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Document: Missouri's Certified Behavioral Health Clinics Impact Report

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Data show a program intended to improve access to mental health and addiction care in Missouri is effective.

In the first three years in which Certified Community Behavioral Health Clinics have offered care to Missourians through a federally created program, access to and effectiveness of mental health services have greatly improved, according to a report from the Missouri Coalition for Community Behavioral Healthcare.

The CCBHC program is intended to help deal with the shortage of mental health services offered in rural communities. Clinics are required to provide mental health crisis services, screenings and assessments, patient-centered treatment planning, outpatient mental health and substance use services, peer and family support, and intensive community-based mental health care for veterans and members of the Armed Forces.

It started out as a federal demonstration project. Missouri was among 20 states that applied for the planning grant and was one of eight chosen for the original Medicaid demonstration program, with Minnesota, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania, according to Dorn Schuffman, project director for the CCBHC initiative for Missouri.

"Missouri has been the leading, and an outstanding state, in the program," Schuffman said. "Missouri was the only state that participated in the demonstration whose plan was to include the whole state."

That includes urban and suburban areas.

The state had done a number of things like the project and knew it could be effective, Schuffman said.

What organizers of the project wanted to see was whether changing the way the government pays for services could improve access and outcomes.

Instead of paying providers for face-to-face visits with patients, which encourage multiple visits, the program pays for a continuum of care through the course of the day. Providers are paid the same whether they are seeing patients or not. The program allows providers to have staff available for when they are needed.

Providers, Schuffman said, create cost reports, which take all their costs and divide them by the number of visits they anticipate.

Medicaid paid poorly for mental health services, he said, so providers couldn't afford to offer psychiatry. Through a prospective payment system, they can.

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The clinics recently produced a report showing year-over-year improvements in access and outcomes.

Data collected four years ago, before the project started, show 119,002 Missourians had access to CCBHCs. The report shows that number has increased to 146,665 — a 23 percent increase.

The project had a focus on veterans, Schuffman said, and veterans served increased by 19 percent to 2,993.

Another goal was to decrease unnecessary and repetitive use of emergency rooms and hospital services for mental health. The data show emergency rooms have had 36 percent fewer visits, and there have been 20 percent fewer hospitalizations.

Before the project started, 3,128 patients received medication-assisted treatments. Through the program that number has increased to 6,292.

"One of the key treatments for opioid disorders is medication-assisted treatment," he said. "Medication-assisted treatments more than doubled during the demonstration, which saves money and saves lives."

Another major component of the project is to relieve law enforcement of the burden placed on it to offer mental health services. From July 2017 through September 2020, law enforcement officers have referred 76,451 people with whom they've had encounters to mental health providers, rather than taking them to emergency rooms or arresting them.

"If we get them into treatment, we get them out of jails," Schuffman said. Among the greatest supporters of the program are local law enforcement agencies and police chiefs."

And several CCBHCs have expanded outreach to schools, he said.

"They engage people, engage families and get them into treatment," he said.

The report shows 74 percent of adults and 78 percent of youths sought and received follow-up care within 30 days after hospitalization.

"One of the best predictors of being re-hospitalized is whether you follow up after being released from the hospital," Schuffman said. "(Follow-ups) divert people from further hospitalization."

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