Improving care state by state

Integrating Behavioral Health Stories of State Policy Change

State agencies, policy makers, and decision makers are exploring viable solutions to better address and integrate behavioral health. Stakeholders are ready for action and are seeking assistance, tools, and tactics to advance policy that supports and achieves whole person health. Each state is unique, at their own level of readiness for change, and may seek help to align behavioral health with broader state strategies for health policy and delivery systems redesign. To accelerate advances, Make Health Whole applies a systematic approach to technical, adaptive and leadership assistance for state-level policy change.

The following vignettes describe three states who represent different stages of change, and different needs. Each of these states has made significant progress toward integrating behavioral health by applying the Make Health Whole Integration Action Framework and using the companion tools to achieve their goals. In each case, the Farley Health Policy Center (FHPC) served as a partner to assist with implementation to catalyze state agency activities and help integrate their fragmented systems. These are their stories.

Idaho | Creating a Clear and Unified State-Level Vision

outline of Idaho
Idaho faces unique challenges as a frontier state with rural communities creating both isolated bright spots and disconnected or absent resources. The resulting impact on adopting integrated behavioral health is insufficient awareness and sharing of best practices. The state has strong relationships between providers and policy makers, built on a Medicaid state innovation model for strengthening primary care medical home. With a strong desire for expanding integrated behavioral health efforts, Idahoans sought to clarify a state-level vision involving stakeholders from multiple sectors.
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Idaho Division of Behavioral Health, Department of Health and Welfare


Applying the Integration Action Framework (IAF), leaders from the Idaho Divisions of Behavioral Health and Medicaid led the charge, analyzing state data and newly collected surveillance to fully understand the behavioral health status of populations across the state. The Integration Networking Tool played a critical role in identifying and organizing the providers, practices, agencies and organizations so that they had a clearer sense of who is engaged and responsible for varying processes in integration and at what level. A facilitated convening brought together providers and leaders from individual practices, federally qualified health centers, health systems, and health plans and payers desiring opportunities to achieve consensus and articulation of the vision for integrated behavioral health across the state.  
To support the technical assistance needs identified, the FHPC assisted in analysis of the state agency data, facilitated the stakeholder convening, and created a report to articulate the prioritized recommendations, and resources to advance integration. Among the resources, FHPC built a mapping tool to display geographic data trends in behavioral health in Idaho.


At a glance -
  • Statewide vision for integrating behavioral health
  • Strengthened network of invested stakeholders
  • A roadmap for tackling policy objectives around finance and education
Ultimately, Idaho achieved a roadmap to guide integrated behavioral health efforts for their State Health Innovation Project with implementation of prioritized action steps. Additionally, they clarified the need for further technical assistance around billing and financing integrated care and promoting education for team-based, integrated care. With this specificity, they are able to continue their journey for implementing both policy and programmatic changes.

Virginia | Leveraging Data for Alignment and Accountability

outline of Virginia
The state of Virginia approached their needs for improving integration of behavioral health with highly motivated policy leaders at executive, legislative and agency-levels and driven by a sense of urgency for improvement. Multiple traumatic events experienced in succession across the state brought front and center the desire to address behavioral health concerns resulting in deep investments from the state directed at the problem without achieving optimal results. With a goal of carving-in behavioral health benefits, Virginia Medicaid is also transitioning provider reimbursement from fee for service to managed care. With this transition, the Medicaid director engaged the FHPC as a partner for adaptive assistance to explore the restructuring of behavioral health services to promote integration.
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Virginia Department of Medical Assistance Services (DMAS)

Putting our systematic approach into action

Applying the Make Health Whole approach, Virginia agency leadership aimed for alignment across agencies seeking greater efficiencies, data and evidence to inform decision makers about best practices for achieving visible and measurable health outcomes, provide effective stewardship of Medicaid dollars, and better serve Medicaid members. The IAF helped redefine the problem to look not only at agencies, but also barriers across the state to greater alignment. The recognized findings were those commonly seen as a result of fragmented healthcare systems and competing governmental approaches: 1) inconsistent regional classification; 2) lack of measures and metrics; 3) investment in programs without accountability for quality or health outcomes. Enlisting the collaboration of 3 agencies, and in partnership with the FHPC, state agency and publically available data were compiled (using the State Data Analytics Tool) to define the scope of the problem and reveal disparate investments by region, age, community and hospital.


At a Glance
  • Integration and alignment of objectives and data
  • Accountability at a state system-level with strengthened partnerships among leaders to build integration into community access for behavioral health.
These learnings brought to focus the traditional and non-traditional venues where people with mental health concerns were seeking care and clarified next steps to align, define measures and improve access. More fully armed with better coordination across agencies, the Medicaid agency then shared these data and a vision to work with policy makers to meet behavioral health needs of the Commonwealth of Virginia.

Oregon | Advancing the Mission of the Collaborative

outline of Oregon
The state of Oregon is deeply invested in integrating behavioral health, seeking to build a “21st century behavioral health system” for the state. They are organized and focused with years of prior work, advancing strategies for improving behavioral health service delivery within their Coordinated Care Organizations (CCOs), an organized behavioral health collaborative with a defined mission, and data at their fingertips.
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Oregon Health Authority (OHA)

Putting our systematic approach into action

Upon enlisting support from the FHPC and applying the Integration Action Framework, the identified need was leadership assistance, more than technical or adaptive assistance, to advance the mission of the collaborative. With many invested entities and organizations, there is tendency toward competing priorities. Thus, Oregon leaders desired assistance to maintain trust while coordinating and prioritizing policy agendas and develop structured recommendations for the state. Implementation of the IAF required an outside resource to serve as an objective sounding board, provide boundaries and guardrails, and ensure momentum of the progress. The FHPC team joined their bi-weekly convenings and applied the IAF to: 1) clarify and prioritize the problems; 2) use their data to identify, illustrate and map assets and gaps in both understanding and services; 3) synthesize and reflect back significance of the data; 4) lay out a series of policy recommendations including workforce focus for the future; and 5) create an implementation plan based on recommendations.


At a Glance
  • Policies and leadership to sustain integration at a delivery-system level, including recognition of need for an expanded behavioral health workforce
Through this process, the collaborative team was reminded that transforming behavioral health in a state does not result from a report of findings. Following a State Policy Approach to Integrating Care requires an incremental process to get from their present to their promising future. Following delivery of the recommendations report, the Oregon Health Authority tasked existing workgroups and committees to be responsible for implementation.

Definitions of technical, adaptive, and leadership assistance

  • Technical

    Some assistance needs are “technical” in the sense of bringing forward or connecting to resources, training, tools, methods, templates, examples, processes, and implementation steps already well known in the field and ready to apply within the state’s present arrangements. Often these approaches rely on content expertise offering specific assistance to a state or program.

  • Adaptive

    Other assistance needs are “adaptive”—bringing about shifts in culture, purposes, relationships, and how to think differently. A state perspective may need to shift in order to move past the status quo and be able to use “off the shelf” technical solutions. This may also require the partner to shift their perspective of how the problem is addressed.

  • Leadership

    Other assistance needs require “leadership” in the sense of understanding how to bring a state and all its stakeholders confidently and effectively through a process of both technical and adaptive change.