Behavioral Health

Jan. 28- Feb. 1: Promising Early Results from Integrating Mental, Physical Health

January 24, 2019 3:21 pm

Among key steps to success in integration programs is early engagement of physicians regarding the initiative.

Jan. 24—Healthcare payers and providers have found good clinical outcomes from pilots that integrate mental health care, but financial analyses remain unfinished.

The promise of improved clinical outcomes and financial savings from tightly integrating mental health care with other care is scheduled to be discussed next week at a large national conference in Las Vegas called the Behavioral Health Management Summit.

A health plan and provider that are pioneering such approaches said this week that they have generated early positive outcomes—and some key lessons.

For instance, a model operated by MemorialCare Health System, a not-for-profit health system in Southern California, has sharply cut the incidence of depression among enrollees in its Medicare Advantage (MA) plan. But financial outcomes (as well any reductions in readmissions or emergency department use) have not been calculated for the year-old initiative, said Kevin Davidson, vice president of business development and strategic services.

“We believe that patients with behavioral health conditions have higher medical utilization and if we can address the behavioral health issue, we can therefore be able to lower the medical cost,” Davidson said in an interview. “We believe that will carry through in our population as well, but it is too early to tell.”

A pilot in Phoenix by UnitedHealthcare Community & State integrated mental and non-mental healthcare services, as well as housing and other nonmedical assistance, for a group of Medicaid patients. The insurer is piloting similar models that include housing in a total of five markets across the nation.

Within the first year and a half of the Phoenix pilot, ED visits declined by 71 percent and inpatient admissions declined by 55 percent among enrollees, said Stephen Cha, MD, chief medical officer for UnitedHealthcare Community & State. However, financial results have not yet been calculated.

“We’re piloting this now and we’ll see where it goes; we’re seeing some pretty impressive results, and we’re tying to run the numbers now,” Cha said in an interview.

The Arizona pilot was developed after state policymakers encouraged Medicaid insurers to offer new types of support for high-risk enrollees—and provided a financial path for them to do that—said Matt Salo, executive director of the National Association of Medicaid Directors. Specifically, the state allowed Medicaid insurers to use a share of their financial reserves to provide such services.  

“That’s probably doable in other states but it may not be as easy if managed care is relatively new in your state. Or if plans don’t have as much history or experience operating in your state, they may not have the ability to do that,” Salo said in an interview. “But it is definitely something people are looking at.”

Lessons Learned

Among key steps to success in integration programs is early engagement of physicians regarding the initiative.

“We had a lot of provider resistance initially,” Davidson said. “The providers really were frustrated that patients weren’t getting the care they needed when they referred their patients out to behavioral health providers. But at the same time this meant caring for a patient they were used to sending out; they didn’t feel like they had adequate training and were worried about the financial liability.”

The health system addressed physician concerns about the new care delivery model through close support from its psychiatrists and from a “physician champion,” who could see the challenges from their perspective.

Another challenge was that some eligible patients did not want to participate for reasons ranging from the stigma of mental illness to challenges traveling to care.

In response, the health system has started to look at virtual care for patients with low-acuity mental illness who can be safely treated at home through technology-enabled communication with providers.

“It gives them things they can work on at home, instead of having to come into a clinic setting,” Davidson said.

MemorialHealth also is trying to figure out financially feasible ways to scale the program beyond its MA plan.

“When we look at rolling this out for other populations, it could get very costly,” Davidson said.

Policy Outlook

The Bipartisan Policy Center issued a report this week that concluded policymakers need to implement a range of changes to encourage more providers and insurers to integrate mental health care.

And Congress is likely to push for implementation of some of the measures, said Chris Jennings, a healthcare consultant and formerly a health policy adviser to President Barack Obama.

For instance, House Democrats were expected to push for fee-for-service Medicare “modernization” that would include implementing mental health coverage parity that already is required for private insurance, Jennings said. Such improvements will be needed before any push to open Medicare enrollment up to the non-senior population, he said.

In addition, House committees were expected to push federal agencies to enforce parity requirements among commercial health plans, Jennings said. Activists have long complained that many private insurers are not meeting the requirements of the federal parity statute. 

Tuesday, Jan. 29

Hearing by the Senate Finance Committee hearing on drug prices. Learn more.

Hearing by the House Oversight and Government Reform Committee on drug prices. Learn more.

Hearing by the Senate Health, Education, Labor and Pensions Committee on legislation allocating five years of funding for community health centers. Learn more.

Webinar by the Centers for Medicare & Medicaid Services (CMS) titled “Question and Answer Session: CY 2018 eCQM Reporting for the Hospital IQR and Promoting Interoperability Programs.” Learn more.

Webinar by the American Hospital Association titled “Creating an Organization that Embraces Cultural Awareness to Advance Equitable and Compassionate Care.” Learn more.

Public workshop by the Food and Drug Administration titled “Content of Premarket Submissions for Management of Cybersecurity in Medical Devices,” Silver Spring, Md. (through Jan. 30). Learn more.

2019 CMS Quality Conference, Baltimore (through Jan. 31). Learn more.

Wednesday, Jan. 30

15th Annual 340B Coalition Winter Conference, San Diego (through Feb. 1). Learn more.

Webcast of Brookings Institution event titled “Reforming Stark/Anti-Kickback Policies.” Learn more.

Webinar by CMS titled “Touring the Hall of Specifications for the Ambulatory Surgical Center Quality Reporting (ASCQR) Program.” Learn more.

Webinar by CMS titled “Eligible Clinician eCQM Diabetes Measures.” Learn more.

Thursday, Jan. 31

Webinar by CMS titled “Navigating QualityNet Pages and Reports: Inpatient Programs.” Learn more.

Webinar by CMS titled “Cooking with CQL: or How to Incorporate CQL into HQMF for eCQMs Webinar.” Learn more.



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