Interconnecting Behavioral and Public Health

October 07, 2019

Effectively preventing behavioral health problems such as suicide, substance misuse, and adverse childhood experiences requires interconnecting behavioral health and public health. In 2019, ASTHO hosted four learning community states with relative experience and knowledge to explore increasing behavioral and public health interconnections through the following systems-level approaches based on an expert panel meeting.

Complementary Sectors and Partnerships

Working upstream to improve behavioral health systems requires collaboration between public health, behavioral health, and Medicaid, which can improve access to preventive services across a continuum of care. Key considerations for cross-agency collaboration, an experience-based approach, include:

• Identifying barriers to cross-sector collaboration, including funding structures, state policies and regulations, processes and procedures, and technological gaps.
• Creating common definitions and shared language across agencies.
• Developing a step-by-step process for collaboration through thoughtful planning, communication, commitment, and sustained engagement.

Finance and Structure

State health leadership seek financing approaches that permit increased flexibility to address their priorities. Two experience-based practices that promote interconnecting public and behavioral health are braided funding and Medicaid 1115 waivers.

Braided Funding

Braided funding coordinates funding from discrete sources to support initiatives while maintaining accountability by tracking each activity to individual funding sources. This financing mechanism effectively coordinates cross-agency funding to address behavioral health because it allows jurisdictions to leverage funding from diverse federal, state, and philanthropic grants. For example, through the Health Equity Zone innovative, place-based approach, the Rhode Island Department of Health and other state agencies created a pool of funding from multiple sources, including federal funds and state general revenue.

Medicaid 1115 Waivers

Section 1115 Demonstration waivers allow states to waive certain Medicaid rules to test new approaches to delivering mental health and substance use services. Current and pending behavioral health waivers address four main areas: substance use disorder treatment services, expanding community-based behavioral health benefits, expanding Medicaid eligibility, and financing delivery system reforms. A sub-category of 1115 demonstration waivers includes Delivery System Reform Incentive Program (DSRIP) initiatives, which provide hospitals and other healthcare delivery systems with incentive funding tied to certain population health improvement performance goals. Washington state’s 1115 DSRIP waiver developed nine regional accountable communities of health through a collaboration between healthcare providers, payers, public health, and social and community services.

Data-Driven Action

Sharing key data with partners to visualize trends in behavioral health and better identify appropriate programs and policies can help facilitate interconnecting behavioral and public health.

Data Sharing Agreements

Effective data partnerships can include data sharing agreements, memoranda of understanding, and contractual agreements that outline shared language and vision, identify sustainable funding, and establish a neutral data governance structure. Data agreements can be supported through statutory authority at a state health agency or through legislation.

Linking Data

Linking data sources involves working across silos to bring together information from multiple agencies and organizations to inform data-driven change. Innovative ways to link data sources include leveraging health information exchanges, working across healthcare systems to link electronic health records, and developing interoperability interfaces.