New centers offer mental health and addiction care, but omit most privately insured patients

Makenzi Buckely answered the phone at the Riverside Community Care location in Norwood and took the call from a concerned mother requesting a mental health assessment on her child.

“And you want that to happen today?” Buckley asked. “OK. So looking at my schedule, we could probably get out at 12:30, 1am.”

This type of mobile response is one of the services offered here and at 24 other community behavioral health centers, or CBHCs, that opened across Massachusetts in January. It is a new nationwide experiment in treating mental health and addiction problems by funding a full range of patient services. For now, however, insurance coverage issues are preventing about three-quarters of patients from receiving much of the care at these new centers.

“A whole new model of care”

In addition to mobile support services like the team Buckley dispatched to conduct an assessment, another service CBHCs offer is essentially a walk-in emergency center for mental health and substance use disorders. They also offer bedside beds for patients who need that level of support and observation.

“We basically created a whole new model of care,” said Vicker DiGravio, president of Riverside. The way the state has set up this new system allows for team care, he said.

“Teams with expertise in substance use disorders, co-occurring disorders, mental health issues, teams that specialize in child and adolescent care,” DiGravio said. “And the team includes a clinician and a care coordinator. This includes a peer specialist or a family partner.”

The state also required CBHCs to have on-site phlebotomy labs to test for drugs, make sure drug levels are okay, and perform other analysis.

A directory of community behavioral health centers in Massachusetts is online here.

An increase in state funds and a new accounting style

The introduction of this system was one of the last major initiatives celebrated by former Governor Charlie Baker – perhaps the culmination of his administration’s Roadmap for Behavioral Health Reform.

“This is incredibly innovative and has the potential to be transformative for a number of reasons,” said Lydia Conley, president and CEO of the Association for Behavioral Healthcare, which represents mental health and addiction treatment centers in Massachusetts, including nearly all new CBHCs.

“It funds behavioral health at a level that it should be,” Conley said. “It’s a specialty. It was never adequately resourced. This model has adequate resources.”

The difference, Conley said, isn’t just that the state pays more to support mental health and addiction treatment. There is a very different model for paying for these services.

Health insurance companies usually charge for every single service that a patient receives. But for those insured for care with a CBHC, there is only one plan for their combined services.

“So when we offer a service, we bill for the package and get that rate,” explains DiGravio. “If we provide three or four services in one day, we bill the bundle once and still get the same rate.”

That means patients can get a wider range of services that they previously didn’t have access to, DiGravio said.

“Hopefully we can better meet the needs of the people we serve and help them avoid accessing higher and more expensive levels of care, including emergency departments and inpatient hospitalizations,” he said.

A push for private insurers to cover CBHC care

While care at these centers is covered under MassHealth, the state’s Medicaid program, for about 1.5 million people, about three-quarters of policyholders in Massachusetts have private insurance or Medicare, neither of which cover these services.

Some insurance companies have committed to cover CHBC care. But most don’t have it and they don’t have to.

“On the service delivery side, it doesn’t feel comfortable to have a two-tier model or to offer care in two different ways when we’re very passionate about this full range of services is what people need,” said Kimberley Fisher. Vice President of Behavioral Health Services at Riverside.

CBHCs will not turn anyone away in a crisis, and state law requires private insurers to cover immediate care in such emergencies. Some of the services at CBHCs can also be billed individually to private insurers. However, patients cannot receive support for recovery coaches, peer specialists, and other services such as the in-house laboratory.

The Massachusetts Association of Health Plans says some may plan to contract with CBHCs and others may still be exploring the idea since the program is in its early stages.

DiGravio said he hopes more insurance companies will sign up once they can demonstrate that this model performs better and is more cost-effective. And, he said, employers can play a role.

“If employers want their employees to have access to these services, they need to let the health plans they contract with know that it needs to be part of the benefits package,” DiGravio said.

Also, state legislation was introduced that would force insurance companies to cover care in CBHCs.

“I’m really confident that this legislation and my bill will make these treatment providers available to everyone in our community, whether you have MassHealth or Blue Cross Blue Shield, you name it,” said Sen. John Cronin, who introduced the bill.

However, this legislation will not be passed overnight. Cronin said he hopes to get an analysis of the bill from the Center for Health Information Analysis in the next year or two, which should be able to make it clearer which insurance companies the state might need to cover this type of care.

New centers offer mental health and addiction care, but omit most privately insured patients

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