The CCBHC Path To Value-Based Care

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

There were only 66 Certified Community Behavioral Health Clinics (CCBHCs) in 2017, but today there are over 500 of them, serving an estimated two million people. And with challenges to access for mental health services and rising rates of suicide, addiction, and gun violence, CCBHCs have been top of mind in federal policy for the past couple of years.

The recent evaluation of CCBHCs by the National Council for Mental Wellbeing, 2022 CCBHC Impact Report – National Council for Mental Wellbeing, provides some context for what CCBHCs have achieved. Nearly all CCBHCs deliver crisis support services in their communities. Since gaining CCBHC status, about half of CCBHCs and grantees (49%) have added crisis response services or partnerships, an indication of the expansion of access to crisis care under this model. Eighty-two percent of CCBHCs and grantees use one or more forms of medication-assisted treatment (MAT) for opioid use disorder, compared to only 56% of substance use clinics nationwide that provide any MAT services. An estimated 69,400 consumers are engaged in MAT through CCBHCs. Seventy-nine percent provide mental health services on-site at schools. And most (96%) are actively engaged in partnerships with criminal justice agencies, providing services in partnership with courts (86%), training law enforcement officers in mental health first aid or other awareness training (65%), or providing re-entry support to individuals returning to the community from incarceration (64%).

And there is new funding for CCBHCs. The Bipartisan Safer Communities Act, passed by Congress as part of comprehensive gun safety legislation, will increase the number of CCBHCs and expand the program to all 50 states for the first time since its inception. Beginning July 1, 2024, and every two years through 2030, up to 10 additional states may start participating in the Medicaid CCBHC demonstration programs. The Act has $40 million in funding for fiscal year 2023 for planning grants and technical assistance to states. The funds will remain available until expended. As a result, on October 18, 2022, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) began accepting state applications for CCBHC Planning Grants. Applications are due by December 19, 2022. SAMHSA anticipates awarding 15 one-year grants of up to $1 million each. The goal is to increase the number of states participating in the Medicaid CCBHC demonstration program from the current 10 states to all 50 states by 2030. The first 10 expansion states will launch in July 2024.

The CCBHC model is a growing component of the health and human service delivery system and provides an opportunity for community-based behavioral health organizations to develop new competencies and prepare for participating in value-based reimbursement arrangements. We learned more about how one organization is leveraging this opportunity in the session, A CCBHC Journey: Expanding Access With Value Based Care, at The 2022 OPEN MINDS Management Best Practices Institute. The session featured Michael D’Amico, Vice President, and Chief Administration Officer for Oaks Integrated Care; Crystal Rutter, Chief Administration Officer for Oaks Integrated Care; and Keith Boushee, Community Strategist for Netsmart.

Oaks Integrated Care is a 50-year-old non-profit behavioral health provider organization with over 230 health and social service programs in 19 counties throughout New Jersey. Their 2,700 employees provide services for addictions, mental health, and developmental disabilities. Their 230 programs include a CCBHC.

To be successful as a CCBHC, Mr. D’Amico of the Oaks Integrated Care team discussed both the executive considerations for CCBHC success, and how to leverage the model to achieve future goals. He emphasized that changing the organizational infrastructure—people, processes, and technology—is essential. “We took a hard look at what our strengths and needs were as an organization, from an operational, human resources, administrative, facilities, and finance perspective,” said Mr. D’Amico. “Understanding our challenges helped to inform the areas that required support and knowledge, and allowed us to use our skills and abilities to lift ourselves to the next level.”

Expanded technology functionality is also key. “Twenty years ago, an EHR was all that you really hoped for in practice management, like being able to register someone or do some scheduling,” said Mr. Boushee. ‘But now we find that the EHR is not enough, you need to be able to expand outside the physical four walls of your clinic. And CCBHC helps you do that. That’s why when I talk to clients about becoming a CCBHC, I tell them it’s critical for them to first understand the technology necessary to support it. They need a certified EHR for data collection, NOMS for reporting secure messaging for care coordination, telehealth for availability and accessibility of services, as well as other required services like patient portals and population health. There are certain services you have to provide, and if you’re not currently providing some of them you can ask a partner to help. If they can’t, you can use the funds you receive from SAMHSA.”

The value of these investments in organizational infrastructure are not limited to the CCBHC program. The Oaks Integrated team also discussed how their CCBHC work is an important part of their future development plans. “We began with a vision for how the CCBHC model could improve our ability to be effective as a service provider and truly improve the health and well-being of the folks that we were serving,” said Mr. D’Amico. “That future includes CCBHC e-grants, addiction treatment services, MAT, evidence-based practice initiatives, and primary care and hospital partnerships and technology, all which will lead to value-based contracts.”

As Mr. D’Amico explained, “The model is an opportunity for us to put into action all the services enhancements that we believe will truly improve the quality of care that we provide as we’re no longer faced with the limitations of a fee-for-service or managed care, contract-based environment.” Before Oaks Integrated Care implemented the CCBHC model, many of their goals and outcomes were focused on process measures, improvements, and functioning specific to behavioral health. But according to Mr. D’Amico, CCBHC shifted their perspective. “The CCBHC model really put an emphasis on goals and outcomes that spoke to the overall health and wellness of the individuals we were serving across those eight dimensions of wellness.”