Behavioral Health Integration

The Building Blocks of Behavioral Health Integration (BBBHI) is a framework of care delivery expectations for behavioral health integration (BHI) in primary care, designed to align expectations across payers, providers, and patients. The framework can be used in practice transformation efforts and alternative payment models supporting flexible approaches to implement BHI so that payers know how additional support is being used, providers are able to choose their approach based on patient needs and local resources, and there are standardized care delivery expectations for patients.

Examples of the framework’s use and application include:

• The Colorado Division of Insurance incorporated elements of the BBBHI framework in regulation on aligned primary care core competencies in alternative payment models used by commercial payers under state jurisdiction.
• The Practice Innovation Program is using the BBBHI framework to guide practice facilitation and assess progress on care delivery expectations with the 144 practices participating in a statewide BHI grant program (created by CO HB 22-1302) focused on increasing access to integrated behavioral health.
• In Kansas, the Sunflower Foundation Integrated Care Learning Network is using the BBBHI framework with multiple stakeholders, including the Rural Health Clinics, Federally Qualified Health Centers, Certified Community Behavioral Health Clinics, and the Kansas Department for Aging and Disability Services to align definitions of behavioral health integration, enhance collaboration across multiple community partners, and support practice readiness and implementation of BHI.

In 2018, the Farley Center created Make Health Whole, a campaign and toolkit designed to assist engaged changemakers in integrating behavioral health and primary care. The toolkit includes resources on a state policy approach, an integration action framework, integration network tool, state data analytics tool, and more. This work was funded by the Robert Wood Johnson Foundation, the Colorado Health Foundation, and the Zoma Foundation. Explore relevant tools and resources at makehealthwhole.org.

To support Colorado’s progress implementing behavioral health and primary care integration in its State Innovation Model, the Farley Center led the readiness assessment for Colorado is Ready, which established a roadmap for concrete BHI implementation efforts.

Integrated care expands access for key populations with urgent need for behavioral health intervention. Pregnant people who misuse substances are at high risk for poor outcomes, including miscarriage, preterm labor, and delivery-related complications. Infants born to people who have misused substances during pregnancy also face negative outcomes. They are more likely to have a low birth weight, be born early, and to need neonatal intensive care than unexposed infants. Integrated Care for Women and Babies (ICWB) supports clinics in integrating obstetric and gynecological (OB/GYN) services with behavioral health and substance use disorder treatment. The Colorado Ambulatory Partnership for Health Innovation and Research Excellence (CAMPHIRE) leads the program. The Farley Center has developed several policy briefs that highlight the successes, challenges, and need for continued investment in interventions that support pregnant and parenting people and their families.

The Department of Health Care Policy and Financing (HCPF) selected the Farley Center to conduct an analysis on the costs of integrated care. HCPF included the results in their report to the legislature on sustainability for behavioral health integration.

The Farley Center conducted two activities to provide information on the cost primary care providers incur:

1. An environmental scan of the literature estimating the cost of integrating behavioral health care services into primary care settings.
2. An analysis of time-driven activity based costing information the Farley Center collected from 11 Colorado primary care practices with difference models of integrated care delivery and levels of experience.

Integrated care has emerged as a promising approach in health care and understanding what it takes and costs is essential. Read more about the Farley Center’s findings in Appendix D of the following report.