The Promise and Challenge of Wrap-Around Services in Behavioral Health Care – Behavioral Health Business

Report on Wrap-Around Services in Behavioral Health and Sustainable Development Goals (SDGs) Integration

Introduction

Recent experiences highlight the critical role of the physical environment in individual health and productivity, extending to broader public health outcomes. This report examines the challenges and opportunities in providing wrap-around services for behavioral health, emphasizing alignment with the United Nations Sustainable Development Goals (SDGs), particularly those related to health, well-being, and sustainable communities.

Context and Importance of Social Determinants of Health

The COVID-19 pandemic has intensified focus on social determinants of health, including housing, food security, social connectedness, and employment. Stability in these areas is essential for effective behavioral health treatment, especially for individuals with substance use disorder (SUD) and serious mental illness (SMI).

• Approximately two-thirds of unhoused individuals suffer from mental health disorders, underscoring the need for integrated care approaches.
• Providers have attempted holistic care models, including direct housing support, aligning with SDG 3 (Good Health and Well-being) and SDG 11 (Sustainable Cities and Communities).

Challenges in Implementing Wrap-Around Services

1. Financial Sustainability: Many providers struggle to maintain business models that support comprehensive wrap-around services due to reimbursement limitations.
2. Reimbursement and Medicaid Reform: Medicaid reforms may restrict funding for social determinant-related services, complicating access for vulnerable populations.
3. Risk in Capitated Payment Models: While capitated models offer flexibility to address social determinants, they impose financial risk on providers, limiting widespread adoption.

Case Studies and Current Landscape

• OneFifteen: An opioid use disorder treatment provider backed by Alphabet, which ceased operations due to reimbursement challenges despite offering comprehensive wrap-around care.
• Firsthand: A venture-backed startup focused on SMI care that recently reduced staff amid financial pressures.
• Cityblock Health: Provides value-based physical and behavioral health services, demonstrating an 11.5% reduction in total care costs and a 19.7% decrease in inpatient utilization among Medicaid and dually eligible patients, reflecting progress toward SDG 3.
• Merakey: A nonprofit behavioral health system offering recovery homes and employment support through foundation funding, contributing to SDG 1 (No Poverty) and SDG 8 (Decent Work and Economic Growth).

Potential Solutions and Future Directions

1. Adoption of Alternative Payment Models: Capitated and value-based payment arrangements could enable providers to integrate social determinant services sustainably.
2. Enhanced Collaboration: Partnerships between healthcare providers, payers, and community organizations are essential to address complex needs effectively.
3. Leveraging Grants and Donations: While helpful, these funding sources require supplementation with sustainable business models for long-term impact.

Alignment with Sustainable Development Goals (SDGs)

• SDG 3 – Good Health and Well-being: Ensuring access to comprehensive behavioral health services that address social determinants.
• SDG 1 – No Poverty: Providing housing and employment support to vulnerable populations.
• SDG 10 – Reduced Inequalities: Targeting care for marginalized groups, including the unhoused and those with mental health disorders.
• SDG 11 – Sustainable Cities and Communities: Promoting stable housing and community integration as part of health care.
• SDG 17 – Partnerships for the Goals: Encouraging multi-sector collaboration to fund and deliver wrap-around services.

Conclusion

Access to behavioral health care is significantly hindered by social determinants such as homelessness and food insecurity. Providers offering wrap-around services that address these factors can improve health outcomes and contribute to achieving multiple SDGs. However, sustainable financing remains a critical barrier. Alternative payment models, combined with strategic partnerships and supplemental funding, are necessary to create resilient systems that support holistic care for vulnerable populations.

1. Sustainable Development Goals (SDGs) Addressed or Connected to the Issues Highlighted in the Article

1. SDG 3: Good Health and Well-being
   • The article focuses extensively on behavioral health, mental health disorders, substance use disorder (SUD), and serious mental illness (SMI), highlighting the importance of health care access and quality.
2. SDG 1: No Poverty
   • Issues related to homelessness and lack of stable housing are discussed, emphasizing how poverty and housing instability impact health outcomes.
3. SDG 2: Zero Hunger
   • The article mentions food insecurity as a social determinant of health affecting vulnerable populations.
4. SDG 10: Reduced Inequalities
   • The focus on vulnerable populations, including those with mental health disorders and homelessness, relates to reducing inequalities in access to health and social services.
5. SDG 11: Sustainable Cities and Communities
   • Access to housing and community services is a key theme, linking to creating inclusive, safe, and sustainable living environments.

2. Specific Targets Under Those SDGs Identified Based on the Article’s Content

1. SDG 3: Good Health and Well-being
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services.
2. SDG 1: No Poverty
   • Target 1.4: Ensure that all men and women have equal rights to economic resources, including access to basic services such as housing.
3. SDG 2: Zero Hunger
   • Target 2.1: End hunger and ensure access by all people to safe, nutritious, and sufficient food all year round.
4. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, or other status.
5. SDG 11: Sustainable Cities and Communities
   • Target 11.1: Ensure access for all to adequate, safe and affordable housing and basic services.

3. Indicators Mentioned or Implied in the Article to Measure Progress Towards the Identified Targets

1. Health and Well-being Indicators (SDG 3)
   • Prevalence of mental health disorders among unhoused populations (e.g., two-thirds of unhoused people have a mental health disorder).
   • Reduction in inpatient treatment utilization (e.g., 19.7% decrease reported by Cityblock’s program).
   • Decrease in total care costs for Medicaid and dually eligible patients (e.g., 11.5% decrease reported).
   • Access to wrap-around services including housing, food, and career education as part of health care.
2. Housing and Social Services Indicators (SDG 1, 10, 11)
   • Number of individuals provided with stable housing or recovery homes.
   • Availability and sustainability of wrap-around services to support vulnerable populations.
   • Reimbursement and funding models supporting social determinants of health services.
3. Food Security Indicators (SDG 2)
   • Provision of food services as part of wrap-around care.
   • Access to nutritious meals for individuals in recovery or with behavioral health needs.

4. Table of SDGs, Targets, and Indicators

Source: bhbusiness.com