UnityPoint Health Making Strides in Behavioral Health Care

Affiliations with community mental health centers are benefitting patients and advancing value-based care.

As part of the organization's efforts to be a leader in value-based care, UnityPoint Health has embraced Certified Community Behavioral Health Clinics (CCBHCs).

Research has shown that mental health conditions can have significant negative effects on physical health. For health systems and hospitals, the provision of mental health services can reduce healthcare costs such as lowering emergency department utilization.

UnityPoint Health is affiliated with seven mental health centers, says Aaron Mchone, MBA, director of behavioral health for the West Des Moines, Iowa-based health system.

"As of 2008, we had two affiliated mental health centers. Then the Affordable Care Act came, and the idea of value-based care got UnityPoint Health excited for a number of reasons. One of the things we saw was that to be successful in value-based care we needed to have partners on the community mental health center side, particularly for some of our vulnerable populations. From 2015 to 2019, we added five more community mental health centers to our service array, and most of our geographies had a community mental health center component," he says.

Five of the mental health centers are CCBHCs under a program administered by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). UnityPoint Health embraced the CCBHC model mainly to limit variation in the services provided by the affiliated mental health centers, Mchone says.

"One of the challenges we faced during the major expansion period is that community mental health centers are usually unique. They provide different services and have different structures. So, it was hard for us as a health system to figure out how to work with seven different mental health centers to provide a systematic approach to [care] for our patients. That is when we became interested in the program that SAMHSA was piloting. They recognized the variability problem as well," he says.

CCBHCs are required to offer nine core services, according to SAMHSA:

1. Crisis services such as mobile crisis response by behavioral health emergency medical technicians who assess suicidality in the homes of patients

2. Treatment planning

3. Screening, assessment, diagnosis, and risk assessment

4. Outpatient mental health and substance use services

5. Targeted case management

6. Outpatient primary care screening and monitoring

7. Community-based mental healthcare for veterans

8. Peer, family support, and counselor services

9. Psychiatric rehabilitation services

At UnityPoint Health, participating in the CCBHC program has assured that the health system has the same services in all of its regions for behavioral health patients, Mchone says. "Today, five of our affiliated mental health centers are also CCBHCs. The other two have not been certified yet—they are still developing. We hope to certify our sixth CCBHC by the end of the year. Having CCBHCs has helped us coordinate care and to make sure that as patients come out of the hospitals that they are able to get the services that they need."

How CCHBCs are financed

In eight states, SAMHSA has established a prospective payment system model for CCHBCs similar to the payment model used at Federally Qualified Health Centers, Mchone says. "Under the PPS model, you typically get higher reimbursement per encounter, and you are not chasing fee-for-service payments, so you can deliver services based on what the patient needs without hopping through hoops to make sure you can cover your expenses."

The PPS model has not been introduced in any of the states that UnityPoint Health serves (Illinois, Iowa, and Wisconsin), so the health system's CCBHCs receive funding through three sources.

• The first is fee-for-service reimbursement for commercial insurance, Medicare, and Medicaid patients.
   
• The second is value-based payments. All five of UnityPoint Health's CCBHCs belong to accountable care organizations. "When we are successful in keeping our patients healthy and keeping our claims down, there are shared savings payments that come in that are distributed back to our CCBHCs," he says.
   
• The third is grants. "These include federal government grants—SAMHSA grants each of our CCBHCs $2 million a year in a direct grant. We also utilize many other types of grants that oftentimes funnel through the states to our CCBHCs. Right now, we have 88 different grant projects for our CCBHCs that total about $29 million, which accounts for about 30% of all revenue for the clinics. We are thankful for the grants, but they are an administrative nightmare," Mchone says.

Reducing hospital readmissions and emergency room utilization

At UnityPoint Health, the CCBHCs have decreased hospital readmissions.

"We are having CCBHC staff go to the hospital, so that the patient can meet the CCBHC staff and make a connection before hospital discharge. Then we are ensuring that we have seven-day follow-ups to make sure that the patient has an appointment at the CCBHC. So far, and we are only a few months into this readmissions project, we have seen our psychiatric unit readmission rate drop 1.5%. The key to success is the connection point prior to hospital discharge, as opposed to having a phone number and date on the patient's discharge plan. We are making a physical, face-to-face connection with the next level of care before hospital discharge," he says.

There are two primary ways UnityPoint Health's CCBHCs have reduced emergency room utilization, Mchone says. The first is mobile crisis response.

"We have established a hotline phone number for patients to call; then based on how the call goes, we can dispatch mobile crisis response including two behavioral health EMTs who go out to the patient, assess the patient, and work with the patient to come up with a plan of care, which may [include] bringing the patient to the hospital. Alternatively, the EMTs can help establish a plan of care with resources that does not involve a visit to the ER," he says.

The second way CCBHCs have reduced emergency room utilization is through managing behavioral health urgent care centers, Mchone says. "We have established behavioral health urgent care centers across a large swath of our organization that are generally managed by the CCBHCs. In that model, the behavioral health urgent care centers can accept walk-ins, which has been powerful because most patients would rather walk into a CCBHC to be evaluated than walk into the ER and deal with the trauma that can occur at an ER."

The CCBHCs are driving value at the mental health clinics, he says. "With the care continuum, we see that untreated behavioral health conditions lead to poor quality results for our patients and higher expense. By being proactive with all of the CCBHC services, we have been able to reduce our emergency department encounters and reduce our number of hospital admissions, which has led to greater quality and greater value for our patients and our third-party payer partners."

Related: Keys to Success in Behavioral Health Acute Care Joint Partnerships