Oral

Many individuals with behavioral health and complex chronic conditions are expected to be eligible for coverage under Medicaid and Health Benefit Exchanges due to implementation of the Affordable Care Act (ACA). The health care needs and service use of these individuals are extensive and innovative strategies to address their needs are essential. The patient-centered medical home (PCMH) and integration of behavioral health and medical care services are promising approaches in ACA to improve health outcomes and reduce expenditures. Planning for care delivery for these populations is needed but essential data on their health care needs and current utilization are sparse. This panel provides data and insights on innovative care delivery strategies needed for successful implementation of ACA. The first two studies report on services use of individuals with complex chronic conditions who receive care according to PCMH criteria and on adequacy of mental health care for individuals with behavioral health conditions. The third and fourth studies focus on enrollees in the Low Income Health Program (LIHP), which covers Medicaid eligible population through a county-operated safety net provider network and is California’s strategy for ACA implementation. The first LIHP study highlights the importance of behavioral and medical service integration among the newly eligible populations with mental health and substance abuse diagnosis. The second study identifies the importance of linguistically and culturally concordant care among limited English proficient program enrollees with chronic conditions. Together, these four studies highlight the need for innovative approaches to delivery of care for successful ACA implementation. Topics include: The role of Medical Home in Care Delivery for Those with Chronic Conditions Health Care Reform and Vulnerable Adults with Mental Health Needs Reducing Emergency Room Visits and Hospitalizations among Patients with Behavioral Health Conditions: Lessons Learned from California’s Low Income Health Program The Role of Limited English Proficiency in Health Care Use of Those with Chronic Conditions: Findings from California’s Low Income Health Program

Session Objectives: Discuss difficulties of managing populations with multiple and complex health care issues to be covered under the Affordable Care Act.