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Advancing Behavioral Health Care Management: How Intelligent Integration Improves Clinical Case and Health Plan Performance
What is Intelligent Integration?
Best Practices White Paper | Medical Affairs Team, ODH, Inc. | April, 2017
• Learn the five best practice steps of successful population health management
• Uncover strategies to improve health plan performance through optimized behavioral health care delivery
• Explore intelligent integration and its critical role in managing high-risk behavioral health populations
• Find out how population segmentation contributes to improvedhealth outcomes and reduced overall health care costs for high-risk, high-need members
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TableOfContents:
I. ExecutiveSummary
II. TheImpactOfBehavioralHealthConditionsOnHealthStatus&HealthCareResourceUse
III. TheRoleOfBehavioralHealthOptimizationInPopulationHealthManagement
IV. BehavioralHealthRiskAssessmentForPopulationSegmentation:TheFirstStepInBehavioralHealthOptimizationInPopulationHealthManagement
V. CaseExampleOfBehavioralHealthRiskAssessmentInPopulationSegmentationInitiatives
VI. References
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I. ExecutiveSummary
Thehealthcaresystemhaslongrecognizedthehumanandfinancialimpactofcomorbidbehavioralhealthandphysicalhealthconditions.Behavioralhealthconditionshaveapronouncedimpactonhealthstatus,healthoutcomes,andresourceutilization.Individualswithphysicalhealthconditionscompoundedbybehavioralhealthissuesaremorelikelytobe“super-utilizers”ofhealthcareresources.1Thosewithundiagnosedand/oruntreateddisordersaremorelikelytobehospitalizedandtousetheemergencydepartment.2Inaddition,lackofintelligentintegrationandcarecoordinationincreasescomplicationsandpoorhealthoutcomes.
Healthplans,providers,policymakers,andadvocateshaveidentifiedandsoughtintegratedbehavioralhealthandphysicalhealthcareasapriorityfordecades.Fortunately,theadventofinnovativemodels,useofdataanalytics,andenablingtechnologyisputtingthisheretoforeelusivegoalwithinreach.
Today,healthplanmanagersareadoptinginnovativestrategiesfocusedonidentifyingandengagingtargetedpopulationsofundiagnosedandhigh-risk/highneedindividuals;expandingaccesstoandsupportingadherencetoappropriatetreatment;coordinatingcareforpopulationswithcomorbidconditions;anddevelopingquality-basedproviderpartnershipstooptimizedeliveryofvalue-basedcare.Examplesofthesestrategiesincludeinnovativeandspecializedintegratedcarecoordinationinitiatives,personalhealthnavigatorprograms,enhancedaccesstotech-enabledservices,psychotropicmedicationreviewinitiatives,specializedemergencydepartmentdiversionprograms,andprovidergainsharingwithincentivesfocusedoninnovativetreatmentmodelsandoutcomes.
Thesestrategiesrequiretheabilitytoidentifyandsegmentpopulations,definepopulationspecifictherapeuticapproachesandvenues,enablecarecoordination,monitortreatmentadherence,andidentifyindividualsforspecifictargetedinterventions.Thispracticeofintelligentintegration–incorporatingpopulationsegmentationbasedonbehavioralhealthriskassessment–isafoundationaltoolinabestpracticesapproachtopopulationhealthmanagement.
Whencombined,clinicalinnovationandtechnologybecomeapowerfultoolforaggregating,analyzingandunderstandinghealthdata,whichmayleadtoimprovedpopulationhealth.
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$26,286
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OneBehavioralHealthDisorder
1Addi`onalCondi`on
2Addi`onalCondi`ons
3Addi`onalCondi`ons
4Addi`onalCondi`ons
IndividualsWithBehavioralDisorders&ComorbidMedicalCondi?onsHaveHigherAverageCosts
2010-2013AverageAnnualPerCapitaHealthCareSpendingFor
IndividualsWithBehavioralHealthDisordersByAddi?onalComorbidCondi?ons
II. TheImpactOfBehavioralHealthConditionsOnHealthStatus&HealthCareResourceUse3,4
IndividualsWithBehavioralHealthDisorders&ComorbidMedicalConditionsHaveHigherAverageCosts&OftenExperienceGapsInCareManagement5
AboutathirdofUnitedStates(U.S.)adultswithmedicalconditionshavebehavioralhealthconditions.Additionally,68%ofadultswithbehavioralhealthconditionsalsohavemedicalconditions.6Behavioralhealthdisorderswithcomorbidmedicalconditionsincreaseaveragehealthcarecostsbyover200%,with4ormorecomorbidconditionsincreasingcostsfrom$12billiontoover$540billionannually.7Behavioralhealthconditionsrankinthetopfivediagnosticcategoriesforhealthcarespending.8,9
Individualswithbehavioraldisordershavehigheroverallhealthcarespending.Theseindividualsmorefrequentlyvisitemergencydepartments,anduse35%morepaidhomehealthcaredaysthantheirpeers.Adultswithabehavioralhealthconditionarealsomorelikelytoremaininthetop10%ofspendingovertwoyears,whencomparedtopeerswithoutabehavioralhealthcondition(34%versus23%,respectively).10
Historicalpopulationhealthmanagementmodelshavefocusedonspecificconditionsinsteadofaholistic,person-centeredapproach.Assuch,individualswithcomorbiditiesoftenexperiencefragmentationorgapsincare,whichcanleadtountreatedhealthproblemsandutilizationofexpensivesettings,includingapotentialrelianceonemergencydepartmentandinpatienthospitalstays.11
Behavioralhealthconditionshaveapronouncedimpactonhealthstatus,healthoutcomes,andresourceutilization.Consumerswithphysicalhealthconditionscompoundedbybehavioralhealthissuesaremorelikelytobe“super-utilizers”ofhealthcareresources.iiiThosewithundiagnosedand/oruntreateddisordersaremorelikelytobehospitalizedandtousetheemergencydepartment.ivInaddition,lackofintelligentintegrationandcarecoordinationincreasescomplicationsandpoorhealthoutcomes.
