Southwest Michigan Behavioral Health: Building trust and improving health

Southwest Michigan Behavioral Health (SWMBH) partners with community mental health providers in Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph and Van Buren counties. Founded as a regional entity by the eight counties’ Community Mental Health Authorities (CMHA) in 2013, SWMBH works to build health, quality, value, and trust by providing benefits management and a range of community mental health services. 

Direct services include mental health therapies, substance abuse treatment, autism services, women’s specialty services, Naloxone training for first responders, and problem gambling prevention. Its Flip the Script program addresses stigma around mental health services that impacts the Black community. The Live Prevention program increases public awareness of four critical factors that are the center of the opioid epidemic. SWMBH also serves as a Prepaid Inpatient Health Plan (PIHP) for the eight counties.

“We work closely with medical health plans and other health and human services agencies to improve health and social functioning for Medicaid enrollees,” says SWMBH CEO Brad Casemore. “Over the years, the Medicaid managed care program has matured with numerous programs, services, and benefits such as Certified Community Behavioral Health Centers, Opioid Health Homes, psychiatric rehabilitation treatment facilities, and more.”

Casemore was appointed to the Mental Health Diversion Council by Governor Whitmer in 2020, the Opioid Task Force by the Michigan House Minority Leader in 2022 and by Governor Whitmer in 2023. MI Mental Health had the opportunity to speak with him about how SWMBH operates and positively impacts the counties it serves.

Brad CasemoreQ. How does SWMBH  help meet mental health needs?

A. SWMBH assures access to quality services in the eight counties, fiscal prudence, and member protections and satisfaction. SWMBH also provides health care data analytics services to CMHAs and substance use disorder prevention and treatment service providers, regional clinical training in best practices as well as public policy advocacy support.

Q. What does managing services in this eight-county region involve?
A. SWMBH is under contract with the Michigan Department of Health and Human Services as a PIHP managing behavioral health benefits for Medicaid enrollees with severe mental illness, serious emotional disturbance, substance use disorders, autism spectrum disorders and intellectual and developmental disabilities. SWMBH is also a state-designated Community Mental Health Entity with statutory roles and authorities for substance abuse prevention and treatment planning, policy, programs and performance.  
SWMBH can be considered a health plan with responsibility for member services, provider network management, program integrity and compliance, information technology, quality assurance and performance improvement, finance and accounting and utilization management. Some of these functions are delegated to CMHAs with required oversight and monitoring by SWMBH. We are pre-funded by a predictable set amount of money via Medicaid payments, which are then shared with CMHAs, as well as fee for service payments to substance use disorder treatment services. At the end of each year SWMBH settles costs with CMHAs and then with MDHHS.  
Q. How have new programs and platforms helped people?

A. Significant investments have been made in health care information exchange, data analytics, and especially integrated care. Health care data can help improve the quality of care for members served. CareConnect360 and Relias’s Population Performance are database applications used by SWMBH containing integrated behavioral health, medical service, and pharmacy data for all members in the SWMBH region. 

Both applications contain useful disease management, demographic, and health care service data to understand Medicaid enrollees’ health status. Population Performance generates analytics on pharmacy use, medication adherence, compliance with best practice health care standards, and risks associated with poorer outcomes and higher health care costs. 

SWMBH uses Population Performance primarily to monitor health care metrics and pharmacy trends so resources can be provided in areas needing improvement. CareConnect360 is managed by MDHHS and is primarily used by SWMBH for identifying and monitoring at-risk individuals who receive support from PIHP-Medicaid Health Plan care teams and to monitor SWMBH’s results on MDHHS’s health care metrics.
Using CareConnect360, a SWMBH health care specialist identified a member who was a frequent visitor to the emergency department. She had complex needs related to untreated bipolar and alcohol use, high-risk pregnancy, and multiple health conditions. Integrated care team meetings with the Medicaid Health Plan assigned a care manager and a specialty obstetric team to better assess and address social health factors that created barriers to treatment. 

SWMBH’s outreach efforts from the integrated health care specialist and involvement with outpatient providers (including a federally qualified health center, and OB/GYN services), helped her to stop using the emergency department. Through weekly huddles with the hospital in her community, the Community Mental Health provider became aware of her complex needs. They now provide her with therapy, medication management, care coordination, and monitor efforts for abstinence from alcohol. All partner agencies recognized the importance of delivering comprehensive and integrated care to address her needs and support the whole person. 
Q. What are some of SWMBH’s major challenges? 

A. The shortage of behavioral health and health providers is a serious issue at all levels including but not limited to personal care assistants, social workers, nurses, nurse practitioners, psychologists and psychiatrists as well as primary care providers. Fortunately, national and Michigan efforts have been underway to address the shortages with emerging favorable impact.

Other challenges include the pace and amount of federal and state requirements and programs. While these are valuable, they strain the clinical and administrative resources of the public behavioral health system. 

Karen Gentry is an established journalist and communications specialist in the Grand Rapids area. She has written for numerous outlets including School News Network, Michigan Trails Magazine, MLive, and MiBiz. She is a graduate of Central Michigan University.

Photos courtesy SWMBH.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of MichiganCenter for Health and Research TransformationLifeWaysMental Health Foundation of West MichiganNorthern Lakes CMH AuthorityOnPointSanilac County CMHSt. Clair County CMHSummit Pointe, and Washtenaw County CMH.
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