Although the company began as a mission to deliver medical services to the very poor in West Philadelphia, Medicaid managed care company AmeriHealth Caritas now works throughout Pennsylvania, the District of Columbia, South Carolina, Louisiana, Delaware, Florida, New Jersey and Michigan to address all aspects of well-being, including behavioral health.
“Our goal is to take the most vulnerable populations and help them live better lives,” Michael Golinkoff, Ph.D., senior vice president and innovation adviser for AmeriHealth Caritas, told FierceHealthcare.
And in order to reach this population, the company looks to integrate behavioral health within medical services. AmeriHealth Caritas believes that the population with mental health issues greatly benefits from a holistic, comprehensive look at health and the implementation of social services.
Although the company primarily works in Medicaid managed care, AmeriHealth Caritas also owns pharmacy management companies, specialty pharmacies and other entities that are both for- and not-for-profit. Golinkoff has 30 years of clinical and medical management experience, particularly in behavioral health—most recently with AmeriHealth Caritas’ behavioral health division known as PerformCare—and he knows the importance of using funds to support behavioral health initiatives.
One of the focal points for Golinkoff and his team is social determinants of health, specifically, using “health to drive prosperity.”
The role of mental health resources for payers and providers has changed in the last five to 10 years, and the biggest difference, according to Golinkoff, is how the industry views behavioral health. Today, most healthcare workers understand that mental health is a major driver of medical outcomes.
In addition, the industry has done a good job of breaking down barriers and stigmas so that people will feel comfortable seeking mental health services.
“I think that mental health was first seen as a concept that people can be in acute distress,” he said.
Yet another change that Golinkoff has noticed in mental health services is the use of telehealth for psychiatric services. As access to the right mental health services can be difficult in many areas of the country, especially for children, more accessibility is key to adherence for many vulnerable patients.
Golinkoff also cites the increasing use of technology, such as mobile apps to help plan members follow care plans effectively.
“When I was clinically active and doing consultations, I wanted to educate providers and patients on the early signs of needing help,” he said. “Psychiatric conditions are cyclical and many are recurrent, so knowing the signs are important. If you can catch things earlier, you can intervene earlier and avoid debilitating effects.”
So what are some of the programs that AmeriHealth is implementing to support mental health services for the Medicaid community? Golinkoff notes two important factors when discussing vulnerable populations: They disproportionately have mental health issues and disproportionately have housing problems.
So secure housing is one of the major factors to consider when seeking to cut down on trips to the emergency department or hospital admissions. While CMS does not directly allow Medicaid benefits to be used for housing, the issue can be addressed within the law. AmeriHealth Caritas actively looks for ways to support people in housing, without actually paying the rent. The company saves money through its other social determinants programs and then uses some of those funds to pay for housing projects.
Golinkoff is currently working on a project with multiple entities including state behavioral health organizations, hospitals, state and city agencies and other managed care companies to do outreach work in the community. Together this virtual team can identify housing insecurities, get people the proper housing vouchers and offer them support for moving into and staying in the chosen housing.
Another important area for mental and behavioral health is getting healthy foods to vulnerable populations, Golinkoff said. While he admits that the evidence supporting social determinants of health programs still needs time to mature, he believes the programs will eventually produce supporting data for reducing costs in the healthcare system.
In 2013, AmeriHealth Caritas announced a program that helps connect members with nonprofit groups that provide GED test preparation classes, offer coaching to keep members on track and pay for the testing fees.
When asked about the policy, Golinkoff quoted AmeriHealth CEO and Chairman Paul Tufano, in wanting to “get the politics out of Medicaid. It’s an issue of humanity and society.” Plus, “it’s good economics for all to have good healthcare for the vulnerable.”
Moving forward, one concern for those offering mental health services is the issue of privacy. While Golinkoff agrees that privacy is important, he’s worried that restrictive policies can stifle health collaborations. Looking at HIPPA and 42 CFR Part 2—the law protecting the privacy of any person seeking a diagnosis and treatment for substance abuse—he’s worried that these rules were created to protect information when behavioral health and substance abuse had more of a stigma, and records were kept on paper, not a computer. He says both of these policies now need to be revisited.
“As we come to appreciate how intertwined everything is, we realize that not being able to share data actually leads to bad outcomes, such as the problem with opioids and substance abuse,” Golinkoff said. So while he agrees that everyone knows there is value in data, the system needs to create a way to appropriately be able to share it without crossing the privacy line.