Transforming Behavioral Health: The CCBHC Model Takes Hold
Written by Gary Enos
Next fall, the mental health community will mark the 60th anniversary of John F. Kennedy’s final bill signing as president, a Community Mental Health Act promising more dignified support for people with mental illness. In the decades since that landmark bill became law, many have debated how close we’ve actually come to realizing the dream. As the anniversary nears, it’s becoming clear that a new model for delivering behavioral health care has the field in a better position than ever to fully meeting communities’ needs.
In many communities across the country, the community mental health center (CMHC) that grew from the 1963 law is transitioning to a Certified Community Behavioral Health Clinic (CCBHC) model. Introduced in an eight-state Medicaid demonstration program in 2017, the CCBHC model offers flexible funding that allows providers to deliver comprehensive mental health and substance use treatment to all individuals, regardless of their location, insurance status, or ability to pay.
Just a year into the CCBHC model’s introduction, the Substance Abuse and Mental Health Services Administration (SAMHSA) began offering grants to allow provider agencies in other states to take on a CCBHC’s responsibilities. And this year, Congress’s Bipartisan Safer Communities Act included language calling for 10 new states to be added to the Medicaid demonstration every two years, ensuring that the CCBHC movement soon will go national.
Even in states where the CCBHC concept is still young, this more comprehensive vision for care delivery is already raising the bar for all providers. Expectations are changing for everyone, so all organizations should be prepared to take on the added responsibilities that will come with open access to comprehensive care.
The Data Are Compelling
The numbers tell us why this change in the landscape is inevitable. The National Council for Mental Wellbeing’s latest annual survey of CCBHCs found that providers with this designation are serving more patients, responding faster than traditional CMHCs, and offering patients a full menu of services. Among the CCBHC Impact Report’s respondents who said their caseloads have increased since becoming a CCBHC, caseloads have grown by an average of 23%.
Much of the growth is happening in more remote communities, where people with mental health needs have traditionally struggled to access care. In the same way that organizations committed to food security are working to eliminate “food deserts” where residents lack regular access to healthy nutrition, CCBHCs are working to make “mental health deserts” a thing of the past.
Among the 249 responding organizations in the 2022 CCBHC Impact Report, staffing is up by 27 positions per clinic. The expanded workforce is delivering a more comprehensive brand of care, with 97% of these providers offering access to mobile crisis response, for example. Access to funding also has given CCBHCs a greater ability to reduce health disparities for people of color and other traditionally underserved populations.
And these former CMHCs don’t see themselves as “mental health only” anymore. A staggering 82% of surveyed CCBHCs offer at least one of the approved medication treatments for opioid use disorder. That’s well beyond what specialty addiction treatment clinics have accomplished in integrating the gold standard of medication-assisted treatment into their practices.
Given all this data, it’s no wonder that National Council president and CEO Chuck Ingoglia has said of CCBHCs, “Their proven ability to transform how people access care in their communities is a blueprint for the future of mental health and substance use continuum of care in America.”
New Funding Brings New Responsibilities
There are now more than 500 CCBHCs in the U.S., with all but four states represented. The CCBHC model checks all the boxes for health care transformation: integrated care, rapid response, a broad social mission. Now that federal funding will be available to expand the model even wider, the CCBHC will become the standard for community-based behavioral health.
As one example of the financial impact, Kansas officials told state legislators this year that once the CCBHC model is fully implemented in the state, provider by provider, Medicaid payments to the state’s mental health agencies will increase by $40 million to $70 million a year.
Even in communities where the concept hasn’t been formally introduced, advocates will see what’s being proven elsewhere and will start demanding that local providers offer a full continuum of behavioral health services. Advocates also will ask these agencies to take steps to address the “social determinants of health” (housing status, job opportunity, etc.) that can hinder so many patients’ progress in recovery.
Given these increased demands on providers, it makes more sense than ever to have an all-in-one system that saves time and maximizes opportunities for care coordination. Sigmund Software’s enterprise EHR solution can meet the ever-expanding needs of behavioral health and addiction treatment agencies.
According to the National Council survey, 94% of the CCBHCs that are setting the new standard for comprehensive care either already conduct electronic information sharing with care coordination partners or intend to do so, and 88% currently or plan to house physical health services directly on site. In this higher-demand environment, a tool such as our AURA solution can give providers total control over the reporting data that will be critical to achieving a quality-driven delivery system.
We are committed to playing a part in helping behavioral health professionals realize the field’s emerging vision. The more we learn about how best to implement the revolutionary CCBHC model, the closer the field will be to fulfilling the promise of true transformation and humane care that our nation’s leaders voiced 60 years ago.
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