Michigan health director outlines vision for integrated physical/mental health care

Taking a new tact away from the controversial Section 298 proposal for integrating physical and behavioral health, Michigan Department of Health and Human Services Director Robert Gordon has called for creating “specialty integrated plans” to oversee those needs for people with significant behavioral health issues.

Gordon first revealed the idea in an op-ed published Wednesday in The Detroit News, and followed that with an outline of the broader concepts before a joint meeting the House Appropriations Health and Human Services and the Senate Appropriations Community Health/Human Services subcommittees.

In outlining the basic idea of the proposal, Gordon essentially said the effort was beginning the process to get public feedback, as well as legislative and associated group input.

Gordon did not expect to see final implementation of the proposal before 2022, meaning a type of integration of mental and physical health administration would not occur until some six years after former Gov. Rick Snyder first triggered the controversy over integration by directing that it occur under the state’s Medicaid managed care plans in Section 298 of his proposed 2016-17 budget.

Dominick Pallone, executive director of the Michigan Association of Health Plans, said Gordon’s proposal was “positive in that it is a fresh restart” from the controversy surrounding Section 298.

But there is much to digest in the proposal and Pallone said he was happy the administration was open to discussion on the details to be developed. And he also said that integration using the Medicaid managed care plans remains a viable option, especially considering how it has worked in other states.

However, mental health organizations have remained resistant throughout to the idea of managed care plans overseeing integration, which Gordon made passing reference to in his outline.

Bob Sheehan, CEO of the Michigan Community Mental Health Association of Michigan, said there were positives and negatives about the proposal. He said it was impressive that the department had a vision for an integration system and that there was “pretty strong pro-public language” in the proposal.

In his op-ed, Gordon said the approach using the specialty integrated plans “preserves the strengths of our system while also addressing its shortcomings. For too long we have treated people as though they were split in two. There’s ‘physical health,’ handled by one set of providers and insurers, and then there’s ‘behavioral health, handled by another. The two sides often can’t coordinate or share information. Dealing with two of everything makes life more complicated for everyone.”

Currently, Medicaid recipients who have only minor to moderate behavioral health issues will be covered by the managed care plans, which also care for their physical health. Recipients who have significant mental and behavioral health issues are cared for by the managed care plan for their physical health needs and by a prepaid inpatient health plan for their mental health needs.

However, the PIHP plans are struggling financially across the state. The state earlier this year was going to close one, then backed off that plan, though the PIHP is suing the state, as is a second PIHP.

Under the proposal, those recipients with mild to moderate mental health needs would stay on the managed care plans as they do now. For those with significant mental and behavioral health issues, under the new proposal their mental and physical care would be handled by the specialty integrated plan.

In outlining the plan, Gordon said it was critical for the state to ensure that its safety net be kept in place and that goals of the proposal need to be person centered, community and evidence-based as well as oriented towards recovery.

Several states are using a specialty integrated plan system, including Arizona, Arkansas and North Carolina. Gordon said North Carolina’s experience is quite recent.

Pallone also said Arkansas and North Carolina had essentially no experience with managed care systems prior to beginning their integrated systems, unlike Michigan which has been operating under a managed care system for more than 20 years.

Gordon also told the subcommittees there would probably be some startup costs for the proposal.

This article appeared in Crain’s Detroit Business. Read more here.