The Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) launched the Cal MediConnect (CMC) program to better serve dual eligible beneficiaries – those enrolled in both Medicare and Medi-Cal. One goal of CMC is to better coordinate behavioral health care service delivery for CMC members.
To improve behavioral health integration and coordination for CMC members, CMC plans examined the ways they have integrated behavioral health services and then shared their findings with other plans during a March 2019 convening.
Almost five years into the program, feedback from CMC plans shows that they are taking a range of approaches in to identifying CMC members’ behavioral health service needs and integrating these services with physical health and other services. DHCS memorialized these findings and lessons learned in a summary report entitled “Improving Behavioral Health Integration and Coordination for Cal MediConnect (CMC) Members.” The report details the complexities and nuances of integrating behavioral health into the care delivery system for dual eligible beneficiaries. CMC plans shared the following lessons learned:
- Identifying Members’ Behavioral Health Service Needs – Plans use a variety of mechanisms to identify members who may need behavioral health services and to ensure members are referred to the appropriate level of care. These strategies include reviewing Health Risk Assessments, analyzing hospital admission data and measures, and tracking referrals from providers, county offices, and CMC members.
- Developing Relationships and Strengthening Communication Channels – Plans refer members who need specialty mental health services to the appropriate county but continue to coordinate the member’s physical health care services. Therefore, a trusted relationship with county partners is a key factor in their ability to successfully coordinate care for CMC members. Plans develop and strengthen these relationships through plan liaisons, memorandums of understanding, educational and training opportunities, and regular meetings with county staff.
- Promoting Data Sharing – CMC plans identified their ability to obtain timely and accurate data on members’ service utilization, medications, current providers, and assessment results is a key aspect of coordinating behavioral health services for CMC enrollees. Most plans have established data sharing agreements with county partners to facilitate sharing of members’ information, although this continues to be a challenge in some counties.
- Enhancing Care Coordination – Behavioral health service delivery and care coordination models vary by CMC plan. Some plans integrate resources to provide behavioral health services while others delegate the provision of services to the county or contracted vendors with behavioral health expertise.