Dissemination of a Behavioral Health Home Model with Improved Physical Health and Wellness across Behavioral Health Settings

Abstract

Research Objective: Behavioral Health Home Plus (BHHP) is an evidence-based model to enhance physical health and wellness for individuals with serious mental illness (SMI) and chronic medical conditions. To better understand model effectiveness and best practices for dissemination, we implemented BHHP in 7 adult Opioid Treatment Programs (OTP) and 5 youth Residential Treatment Facilities (RTF). Study Design: We utilized a hybrid study design to examine dissemination and support of BHHP through a 12-month Learning Collaborative (LC) and outcomes via propensity-score matched analyses. Mixed methods included semi-structured staff interviews and confidence surveys to assess feasibility. Data were collected on involvement/confidence in managing physical health (survey) and utilization of primary/specialty care and unplanned healthcare (claims) over 18-months. Population Studied: In Pennsylvania's Medicaid HealthChoices program, behavioral health agencies serve as health homes with support and training in wellness by a behavioral health managed care organization, Community Care Behavioral Health of the UPMC Insurance Services Division. Enrollment into BHHP for OTP included adults (n = 689), average age 39.19 +/- 9.99 years, 60% female and youth (n = 354) for RTF, average age 14.04 +/- 2.52 years, 31% female. Propensity score matching was successful for OTP (n = 688) and RTF (n = 312) members. Principal Findings: Providers reported barriers (training time, staff turnover, workflow integration, family engagement) and facilitators (model resources, education on population-specific health topics, learning from other sites implementation experiences) to implementation. At 18-month follow up, over 70% of staff reported being highly confident in working with individuals on physical health and wellness; over 60% of service-users reported being highly involved in working with their behavioral health provider on physical health and wellness, and 67% of OTP and 43% of RTF service-users reported being highly confident in their ability to manage their physical health and wellness. Service utilization outcomes showed large decreases over 18 months in medically emergent care for OTP members while rates remained steady for the matched comparison group (p = 0.0055); a similar pattern was found for medications for physical health chronic conditions (p < 0.0001). For OTP, more individuals remained connected to ambulatory substance use disorder services in the comparison group at 18 months. For RTF both intervention and comparison groups showed decreased behavioral health hospitalizations; however, a greater proportion of the intervention group remained connected to ambulatory psychiatric service at 18 months (62% v. 48%). The comparison group showed larger decreases in medically emergent care over time (p = 0.0186). Conclusion(s): Sites have fully integrated the BHHP model into workflows and promote physical health and wellness amongst their complex and medically vulnerable populations. BHHP is associated with positive changes in service utilization outcomes but was comparable to matched comparison groups. Implications for Policy or Practice: Health homes offer an opportunity for improved health outcomes for vulnerable populations with chronic conditions. The LC approach, which allows for full virtual implementation, is an effective and scalable approach to wide-spread implementation and successful uptake of care models.