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The Blue Cross Blue Shield of Massachusetts Foundation released a report today offering an early examination of the state’s implementation of the Roadmap for Behavioral Health Reform (the Roadmap), a sweeping set of changes aimed at improving access to the outpatient mental health and substance use disorder treatment system for all Massachusetts residents.  Researchers found both successes and challenges since the Roadmap’s launch in early 2023, and identified opportunities to strengthen the multiyear strategy to close critical gaps in community-based care.

The report highlights last year’s rollout of the statewide Behavioral Health Help Line, providing 24/7 access to individuals and families seeking crisis and other services, along with the opening of 27 Community Behavioral Health Centers (CBHCs) to serve as “one-stop locations” for treatment across the state.  A third major component of the Roadmap, community-based Behavioral Health Urgent Care sites providing same-day or next-day outpatient appointments, is also reviewed.  The report, prepared by research partner Manatt Health, is based on input from key stakeholders and early implementation data.

Other components of the Roadmap are still getting under way. These include improving integration of behavioral health and primary care - incentivized through new payment models - and improving people's experience in accessing community-based behavioral health care services, particularly for acute and crisis care, to help reduce unnecessary visits to hospital Emergency Departments.

“This report shows improvement in access to community-based behavioral health care as a result of the implementation of the Roadmap, and that is a major step forward given the barriers to care that have existed for so long,” said Audrey Shelto, President and CEO of the Blue Cross Blue Shield of Massachusetts Foundation. “There is broad support for the state’s progress and commitment to the Roadmap, and a recognition of the need for more active stakeholder engagement and public education about these reforms moving forward.”

Stakeholders interviewed for the report – including providers, advocates, state government officials and others – acknowledged initial successes while also identifying some early implementation challenges.  For instance, variability in network coverage and payment across different insurance carriers has created difficulties for some individuals in accessing and receiving timely care. Additionally, uncertainty about the role of ambulance providers and law enforcement in transporting individuals in crisis to CBHCs may be limiting access to these essential services, preventing those in need from receiving care in the most effective and seamless manner. 

“This Roadmap is a brand-new approach and, as with any pioneering initiative, the need for monitoring, feedback, adjustments and refinements is a key part of its rollout,” said Kaitlyn Kenney Walsh, Vice President of Policy and Research at Blue Cross Blue Shield of Massachusetts Foundation.  “With proactive coordination across stakeholders, the solutions described in this report can help address early implementation challenges and sustain and enhance this critical behavioral health initiative.”

The report outlined opportunities for improvements to the Roadmap implementation and broader system reforms that are crucial to its long-term success:

Specific Improvements to Roadmap Implementation

• Improve coordination among state agencies to enhance cross-agency collaboration, ensuring cohesive policy guidance.
• Expand and clarify coverage for services across different insurance plans to ensure broad access.
• Address transportation challenges related to ambulance and law enforcement dropoffs at CBHCs.
• Enhance stakeholder engagement and develop a public awareness campaign to promote key aspects of behavioral health reforms.

Broader System Reforms Required

• Strengthen and diversify the behavioral health workforce through training programs and payment reforms.
• Advance data sharing and interoperability by adopting electronic health records and other technology platforms.
• Support community-driven solutions to promote equitable access to behavioral health care services, particularly in marginalized communities.

The report, titled Massachusetts Roadmap for Behavioral Health Reform: Overview and Implementation Update, is available online at the following link: https://www.bluecrossmafoundation.org/publication/massachusetts-roadmap-behavioral-health-reform-overview-and-implementation-update

About the Blue Cross Blue Shield of Massachusetts Foundation

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to ensure equitable access to health care for all those in the Commonwealth who are economically, racially, culturally or socially marginalized.  The Foundation was established in 2001 with an initial endowment from Blue Cross Blue Shield of Massachusetts.  It operates separately from the company and is governed by its own Board of Directors.  For more information, visit www.bluecrossmafoundation.org.