An innovative model to coordinate healthcare and social services for people with serious mental illness: A mixed-methods case study of Maryland's Medicaid health home program

Gen Hosp Psychiatry. Mar-Apr 2018;51:54-62. doi: 10.1016/j.genhosppsych.2017.12.003. Epub 2017 Dec 16.

Abstract

Objective: We conducted a case study examining implementation of Maryland's Medicaid health home program, a unique model for integration of behavioral, somatic, and social services for people with serious mental illness (SMI) in the psychiatric rehabilitation program setting.

Method: We conducted interviews and surveys with health home leaders (N=72) and front-line staff (N=627) representing 46 of the 48 total health home programs active during the November 2015-December 2016 study period. We measured the structural and service characteristics of the 46 health home programs and leaders' and staff members' perceptions of program implementation.

Results: Health home program structure varied across sites: for example, 15% of programs had co-located primary care providers and 76% had onsite supported employment providers. Most leaders and staff viewed the health home program as having strong organizational fit with psychiatric rehabilitation programs' organizational structures and missions, but noted implementation challenges around health IT, population health management, and coordination with external providers.

Conclusion: Maryland's psychiatric rehabilitation-based health home is a promising model for integration of behavioral, somatic, and social services for people with SMI but may be strengthened by additional policy and implementation supports, including incentives for external providers to engage in care coordination with health home providers.

Keywords: Healthcare policy; Integrated care; Serious mental illness.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Delivery of Health Care, Integrated* / organization & administration
  • Delivery of Health Care, Integrated* / statistics & numerical data
  • Humans
  • Maryland
  • Medicaid* / organization & administration
  • Medicaid* / statistics & numerical data
  • Mental Disorders / rehabilitation
  • Mental Disorders / therapy*
  • Mental Health Services* / organization & administration
  • Mental Health Services* / statistics & numerical data
  • Primary Health Care* / organization & administration
  • Primary Health Care* / statistics & numerical data
  • Psychiatric Rehabilitation* / organization & administration
  • Psychiatric Rehabilitation* / statistics & numerical data
  • Social Work* / organization & administration
  • Social Work* / statistics & numerical data
  • United States