Examining Virginia’s Behavioral Health Care Transformation – A Layered Approach

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In a column on state policy, Alison Cuellar and William Hazel examined the transformation of behavioral health care in Virginia.

Cuellar and Hazel examine how Virginia transformed the state’s behavioral health and substance use treatment landscape over the past five years.

In a column on state policy, Dr. Alison Cuellar, professor in the Department of Health Administration and Policy at George Mason University and Dr. William Hazel, former Virginia secretary of health and human resources, examined the transformation of behavioral health care in Virginia resulting from a “layered approach” that included policy changes in procedures, outreach, eligibility and coverage, workforce, and payment. Changes resulted in an increase in the number of substance use providers and in the number of patients treated and laid a foundation to address social determinants of health and disparities.

The article published in Psychiatric Services, examined the ways in which Virginia transformed the state’s behavioral health and substance use treatment landscape over the past five years through policy mechanisms to shift funding, the workforce, and delivery of care and to enhance access. 

Virginia’s efforts to increase access to behavioral health and substance use services were driven by the high cost of institutional care which was often shifted from the community to the state level, inadequate jail and crisis services, and the opioid epidemic. Cuellar and Hazel cite a layered approach to key areas of policy change that made expanding access to care possible: procedure, outreach and coordination, eligibility and coverage, workforce, and payment.  

The article detailed Virginia’s policy changes of note, such as a federal Medicaid waiver to expand coverage for outpatient primary care visits, specialty behavioral health care, medication for uninsured individuals with severe mental illness who were treated by local community service boards as well as for those at incomes 60% of the federal poverty level. The state also emphasized fostering outpatient, office-based treatment and focused on recruiting providers to deliver medication-assisted therapy, particularly with multidisciplinary teams.

Workforce policy changes included expanding nurse practitioners’ (NP) scope of practice and increasing the number of licensed NPs. NPs now represent 25% of the buprenorphine-waived providers. The state has increased its waivered provider rate faster than the national average and increased the number of licensed mental health professionals per capita by 30% in rural counties – faster than the national average of 22% for rural counties.

“The collective impact of the changes Virginia has implemented over the past five years has laid the foundation for the transformation of behavioral health care,” says Cuellar. “This approach may inform other states’ approach to addressing the opioid epidemic and meeting the growing demand for behavioral health services.”

About George Mason University

George Mason University is Virginia's largest and most diverse public research university. Located near Washington, D.C., Mason enrolls 39,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity and commitment to accessibility. For more information, visit https://www2.gmu.edu/.

About the College of Health and Human Services

George Mason University's College of Health and Human Services prepares students to become leaders and shape the public's health through academic excellence, research of consequence, community outreach, and interprofessional clinical practice. George Mason is the fastest-growing Research I institution in the country. The College enrolls more than 1,900 undergraduate and 1,370 graduate students in its nationally-recognized offerings, including: 5 undergraduate degrees, 13 graduate degrees, and 7 certificate programs. The college is transitioning to a college of public health in the near future. For more information, visit https://chhs.gmu.edu/.