Fostering Integrated Peer Support for Emergent Health Homes

A wonderful, nationwide opportunity to advance peer support practice awaits in the emergent health homes now beginning to dot our healthcare landscape.  And like the health homes themselves, peer support itself is undergoing dramatic transformation. Traditional peer support with behavioral health consumers in specialty clinics is rapidly beginning to evolve to include integrated peer support with all types of behavioral and health care consumers in the new health homes.

The tools of peer support, such as mutuality, wellness coaching, and emotional support, have great value not only for persons with mental health and substance use conditions, but also for those with heart disease, diabetes, and cancer. Because health homes will include consumers with all of these conditions, we must continue to transform peer support so that it can become an integral service in these new settings. This task is both immediate and urgent.

What steps will be necessary to make this promise a true reality?

At least three key steps appear necessary: provision of necessary training and credentialing; formation of fully integrated service teams; and development of integrated payment mechanisms.

Training and Credentialing. If integrated peer support is to become a valued service in health homes, our training and credentialing must be very clear, transparent, and directly relevant. Several outstanding training programs for peer support in specialty clinics already are well established. We need to determine what needs to be added to these programs so that they can become directly relevant for integrated peer support services. Similarly, considerable national work is underway to develop a peer support service credential for mental health and substance use services. We can build on this work to evolve this credential so that it also is a point of entry into health homes. We must develop new partnerships with community colleges with funding through federal programs outside of health care to take these programs to national scale.

Formation of Fully Integrated Service Teams.  An essential feature of health homes will be fully integrated service delivery teams. Such teams will include primary care and behavioral health staff, working closely together on a daily basis. An integrated peer support specialist must be a key member of each of these teams. To promote this development, primary care staff must become aware of peer specialists and understand their value to the integrated service delivery team. We must undertake outreach to national and state primary care entities to foster this understanding.

Development of Integrated Payment Mechanisms.  The advent of health homes will lead to major reforms so that payment mechanisms can become more compatible with whole health approaches. Thus, over time, fee-for-service payment systems will be replaced by case and capitation rate systems. As these new systems are developed, it will be essential that integrated peer support services be included within the covered service bundle. To accomplish this, we must outreach to state Medicaid directors configuring the Alternative Benefit for the Medicaid Expansions and to insurance executives configuring the Qualified Health Plans.

Today, we are on the cusp of very exciting new developments in the evolution of peer support,  undoubtedly already the most promising development in behavioral healthcare in a generation.  In order to build momentum for the three major tasks described above, small-scale local demonstrations can play a pivotal role. Thus, I encourage you to reach out today to local primary care colleagues to begin informal dialogues.  If possible, place a local peer support specialist into a primary care practice on a trial basis. Become engaged in local work to build an accountable care organization that will operate a new health home. Reach out to your local federally-qualified community health center and indicate that you want to work with them.

The tasks are many and time is short. Because of their centrality and national scope, I encourage SAMHSA and HRSA to join with us to facilitate these pivotal, groundbreaking efforts.