Total Cost of Therapy-Based Care Versus a Brokerage Model of Case Management for Persons With a Serious Mental Illness Served in the Community

A five-year evaluation compared total Medicaid and General Fund behavioral health care costs of a behavioral health home (BHH) model with those of a brokerage model of case management (treatment-as-usual) for the community care of adults with a serious mental illness. The BHH was an interprofessional, team-based intervention that used cognitive behavioral therapy, motivational interviewing, and dialectical behavioral therapy skills as primary interventions. By the third full year, the BHH total cost was less than half that of case management. The difference was due largely to less utilization of inpatient and community residential services among those served by the BHH. Results are limited by the non-randomized assignment among the groups and the availability of only aggregate data, but they strongly suggest the value of further examination of the effectiveness and cost of BHH versus case management-based interventions in a community mental health setting.