The implementation of the ACA has launched a number of innovations in healthcare delivery. Among those innovation has been a renewed emphasis on better integration of behavioral health services with primary care services. Unfortunately, few measures exist to assess the degree to which healthcare systems are implementing behavioral health integration.
Medicaid claims data for a large urban community in the southwest US was analyzed for a population of approximately 350,000 claimants. Using ICD and procedure codes, these claims were sorted into two categories of behavioral health procedures and primary care procedures. Individual patient Integration Quotients (IQ) were calculated as a ratio of behavioral health claim volume and value to primary care claim volume and value. Comparative analysis were conducted to evaluate the IQs among those individuals identified to be seriously mentally ill, experiencing general mental health and/or substance use disorders, with those individuals with no identifiable mental health or substance use disorder. Year over year comparisons were calculated to assess the impact which state Medicaid agency policies were having upon IQs, along with secondary analyses to identified patient and provider characteristics.
Claims data analysis reveal striking patterns distinguishing IQs by patient group (SMI, GMH/SA, non-BH) and provider. IQs were found to vary based upon total health care claim value and by provider type and group. Finally, time series analysis, demonstrated change in ratios over time for some patient groups (e.g., SMI), but not others, in alignment with recently enacted state medic policy directives.
These preliminary results suggest that use of claims data to assess the degree of healthcare integration that patients are experiencing may be a non-invasive, cost-effective method for assessing health care integration.