CalAIM Corner: Transforming Behavioral Health
CalAIM is strengthening the state's behavioral health continuum of care for all Californians, including Medi-Cal beneficiaries living with serious mental illness, serious emotional disturbance, or substance use disorder. The goal is to improve outcomes for people living with the most complex needs through better coordinated treatment, and to allow providers to respond in a patient-centered manner.
To learn more about CalAIM's Behavioral Health initiative, we spoke with Tyler Sadwith, Deputy Director of Mental Health and Substance Use Disorder Services at DHCS.
What is the overall behavioral health goal for CalAIM?
Medi-Cal beneficiaries deserve a system that delivers high-quality care when and where they need it. DHCS is transforming the delivery of mental health care and substance use disorder care so that no matter where you live or which door you enter, you find a compassionate person who will find out what you need and connect you to that service. People show up for care as whole people. They have challenges in their mental health. They may have a substance use disorder that helps them cope with their mental health needs. They may even have medical problems that make it hard to get up, or face challenges meeting their basic food and housing needs. Medi-Cal services responding to these needs are funded separately with different sources, but that doesn't mean they can't be streamlined, coordinated, and integrated.
How is CalAIM transforming the delivery of behavioral health care in Medi-Cal?
A key feature of CalAIM is the “no wrong door" approach to the delivery of behavioral health care. It can be very confusing to know where to get help, especially for people who may speak a different language, who have never before used their Medi-Cal coverage, or don't even know that they are entitled to mental health treatment and substance use disorder services. We are trying to make it easy for people to access care and services. This includes transferring patients to the right services seamlessly and making sure those services are reimbursed by Medi-Cal no matter what door the patient entered through.
Also, people are not static, and their care plan and treatment needs will likely change over time. They need a care plan that shifts along with them. CalAIM allows people to continue to see their trusted providers, while at the same time being able to access care in a different system, based on their needs. We're improving the care experience, and ensuring continuity of care and coordination of services so people can receive the right care and treatment to meet their unique health needs.
How will integrating specialty mental health services and substance use disorder treatment improve patient care in CalAIM?
DHCS recognizes the need to address the link between mental illness and substance use. Half of people who have a mental illness also use substances, often as a way to cope with their illness, and half of people using substances have some type of mental health condition. Unfortunately, for decades, payment for specialty mental health services and substance use disorder treatment is separate, creating a barrier to integrated care for patients. It's time to try something new, which is why DHCS is going to integrate oversight, administration, and payment of specialty mental health and substance use disorder services into one contract between DHCS and counties. DHCS has also done a lot of work through the California Bridge program to train and educate clinical staff on how to integrate care by identifying opioid use disorder, treating it, and connecting patients with ongoing treatment and care. Through CalAIM, DHCS is going to make it possible for patients to receive multiple services in one coordinated location or during one visit.
How do the behavioral health initiatives fit into the larger CalAIM goals, such as health equity?
DHCS' focus on improving the state's behavioral health system is driven by the stark inequities in access to health care by race, ethnicity, and income. There are certain populations, especially Black, Indigenous, and People of Color, who have historically been underserved in the health care system. They have worse outcomes and a shorter life expectancy on almost every measure. We are taking the first step in a long journey to ensure that Medi-Cal is an agent of change with a focus on health equity. DHCS is also looking at data to identify inequities and use the best quality improvement techniques to ensure health care is better, fair, and equitable.
Another challenge is that the behavioral health workforce does not always mirror the people it serves. While it is a requirement that every service must be available in a threshold language, it can still be challenging for patients in a counseling visit to engage and build trust with a provider who is not a fluent speaker of their language, does not look like them, or may not have the same lived experiences as them. We need those who serve a community to come from that community, whenever possible. We are committed to looking at the workforce and making necessary investments, so that in five years, our workforce will more closely resemble the communities it serves.
What is the best way to stay up to date on CalAIM's Behavioral Health initiative?
The CalAIM Behavioral Health Initiative website has many resources available, including links to important updates and the CalAIM Behavioral Health fact sheet. Information about registering for an upcoming webinar is available, as well as links to presentation slides from previous webinars. You can also follow CalAIM on Twitter and Facebook.
