Becky Hayes Boober , PhD, Senior Program Officer Maine Health Access Foundation

1. Session #D4a Saturday, October 18, 2014 Claiming a Seat at the Table: Strategies to Promote Behavioral Health Integration in Healthcare Reform Becky Hayes Boober, PhD, Senior Program Officer Maine Health Access Foundation Rick Ybarra, MA, Program Officer Hogg Foundation for Mental Health Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, participants will be able to: • Explain three strategies for including behavioral health in planning for health care reform. • Articulate Triple Aim benefits for embedding integrated behavioral health/primary care into new health care system structures, such as Accountable Care Organizations and managed care systems. • Identify at least one policy opportunity in their home states and select relevant strategies to use to address that opportunity.

4. Health Reform Race • In the next 30 seconds, list the names (or other identifier) of as many health reform initiatives as you can recall. • Example: Affordable Care Act • Can be local, county, regional, state, national, international • GO!

5. History of Integrated Health Care in TX • Multi-year, multi-site grant program begun in 2006 implementing collaborative care model • Statewide conference in 2008; Resource guide published • Multi-year learning community begun in 2009 • Office of Minority Health / Hogg collaboration (2012). Lit review, consensus report on eliminating health disparities through IHC, and funders report published • 2012-2015 planning and implementation grants

6. Key Policy Opportunities in Texas • 2011: 82nd Leg. Session. HB 2196 Report of Integration of Health and Behavioral Health Workgroup • first state to establish a legislatively mandated workgroup on integration • Hogg influential in developing a track record in IHC • Workgroup submitted final report with nine recommendations • new relationships proved instrumental in influencing state health policy Strategies: after report submitted to the Leg, TX HHSC sought a waiver under section 1115 of the SSA to expand Medicaid managed care in TX; approved by CMS December 2011

7. Key Policy Opportunities in Texas • 2011 Texas Healthcare Transformation and Quality Improvement Program, 1115 Demonstration Waiver • Strategies: CFHA 2012 Policy Summit 17 of 20 regional health partnerships (RHPs) attended; each charged with planning for health care delivery best suited to their communities; CFHA Policy Fellow one year appointment to follow-up with RHPs, provide TA, connect RHPs to SMEs, develop policy briefs; approx 396 Delivery System Reform Incentive Payment (DSRIP) BH projects funded by the 1115 waiver; 140 of those projects planned to integrate physical and behavioral health care • 2013: 83rd Leg. Session. SB 58 IHC workgroup • Strategies: Hogg Foundation executive director chairs committee

8. Key Policy Opportunities in Maine • MeHAF 42 grants: clinical practice and systems transformation, 150+ partner organizations • 6-year Integrated Care learning community • State Integrated Care Policy Committee • Anthem Pilot • PCMH Pilots—All payers, including Medicare • Health Homes, Behavioral Health Homes, CCTs • State Innovation Model initiative • KeepMEHome (House Speaker Eves)

9. Result • Over 45% of primary care practices in Maine have some level of integrated care! And growing. • Strong state champions!

10. How? Tips We Learned • Be at the table. • Be strategic. • Be opportunistic. • Know the real issue and not just the surface system. • Show and Tell.

11. If you’re not at the table… You are on the menu!

12. More Tips: BFFs • Identify and nurture your champions. • Be a friend. • Mid-level officials • Administrative staff (gatekeepers) • State and other systems and political leaders • Communicate in their language, value system. • Have neutral party (i.e., funders) convene policy committee.

13. More Tips • Be specific and realistic with your Asks. • Time the requests right. • Let decision-makers know when what they did makes a positive difference. • Don’t expect immediate results. Stay in it for the long haul—at least 10 years. • Recognize the Adaptive System, Collective Impact nature of embedding Integrated Care.

14. The Triple Aim Be at the Table! Strategic Partnerships Convening Look for opportunities Leverage your influences BFFs Long Term View Celebrate small wins in a BIG way!

15. Your Opportunities • Think of an opportunity you have to be able to influence the expansion and/or sustainability and support of integrated care. • What is one step you can take within the next 2 weeks?

16. Learning Assessment Discussion / Q&A

17. Bibliography / Reference Linkins, K.W., Frost, L., Boober, B.H., and Brya, J. (2013). Moving from partnership to collective accountability and sustainable change: Applying a systems-change model to foundations’ evolving roles. Foundation Review, 5:2, 52-66. Gratham, S., Boober, B.H., McKinney, A., Truesdell, N., Coakley, E., and Ward, M. (2014). “Working toward collaborative care” in Case studies in organizational behavior and theory for health care. Ed. Borkowski, N. and Deckard, G. Burlington, MA: Jones & Bartlett Learning. D. Bachrach, S. Anthony, and A. Detty, State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment, The Commonwealth Fund, August 2014. Sanchez, K., Frost, L.E., and Held, M.L. (2013). Assessing the Legacy of a Legislative Workgroup for Bidirectional Integration of Services. Journal of Behavioral Health Services & Research, 2013, 1-10. Center for Health Care Strategies (CHCS). Improving Health Care Quality and Equity: Considerations for Building Partnerships Between Provider Practices and Community Organizations. Robert Wood Johnson Foundation Primer/Brief. April 2013.

18. Contact us: • Rick Ybarra, Program Officer • Hogg Foundation for Mental Health; Austin, TX • 512-471-9154 • rick.ybarra@austin.utexas.edu • Becky Hayes Boober, Senior Program Officer • Maine Health Access Foundation; Augusta, ME • 207-620-8266 ext. 114 • bhboober@mehaf.org

19. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!