Trans-agency collaboration to inform behavioral health services and policy in Texas Medicaid

Serious and Persistent Mental Illness (SPMI) can be managed successfully with coordinated medical and psycho-social services and supports. Low-income and under/uninsured adults with SPMI face elevated risk for morbidity and mortality due in part to fragmented care involving numerous providers, payers, and programs. States rarely have analytic capacity to evaluate quality of care across public-payer systems, despite recognition that patients typically receive care from multiple programs. The Texas Institute of Health Care Quality and Efficiency (Institute) leveraged its multi-agency structure and stakeholder relationships to facilitate development of an integrated database capturing Medicaid, Medicare, and other publicly funded health utilization for adults with SPMI. The Institute and its partners, including the Meadows Mental Health Policy Institute and the University of Texas School of Public Health, used the database to inform policy recommendations to improve services for adults with SPMI.   Preliminary results indicate that 10.5% of adult Medicaid clients had at least one SPMI-related claim from 2010 to 2012, and 40% of these clients were dually-enrolled in Medicare.  Medicaid enrollees with SPMI were more likely than other adult enrollees to have one or more of 13 major medical comorbidities, and 9% had at least one enrollment gap.  The project led to recommendations to streamline data integration and access, standardize behavioral health performance metrics, and improve continuity of care for Medicaid and justice-involved individuals with SPMI.  Moreover, the multi-stakeholder, public-private partnership model establishes a framework for health quality improvement initiatives for other populations receiving services through multiple health and human services programs.