Health care reform, national parity, and myriad pressures to “bend the cost curve” are changing the landscape of health care delivery and financing. The models of integrated care, provider collaboration, and system alignments that are key features of the dramatic shift in service delivery should not feel so new to directors of state mental health and substance abuse agencies, according to a report by the National Association of State Mental Health Program Directors (NASMHPD). The report reminds state agencies of the knowledge and experience that they already possess and outlines opportunities for them to be “at the table” in creating more effective systems of care.

The 110-page report provides a framework structured on four critical objectives—or “cornerstones”—for state behavioral health agencies (SBHAs) to pursue even in a health care environment characterized by rapid change. The first cornerstone focuses on improving coordination of behavioral health care with primary care and with supportive services, such as supported housing, for people with mental illnesses and substance use disorders. The second cornerstone emphasizes the importance of prevention and health promotion to reduce risks of behavioral health problems among children and adolescents. The third cornerstone directs SBHAs to bring together new developments in health technology and outcomes measurement to support a stable behavioral health workforce that has been trained to provide evidence-based, recovery-oriented services. The fourth cornerstone directs SBHAs to work with public and private insurance plans to make certain that covered benefits and payments systems adequately address the behavioral health of enrollees.

For each cornerstone, the report describes critical roles for SBHAs, along with numerous specific steps that SBHAs can take to fulfill each role. SBHAs are advised to review the 12 roles and potential actions and prioritize areas that address state-specific needs and interests. Armed with a list of priorities, SBHAs can begin to directly implement—or assist in promoting—specific actions.

“SBHAs are beginning to implement several initiatives in response to health care delivery changes. The Cornerstones document tries to get ahead of the curve by identifying potential collaborative efforts that individual agencies can develop in regard to enhancing integration and prevention and improving the quality of behavioral health care,” said Joel Miller, senior director of policy and health care reform at NASMHPD and author of the report. Mr. Miller also noted that the report's release marks the launch of NASMHPD's “Cornerstones Initiative,” which will include a series of 12 reports and fact sheets that correspond with the 12 roles, along with webinars and supporting conference calls. NASMHPD has also developed a “crosswalk” document to allow SBHAs to navigate between section numbers in the Patient Protection and Affordable Care Act and the actions that they can implement to address those provisions.

Cornerstones for Behavioral Healthcare Today and Tomorrow: Forging a Framework to Position State Behavioral Health Agencies to Optimize Their Role in the Changing Landscape of Healthcare is available on the NASMHPD Web site at www.nasmhpd.org.