Health care and health policy experts in Michigan all agree that the behavioral health system is not meeting the needs of Michiganders.
On our “On the ground: Michigan” panel at our 2022 State of Reform Federal Health Policy Conference, four experts discussed the issues surrounding behavioral health integration, workforce shortages, and crisis stabilization.
The panel included Rep. Mary Whiteford (R-Allegan), chair of the House Appropriations Subcommittee on Health and Human Services, Phillip Bergquist, chief executive officer of Michigan Primary Care Association, Allen Jansen, Senior Deputy Director of the Behavioral Health and Developmental Disabilities Administration at the Michigan Department of Health and Human Services (MDHHS), and Dominick Pallone, executive director of the Michigan Association of Health Plans.
The panelists first discussed legislation surrounding the creation of specialty integrated plans (SIPs). Senate Bills 597–598 aim to integrate behavioral health and physical health financing from public prepaid inpatient health plans (PIHPs) to private Medicaid health plans, in hopes of improving whole person outcomes for Medicaid members, said Pallone.
Pallone said the state would contract with these private SIPs, who will manage the physical and behavioral health plan for Medicaid recipients.
“At its core, the proposal would better integrate the Medicaid program financially, operationally, and clinically through a public procurement process that’s intended to select several SIPs,” said Pallone.
He said SIPs would lower costs on the health care systems by treating behavioral health issues earlier on the continuum of care. This would lead to less physical health emergency visits that strain costs for hospitals and payers, he added.
Whiteford has a different plan to reform the behavioral health system that is working its way through the legislature. House Bills 4925-4929 would replace the 10 current PIHPs with a single administrative services organization (ASO) and run the Medicaid behavioral health program directly through the state.
She says this will get rid of the “bureaucracy” surrounding the coverage of behavioral health plans in the state.
“As a state, we have huge budgets [for behavioral health], but how do we get that high number down to people? The more layers you put between [the state funds and the people], the more cost to the taxpayers there are,” said Whiteford. “So, I think our system is disrespectful to our taxpayers and to the people who need [treatment]. And I think going to a SIP is also disrespectful.”
These bills still lie in the House Health Policy Committee.
Workforce shortages in behavioral health are also a top concern. Jansen said entry level positions were not funded adequately before the pandemic began. Once COVID hit, many frontline entry level workers resigned for higher paying, less intensive positions.
Jansen said MDHHS is about to roll out a proposal to expand wages to entry level health care positions. He said the department plans to expand wages from roughly $14/hour to $17/hour.
“That’s 165,000 people that need a $3 an hour raise,” said Jansen. “So, that’s a lot. But, there will be more clarity coming out of our office on that fairly soon.”
Bergquist said a more balanced, trained, and expanded workforce will be needed to reach the full potential of the SIP legislation: to integrate behavioral health and physical health care in financing —and eventually—delivery.
Having the conversation around better caring for the whole person in one centered method of payment and delivery is a great step for reforming behavioral health in the state, Bergquist said.
“Coming out of COVID, I am hoping that we can harness the creativity long-term that we have had around providing services differently, and then we are always using the conversation around systemic transformation as an opportunity to also think about how that systemic transformation supports, informs, and gives the financial and people resources needed for integration at the ground level.”