Lessons from a payer-led behavioral health home model

Doctor examining patient
Payers may be able to leverage their unique relationships with community mental health providers to integrate physical health and wellness support into their existing care delivery settings, according to a new study. (Getty/kazoka30)

A payer-led initiative in Pennsylvania offers important lessons on how to design a behavioral health home model aimed at improving and integrating care for individuals with serious mental illnesses, according to new research.

The initiative in question is the Behavioral Health Home Plus model developed by the Community Care Behavioral Health Organization, a UPMC-affiliated nonprofit managed care organization. The organization rolled out its model at 11 community mental health providers, employing one of two approaches at each one. 

The self-directed care approach used a secure web portal to give patients access to tailored content that helped them learn about their conditions and take an active role in their own care. The other approach, known as provider-supported care, made use of a full-time registered nurse on staff at each community mental health provider to offer consultation to wellness coaches. 

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To test which one worked the best, leaders at UPMC and other researchers conducted a study that assessed their effects on outcomes like patient activation, perceived health status, and engagement in primary and specialty care.

Here’s what they found, according to the study published by Health Affairs:

  • Both models led to an increase in patient activation scores. But in the provider-supported approach, activation remained stable over time, whereas with the self-directed approach, it began to decline after initial improvement. Researchers suggested the difference was likely due to the role of a wellness nurse in the provider-supported approach.
  • Overall, embedding health navigation into the case manager role and training all staff members in supporting a culture of wellness may have been the key elements leading to similar successful outcomes with both approaches.
  • The behavioral home health models resulted in a 36% overall increase in primary or specialty care use for patients. The increase in primary care use, the study authors noted, is an encouraging sign since it can signal an uptick in the use of preventive care among those with behavioral health issues.
  • For patients involved in both models, overall perceived mental health scores improved over time. However, perceived physical health scores worsened, which may be a result of increased awareness of physical health diagnoses and challenges.

Given these results, the study authors concluded that payer-led behavioral health home models likely work best when they blend both approaches—providing both wellness nurses and self-management resources. 

More broadly, the findings suggest that payers may be able to leverage their unique relationships with community mental health providers to integrate physical health and wellness support into their existing care delivery settings. The findings can also can “inform national efforts to improve the health outcomes of people with serious mental illnesses,” the authors said.