New York is undertaking a transformation of the Medicaid Managed Care (MMC) program for individuals with behavioral health needs. This transformation involves integration of the health, mental health and substance use disorder systems of care as well as expansion of community based care coordination and recovery supports for individuals with significant behavioral needs. This state initiative requires Managed Care Organizations to integrate all Medicaid State Plan covered services for mental illness, substance use disorders (SUDs), and physical health (PH) conditions. As of 2015, adults (21-64) in Medicaid Managed Care requiring behavioral health services became eligible for either mainstream Managed Care Organizations (MCOs) or specialized Health and Recovery Plans (HARPs). HARPS are specialized and integrated Medicaid Managed Care product line for individuals meeting criteria for serious mental illness and/or Substance Use Disorder. HARP enrolled individuals receive an independent person-centered assessment and service plan. The assessment includes completion of the Community Mental Health InterRai, an assessment instrument used to determine eligibility for Home and Community Services. The assessment determines the medical and psychosocial status and level of need for HCBS services including: employment supports, education supports, peer supports, respite, habilitation and rehabilitation supports. In addition, the assessment includes detailed demographic items to assess gender identity, sexual orientation, religion, race/ethnicity, and preferred language. This presentation will offer a descriptive analysis of the HARP enrolled population using data us from the Community Mental Health InterRAI. Findings will suggest a basis to understand disparities in access and outcomes for the individuals in HARPs.

In 2011, the Florida Legislature created the Statewide Medicaid Managed Care (SMMC) program that requires enrollment in managed care plans for most Medicaid members. The SMMC program was fully implemented in August 2014 and currently serves 4 million members at an annual cost of approximately $25 billion (Senior, 2015). The SMMC program is comprised of two parts: the Managed Medical Assistance (MMA) program and the Long-Term Care program. The primary goals of the SMMC program are to improve access and choice to health care services, provide opportunities for members to be more active in making their own health care decisions, reduce the administrative complexity, and slow the rate of growth of expenditures through better care coordination, reduction of over-utilization, and reduction of fraud (Armstrong et al., 2014). In addition to its standard and comprehensive managed care plans, the MMA program also has six specialty plans that serve members with a distinct diagnosis or chronic condition. One of these specialty plans, the SMI Specialty Plan, is operated by Magellan Complete Care. Although many members with SMI are enrolled in the specialty plan, some members may choose to enroll in a standard/comprehensive plan or may reside in a region where the specialty plan is not operating. The purpose of this presentation is to share evaluation findings regarding access to health care, the integration of physical and behavioral health services, and quality of care for individuals with serious mental illness (SMI) who are enrolled in Florida's Managed Medical Assistance (MMA) program. The primary purpose of the study is to compare SMI Specialty Plan with standard MMA plans that serve enrollees with SMI. The research design consists of qualitative and quantitative methods. Qualitative methods include reviewing documents, conducting interviews with managed plans leaders and providers, and focus groups with consumers. A content analysis of these data will examine themes, patterns, and trends. Quantitative methods include analyses of administrative data to describe characteristics of consumers, penetration rates, service utilization patterns, quality of care, and outcomes across plans. These data will be analyzed using descriptive and multivariate statistics.

Practices that effectively integrate behavioral health services and primary care have been shown to improve clinical outcomes and quality of life for healthcare consumers. Additional benefits include enhanced team performance, increased mental health and well-being, improved satisfaction, and health system cost savings. The Satcher Health Leadership Institute at the Morehouse School of Medicine’s (SHLI/MSM) Division of Behavioral Health developed the Integrated Care Leadership Program (ICLP) to provide clinical and administrative health care professionals with the knowledge and training needed to successfully develop integrated care practices. The ICLP addresses mental health disparities by offering tools and strategies that increase readiness to integrate behavioral health into primary care thereby achieving the Institute for Healthcare Improvement's (IHI) Triple Aim and advancing health equity. Eleven primary care and behavioral health practice sites are currently enrolled in the program and completed baseline self-assessments. The program consists of an online curriculum, coaching calls and webinars designed to develop transformative leadership within each organization. Additionally, site visits were conducted by program staff to review current practice and inform technical assistance efforts. This presentation will examine the development, implementation, and preliminary evaluation of this innovative learning collaborative. Lessons learned from preliminary program evaluation data will be discussed through review of quantitative and qualitative data, including a readiness for integrated care-questionnaire (RIC-Q) administered at baseline and 6 months. Mean baseline readiness scores revealed participating sites were generally highest on motivation and lowest on innovation specific capacity for integrated practice. Although readiness assessment results at 6 months failed to reveal statistically significant changes at the aggregate level, documented improvements in behavioral health screening practices across participating sites suggest the ICLP may be a promising model for enhancing readiness for integrated practice. Additional implications for policy, research, and practice will be explored, with an emphasis on strategies for supporting organizations in successfully implementing integrated practice in challenging policy environments.