New centers offer care for mental health and addiction, but leave out most privately insured patients

Makenzi Buckely answered the phone at Riverside Community Care location in Norwood, and took a call from a worried mom, requesting a mental health evaluation for her child.

“And you would like that to happen today?” Buckley asked. “OK. So, looking at my schedule, we could probably come out for 12:30, 1 o’clock.”

This kind of mobile response is one of the services offered here and at 24 other community behavioral health centers or CBHCs that opened across Massachusetts in January. It’s a new statewide experiment in addressing mental health and addiction issues by funding a comprehensive range of services for patients. For now, though, insurance coverage issues prevent roughly three-quarters of patients from accessing much of the care these new centers provide.

'A whole new model of care'

In addition to mobile response services like the team Buckley dispatched to do an evaluation, another service CBHCs provide is essentially a walk-in urgent care center for mental health and substance use disorders. They also offer overnight beds for patients who need that level of support and observation.

"What we've basically done is construct a whole new model of care," said Riverside President Vicker DiGravio. The way the state set up this new system allows for care from a whole team, he said.

“Teams with expertise in substance use disorders, co-occurring disorders, mental health issues, teams that specialize in serving children and adolescents,” DiGravio said. “And the team involves a clinician and includes a care coordinator. It includes a peer specialist or a family partner."

The state also required CBHCs to have phlebotomy labs on site to test for drugs, make sure medication levels are OK, and other analysis.

A directory of community behavioral health centers in Massachusetts is online here.

A boost of state funds and a new style of billing

The launch of this system was one of the last big initiatives celebrated by former Gov. Charlie Baker — perhaps the crowning achievement of his administration's so-called Roadmap for Behavioral Health Reform.

“This is incredibly innovative and it has the potential to be transformative for a variety of reasons,” said Lydia Conley, president and CEO of the Association for Behavioral Healthcare, which represents mental health and addiction treatment centers in Massachusetts, including almost all of the new CBHCs.

“It funds behavioral health on a level that it should be,” Conley said. “It is a specialty. It has never been adequately resourced. This model adequately resources it.”

The difference, Conley said, isn’t just that the state is paying more to support mental health and addiction treatment. There’s a whole different model for paying for those services.

Usually, insurance companies bill for every individual service a patient gets. But for those who are covered for care at a CBHC, there’s just one rate for their combined services.

”So if we provide one service, we bill the bundle and we get that rate,” DiGravio explained. “If we provide three or four services in one day, we bill the bundle once and we still get the same rate.”

That means patients can get a broader range of services that they didn’t used to have access to, DiGravio said.

“Hopefully, we’ll do a better job meeting the needs of the individuals we serve and helping them to avoid accessing higher, more expensive levels of care including emergency departments and inpatient hospitalizations,” he said.

A push for private insurers to cover CBHC care

While care at these centers is covered for about 1.5 million people under MassHealth, the state’s Medicaid program, roughly three-quarters of insured people in Massachusetts have private insurance or Medicare, neither of which cover these services.

A few insurance companies have signed up to cover CHBC care. But most haven't, and they aren't required to.

"It doesn't feel comfortable on the service delivery side to have sort of a two-tiered model or be offering care in two different ways when we feel very passionately that that full complement of services is what people need," said Kimberly Fisher, vice president of behavioral health services at Riverside.

CBHCs won’t turn away anyone in crisis, and a state law requires private insurers to cover immediate care in those kinds of emergencies. Also, private insurers can be billed individually for some of the services at CBHCs. But patients can’t get coverage for recovery coaches, peer specialists, and other services like the in-house lab.

The Massachusetts Association of Health Plans says some may be planning to contract with CBHCs, and others may still be evaluating the idea, since the program is in its early stages.

DiGravio said he hopes more insurance companies will sign up once they can prove this model has better outcome and is more cost effective. And, he said, employers can play a role.

"If employers want their employees to have access to these services, they need to let the health plans they contract with know that this needs to be part of the benefit package," DiGravio said.

Also, state legislation has been filed that would compel insurance companies to cover care at CBHCs.

“I'm really hopeful that this legislation and my bill will make these treatment service providers available to everybody in our community, whether you have MassHealth or Blue Cross Blue Shield, you name it,” said state Sen. John Cronin, who introduced the bill.

That legislation isn’t going to pass overnight, though. Cronin said he’s hoping in the next year or two to get an analysis of the bill from the Center for Health Information Analysis, which should be able to make it more clear which insurance companies the state could require to cover this kind of care.