Regional Health Collaboratives improving access to behavioral health services

An evolution of Community Health Innovation Regions (CHIRs) established in 2015 as part of Michigan’s State Innovation Model, Regional Health Collaboratives are a model for improving a region’s wellbeing and unnecessary medical costs through collaboration and systems change.

Michigan’s six Collaboratives include Greater Flint Health Coalition in Genesee County, Jackson Collaborative Network in Jackson County, Health Net of West Michigan in Kent County, MI Community Care (MiCC) in Livingston and Washtenaw counties, Access Health, Inc. in Muskegon County, and Southeastern Michigan Health Association, which operates in seven southeastern Michigan counties and metro Detroit.

One of the Collaboratives’ shared goals has been to improve access to behavioral health services.

“Behavioral health needs are rising — the pandemic has played a role in this,” says Ayse Büyüktür, program manager for MI Community Care (MiCC), “Social determinants of health needs such as transportation, housing, and food insecurity are also rising, leading to more complicated lives and exacerbating behavioral health needs.”

Each collaborative has engaged a broad group of stakeholders to identify and address factors that affect residents’ health, not only access to medical and behavioral health care but also those social determinants of health.

“We cannot tackle these in silos and expect anything to change,” Büyüktür says. “Secondly, behavioral health is still stigmatized. Not everyone is comfortable asking for help or knows how to access services in the first place. If someone is struggling with behavioral health needs, expecting them to navigate complex systems of care on top of that places extra burden on them.”

The Center for Health Research Transformation (CHRT) serves as the administrative backbone for MiCC and is in the midst of evaluating the progress that each collaborative is making. While the numbers aren’t all in, evaluator Jonathan Tsao shares that improvements are being seen in access to behavioral health care among Michigan residents.

“Each of these [collaboratives] were designed to improve the quality of life and health of their region’s residents. Most of the residents who come to their region’s programs have complex medical, behavioral health, and social needs,” says Tsao, senior project manager of the CHRT research and evaluation team. “Their programs are designed to address all of those needs through care coordination.”

Tsao notes that the collaboratives have made considerable progress in building up infrastructure, promoting health equity initiatives, expanding capacity to serve more people, and improving the process of referring people to needed community resources. The Collaboratives also meet regularly to share best practices, successes, and challenges.

“They are finding more alignment in terms of standard practices and also data collection,” Tsao says. “Through this learning network, the regions can provide technical assistance to each other. And, there is a more focused effort on continuing to expand Community Information Exchange within the regions.”

MiCC and WCCMH: mental health care for people where they are

In Washtenaw County, MiCC partners with Washtenaw County Community Mental Health (WCCMH) in meeting the behavioral health needs of county residents. WCCMH employs a lead care coordinator who reviews each patient’s chart and helps them arrange care and access resources across sectors, for example, housing, food, or transportation.

“MiCC recognizes that improving cross-sector coordination and holistic approaches is needed to help alleviate needs more than ever,” Büyüktür says.

While MiCC and WCCMH already collaborate to provide residents in need with the services of community health workers (CHWS), Büyüktür and Tsao concur that embedding more CHWs as well as community paramedics (CPs) and peer support specialists (PSPs) in the community would be a powerful way to provide even better mental health care to community members.

“CHWs and CPs meet people where they are,” Büyüktür says. “They see their living situations. They have the expertise to recognize needs and problems. They also have the expertise to help community members navigate and access systems of care by tackling social determinants of health barriers. They are incredibly knowledgeable about community resources. Because they build strong, trusted working relationships with community members based on those individuals’ personal goals, they help to de-stigmatize behavioral health at the individual level.”

CHWs and CPs help people not only access services, but also navigate accessing those services. Building a strong, sustainable workforce of CHWs, CPs, and PSPs — who have the lived experience to support community members with behavioral health needs —is an important systems-level change that MiCC is working on with its partners and modeling for the other collaboratives.

CHRT’s evaluation of all six Regional Health Collaboratives will no doubt shed light on the efficacy of not only CHWs and coordinated care but also pave the way for the state’s health systems and community resource agencies to collaborate on technologies, share data, and model each other’s successes.

“Behavioral health is still stigmatized to a fair extent by our overall culture. Every individual is not comfortable asking for help or knows how to access services,” Tsao concludes. “We don’t have actual metrics at the moment, but as we work towards measuring [the results of the evaluation], we’d like to see improved patient satisfaction in the services received in these regions and an increase in needs met — social needs and health needs.”