differently that the intention is that that’s going to really make it difference in terms of what services people wind up getting right right and here’s a perfect example this is my one of my favorite examples is in the past when you have children and families where the child has ADHD for example or behavior problems and the parent is really struggling in the old system of community behavioral health we could not do a parent group without diagnosing the parents and billing for the parent so because the child is the patient we didn’t get reimbursed for doing a group with parents who can share that’s one of the best modalities is for people with similar experiences to share together with this model because the bundle payment pays for wraparound Services we can have parent education programs and drop-in programs the one of the issues that we see in the state is that there’s a really shortage of people who work in this industry uh increasingly so right um should this make a difference in terms of Staffing do you have enough staff to be able to handle the demand so the short answer is yes in in the short term staffing has always been an issue for our industry and I think it always will be but the increased reimbursement rates the investment the state has made in this service has allowed us to pay better salaries so we now can compete with hospitals Health Centers other other health care organizations that typically we would lose staff to the other thing about this service though that’s helped with Staffing is it’s truly a historic revolutionary type service we have people who want to work in the cbhc because they see that we’re we’re able to provide a level of care and a different type of care than they’ve ever been able to do historically so people want to come to work in cbhcs which is really exciting one of the issues here though is that not everybody necessarily has access to that full Suite of services offered in in this one payment right if you have mass health which is the state’s Medicaid Program you have access to this or you know I mentioned some other limited insurance companies are doing it but across the board most people with private insurance can’t access the full Suite of care that you provide right right so what’s up with that well I do believe and Vic probably knows more about this than I do but I do believe that we’re working hard the state is working hard to get other insurance companies on board understanding the importance of this level of care for their members um and I think in the meantime none of us will turn people away um if they’re coming to see care with us but the full array of services is available to folks with MassHealth Vic do you have other yeah I think um one of the commercial insurance Optum is purchasing the service on the eastern part of the state which is great but I think part of it’s going to take submerging from state government but commercial insurers need to step up to the plate this is a service it’s a um it’s a service that is a legitimate service it’s built on evidence-based practices there really should be no reason why Commercial Insurance product should not offer this benefit to their members okay I reached out today to the Massachusetts Association of health plans and they said that some plans may be planning to contract with cbhcs and others maybe it’s still evaluating it but they said you know the program is of course still in its early stages it just launched this month so there’s there’s a chance that they may still do it uh the state also uh just launched this behavioral helpline a phone number that people call to get matched up with Services how’s that tie into this is that going to make a difference yes so the way I’m understanding is really is of no wrong door so there are three options for folks there is the state central line there’s also the 988 number and so from the perspective of a Community member you can call your local cvhc directly you can call the State Central helpline you can call 988 and the idea is that they’re all connected and the state central line is staffed 24 hours a day with Master’s level clinicians their goal is to take some of the heat off the local sites and do some triage to determine what really does an individual need and then get them to the right level of care so that they’re not waiting in wait lists for services that are not relevant and won’t help them okay and there’s been a documented increase in mental health issues in the state and nationally since the pandemic began I think it sounds like this is not going to solve all of our behavioral health problems in the state but is it a start is it getting us in a direction we need to go it’s a very important start and and one of the things that we need to remember is that we have experienced 40 Years of underfunding in neglect of the community behavioral health system this is really transformational but it’s gonna it’s not going to fix 40 Years of underfunding in four weeks or four months maybe four years five years but it’s a very important step okay Victor gravio and Kathy mcgu thank you so much for joining us today thank you thank you Craig

Massachusetts has opened up over two dozen new community behavioral health centers across the state in an effort to increase access to mental health services. Kathy Mague, Senior Vice President of the Behavioral Health Network and Vicker DiGravio III, President of Riverside Community Care, joined Craig LeMoult to discuss what the centers they oversee are seeing so far.

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