How Texas Is Busting The Traditional Silos Of Mental And Physical Health Care
Kerstin Taylor’s home is evidence of a life rebuilt. It’s filled with her grandmother’s paintings, Christian crosses, photos and stuffed animals.
“They all have names,” she said in reference to those stuffed animals. “That has to do with, truly, the family I never had – my broken family.”
Taylor, 52, moved to Austin from Illinois in the 1990s and struggled for years with substance use disorders. Bipolar and obsessive-compulsive disorders compounded those addictions. For years, she sought conventional psychiatric and substance abuse treatment, but recovery never lasted long.
“I was lost and I felt like a lost cause,” she said.
But that changed in 2012 when Integral Care in Austin offered Taylor a new type of service. The center not only treated her with psychiatry and therapy, but she also saw a primary care doctor, was put into a chronic disease management program and got help with lifestyle skills like proper nutrition, rest and exercise – things she had neglected for years.
Taylor said it was the holistic approach that made all the difference, because for a long time, her addictions and mental health issues made it hard for her to take care of basic needs.
“I wasn’t doing anything to help myself,” she said. “It affected my thinking, way of thinking. I was afraid, afraid to ask for the help.”
Integral Care’s approach is part of a growing movement called “integrated health care,” which treats mental health as just one component of a person’s overall health. The Department of Defense and other organizations were experimenting with the concept back in the 1990s, but Keith Humphreys, a professor at Stanford’s Department of Psychiatry and Behavioral Sciences, said the Affordable Care Act helped legitimize the movement by defining mental health care as an essential health benefit. This encouraged improvements to how insurers paid for mental health care, because it had often been covered differently – and separately – than physical health.
“So in that very short period, 2008 to 2010,” he said, “there was a dramatic change in policies to bring mental health financing into mainstream health financing.”
In Texas, the move toward integrated care has led to new training programs at UT-Austin in the School of Social Work and the College of Education, which teach students specializing in mental health care to work in primary care clinics. In July, the Hogg Foundation for Mental Health awarded UT-Austin’s Dell Medical School a $440,000 grant to build a curriculum to train medical students in integrated care.
Hogg Program Manager Rick Ybarra said the timing was finally right.
“We engaged these schools with the idea to really deepen the understanding of integrated health care, recovery, how peer support can be a vital asset and really with a deepening understanding of the social determinants of health,” he said.
But paying for this kind of care can be complicated, especially in Texas, where the rate of uninsured people is the highest in the nation. Taylor qualifies for public money, which covers services at the clinics where she receives care. But greater buy-in from private insurers and private doctors is needed to reach a wider range of people, including the millions who have commercial insurance and don’t use the public health system.
Since integrated care requires collaboration among providers, its future depends on a more flexible payment model, says Dr. Bill Tierney, chairman of Dell Medical School’s Population Health Department. That includes a system, often called “value-based care,” that reimburses doctors based on the overall health of their patients, rather than on a fee-for-service basis.
The Centers for Medicare and Medicaid Services just rolled out a program for Medicare doctors in 2017 that uses such a system. In 2018, the agency is also testing a “bundled payment” system that gives a lump sum to providers for the full care of a patient’s medical condition. It’s meant to encourage collaboration and efficiency among providers.
A move toward value-based payment will make integrated care more feasible, but the system is slow to change. Greg Scott, health plan lead for multinational accounting and consulting firm Deloitte, wrote recently that he expects the industry to move incrementally toward value-based payment in 2018, but it’s a few years away from being the norm.
“The tipping point toward value-based care … will hopefully occur in the next several years,” he wrote.