Improving
Behavioral Health and Primary Care Integration T
his article describes the Targeted Investments (TI) Program, the Arizona Health Care Cost Containment System’s (AHCCCS) strategy for incentivizing providers to develop systems for integrating physical and behavioral health. The TI Program is a five-year project that provides financial incentives totaling $285 million to eligible AHCCCS providers with the aim to reduce fragmentation between acute care, primary care, and behavioral health care; increase efficiencies in service delivery for members with behavioral health needs; and improve health outcomes for AHCCCS members. The TI Program includes approximately 150 health care organizations and consists of six areas of concentration (Adult Primary Care Providers, Adult Behavioral Health Providers, Pediatric Primary Care Providers, Pediatric Behavioral Health Providers, Criminal Justice focused clinics, and Hospitals). For each of these areas of concentration, AHCCCS has established milestone targets that support improved care coordination and clinical outcomes through use of standardized performance measures. Historically, care coordination between primary care providers and behavioral health providers for persons with behavioral health disorders has been extremely challenging. This is due to many factors including separate payer sources, distinct clinical structures, and unaligned provider communities.
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The consequence is that important patient care guidelines are poorly met. Nationally, 73% of children three to six years of age with Medicaid coverage received a well-child visit with a primary care provider in the last 12 months; metabolic monitoring for children on antipsychotic medication is 35%; diabetic screening for adults with severe mental illness on antipsychotic medications is 80%; and the ambulatory follow-up for hospitalized adults discharged for severe mental illness within 30 days is 58%. Similar to national performance, adults and children in Arizona covered under the AHCCCS program have gaps in care when compared to clinical standards.
QUALIT Y IMPROVEMENT METHODS THAT IMPROVE OUTCOMES The TI Program is currently in its fifth year. Since 2019, AHCCCS has partnered with a team from Arizona State University (ASU) led by Dr. William Riley and Dr. George Runger, from the College of Health Solutions, to develop a Quality Improvement Collaborative (QIC) for assisting the TI participating providers to meet their performance measure target. Quality Improvement (QI) methods have been widely used in the health care delivery system over the last 20 years to successfully improve outcomes and increase
