Semi-Structured Interview Questions for Case Studies
On behalf of the Substance Abuse and Mental Health Services Agency (SAMHSA), Truven Health Analytics, the National Association of State Mental Health Program Directors Research Institute (NRI), and the National Association of State Alcohol and Drug Abuse Directors (NASADAD) are developing case studies of early innovator state activities to promote the enrollment of individuals into health insurance and Medicaid plans. Selected state case studies will be collected into a special 2014 state profiles report of three policy areas. The policy areas are the implementation of evidenced-based practices, changes to business practices, and
behavioral health integration with primary care. The 2014 state profiles case study report is intended to provide useful information for all states as they address these policy areas in the next several years.
Below is a set of questions to guide a dialog between the state profile project research team and staff members from state mental health agencies (SMHAs) and single state agencies (SSAs) to determine the experiences, successes, and barriers that early innovators are encountering.
For each early innovator state, a key contact person will be identified to coordinate dialog. State profile project staff will work with the state contact person to coordinate scheduling of a one-hour call with a team from the state to discuss their experiences in this area. Prior to the call, the set of questions will be shared with the state to help them prepare for the dialog. State profile staff will then complete a draft summary of the call, which they will send to the state for review.
If necessary, a follow-up call will be held with the state to elaborate on discussion areas.
Whenever possible, additional documentation will be requested from the state to provide examples from the discussion and to potentially be included as part of the case studies being prepared.
Health–Behavioral Health Integration: This case study will focus on SMHA and SSA activities around health–behavioral health integration, integrated service coverage, delivery system, payment, information sharing, care coordination, and quality measurement initiatives.
We want to discuss areas where your state has been successful in integrating care, discuss factors that contributed to the success, identify barriers encountered, and describe your state’s
recommendations for what could assist states in addressing these barriers.
1. What types of health–behavioral health integration activities are your SMHAs and SSAs undertaking? These can include services, care coordination, delivery systems, quality measurement, value-based purchasing or bundled reimbursement, and information sharing.
We are interested in efforts to better integrate behavioral health care into primary care
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settings and in efforts to integrate primary care into behavioral health settings. Please describe activities in your state to integrate both sides of general health care and behavioral health care.
A. Is the activity statewide or local?
B. Do you track the number of people served by an integrated system?
i. If so, do you have an approximate number of those served?
ii. Are there specialty populations you may be targeting for your integration efforts?
1. Children 2. Older adults
3. Individuals with dual diagnoses (mental and substance use disorder) 4. Veterans
5. Other: describe
C. Describe how the SMHA and SSA promote or manage integration efforts.
D. How do you measure your integration efforts? (please describe) E. Are you using a control group or data sample?
i. Are your integration efforts producing better outcomes for individuals not served by an integrated system? (Discuss pre- and post-test or local integration efforts.)
1. What types of outcomes are you measuring?
a. Money savings to the state
b. Fewer visits to emergency departments c. Reduced psychiatric hospitalizations d. Improved care coordination
e. Improved consumer outcomes and improved functioning
2. Does your state have any specialty populations that are targets of your integration efforts?
For example, patients with specific medical and behavioral health comorbidities.
A. If yes, what are the specific target populations? How did you select these client populations? (e.g., were they identified because of high costs, intensive service use, or poor outcomes?)
3. Is your state implementing health homes that include behavioral health services (a provision of the Affordable Care Act)?
A. Are they implemented locally or statewide?
B. Is primary care co-located in community mental health centers (behavioral health homes)? Is this a statewide initiative or locally based?
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C. Conversely, does the state require the inclusion of behavioral health providers in community health centers (primary medical home model)? If yes, please describe your experience in getting behavioral health included in these health homes.
4. Health–behavioral health integration activities (other than health homes)
A. Please describe activities (other than health homes) your SMHA or SSA is supporting to integrate primary care into your community mental health system.
i. What specific integration activities are underway?
ii. How are these integration activities financed or reimbursed?
1. Are there special reimbursement rates or bonus incentives for behavioral health providers that are integrating health services?
2. Does your state provide any kind of incentives to behavioral health providers to obtain and implement the technology they need to do this work?
iii. What outcomes are you monitoring or measuring?
1. Is there an alignment with what the state is requesting from providers in terms of quality measures and meaningful use? (e.g., if physicians are claiming or billing for meaningful use incentive payments, are they reporting the same measures?)
2. Are you utilizing any procedural measures because of the absence of appropriate outcome measures?
3. Are other outcome measures in development?
4. Do you have results that can be shared?
B. Please describe activities (other than health homes) your SMHA or SSA are supporting to integrate behavioral health care services into your state’s primary care system
(including work with federally qualified health centers [FQHCs]).
i. What specific integration activities are underway?
ii. How are these integration activities financed or reimbursed?
1. Are there special reimbursement rates or bonus incentives for providers that are integrating behavioral health services?
iii. What outcomes are you monitoring or measuring?
1. Are you using any procedural measures because of the absence of appropriate outcome measures?
2. Are other outcome measures in development?
3. Do you have results that can be shared?
iv. How would you describe the “environment” between FQHCs and behavioral health providers? Are they generally cooperative and integrating well? Or are they
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engaging in turf wars and not really integrating (or somewhere in between)? Can you provide examples of where and why the environment is working well or not?
5. Is your state providing or supporting a specific patient registry function that supports the integration between medical and behavioral health providers?
A. If yes, please describe the registry—was it built by the state or purchased commercially?
B. How was the registry financed?
C. How well is it working? Are both medical and behavioral health providers using it equally?
6. What training is the SMHA or SSA providing to support health–behavioral health integration?
A. This may include specific training for providers (e.g., use of standardized screening tools) B. Peer support training
7. Are there barriers your SMHA or SSA is encountering in response to your health–behavioral health integration efforts?
A. How could the barriers be reduced or eliminated? Are any of those barriers caused by provider, member, or patient resistance? If so, how strong has that resistance been and how has it been resolved?
B. What activities could NRI, NASADAD, NASMHPD, or SAMHSA undertake to address these barriers?
8. What lessons can be learned from your health–behavioral health integration experience that should be shared with SAMHSA and other states?
9. Please provide any written documentation about your health–behavioral health integration activities.
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