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IndividualsWithBehavioralDisordersOftenHavePoorOutcomesDespiteBeing“Super-Utilizers”OfHealthCareResources12,13
Individualswithabehavioralhealthconditionaremorelikelytobelabeled“super-utilizers”duetotheprevalenceofmultipleillnesses,uncoordinatedandfragmentedcare,andrelatedhighresourceuse.14
Super-utilizersarethe5%ofthepopulationwhoconsumeadisproportionateamountofhealthcareresources.15Thereisauniqueopportunitytousetechnologytoidentifyfactorstopredictwhoislikelytobeclassifiedasasuper-utilizer.Inmanypopulations,the5%grouputilizesasmuchas50%oftheresources,16furtherunderscoringtheimportanceofknowingwhichmembersareinthe5%.Morethan80%ofMedicaidsuper-utilizershaveacomorbidmentalillness.17Inaddition,mentalhealthandsubstanceabusedisordersareamongthetenmostfrequentdiagnosesforsuper-utilizers,regardlessofpayersource.18
Despitehigherutilizationofhealthcareresources,theimpactofuncoordinatedandfragmentedcareultimatelyincreasesthelikelihoodofpoorhealthoutcomesfortheseindividuals.19Foranypopulationhealthprogramtobesuccessful,identificationandmanagementofthissuper-utilizergrouparekey.Riskstratificationandpopulationsegmentationarecriticaltoidentifyingwhotheyare,whatservicestheyuse,andeffectivestrategiesfordiseasemanagementandrecovery.
UntreatedBehavioralHealthConditionsHinderTreatment&LeadToIncreasedUseOfHighCostServices20
Theimpactofbehavioralhealthconditionsonhealthcareuseandspendingislikelyunderestimatedsincebehavioralhealthconditionsoftengoundiagnosedoruntreated.21Individualswithuntreatedbehavioralhealthconditionssufferfromdiminishedhealthstatus,andaremorelikelytousehigh-costservices.22,23
Untreatedbehavioralhealthconditionsresultinrecurrenceofacutecrises,includingadversesocialoutcomessuchaslosthousingandpotentialincarceration,whichrequireimmediateintervention.24Recurringacutecrisesalsoresultinapatternofindividualsseekingcareinhospitalemergencydepartmentsandinpatientunits,twohigh-costlocations.In2013,themostrecentyearforwhichthereisfederaldata,emergencydepartmentshadanestimated640,000visitsforsymptomsofschizophreniaorotherpsychosis.25
Almost60%ofindividualssufferingfromdepression,oneofthemostcommonbehavioralhealthdiagnoses,havenotreceivedtreatmentwithinthelastyear—andtwo-thirdsofdepressioncasesgoundiagnosedinprimarycaresettings.26,27Mooddisorderslikedepressionarethethirdmostcommoncauseofhospitalizationamongnon-elderlyadults.28
Substanceusedisordersalsopresentapopulationhealthmanagementchallenge.Only11%ofthosewithasubstanceusedisorderreceivetreatment.29Individualswithuntreatedsubstanceusedisorderswere46%morelikelytoreportanemergencydepartmentvisitinthepastyear,and81%morelikelytobeadmittedtothehospitalduringanemergencyroomvisit.30,31
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LackOfIntelligentIntegration&CareCoordinationResultsInPoorerOutcomes&HigherCosts
Traditionally,healthcaresystemshavefocusedonmanagementofspecificdiseasestatesinsteadofusingintelligentintegrationandcarecoordination.Agrowingbodyofknowledgeabouttheeffectsofcomorbidconditionshascreatedgrowinginterestincoordinatedcaremanagement.Therearemultipleopportunitiesforimprovedcarecoordinationforindividualswithcomorbidities.
Thefirstistoaddressthemedical,behavioral,andsocialneedsofbehavioralhealthindividuals.Theabsenceofcoordinated,person-centeredcaremanagementforindividualswithcomorbidbehavioralhealthconditionsleadstomisseddiagnoses,poorfollow-up,andgapsincare.32Forexample,whenschizophreniaisleftuntreated,complications–suchassuicideandalcoholabuse–aresignificantlyincreased.Currently,thesuiciderateforschizophreniaisbetween5%and10%,whichissignificantlyhigherthanthegeneralpopulation.33Estimatesputtherateofexcessiveuseofdrugsoralcoholat50%ofthatpopulation,andnicotineuseatamuchhigherrate(60%to65%)thanthegeneralpopulation(15%).34,35,36Socialproblems,suchaslong-termunemployment,poverty,incarceration,andhomelessness,aremorecommonforindividualswithseriousmentalillness(SMI),whichincludesschizophreniaandmajordepressivedisorder.37Forindividualswithapoorlymanageddiagnosis,allofthesefactorscontributetoanaveragelifeexpectancythatis13to30yearsshorterthanforthosewithoutthediagnosis.38
Appropriatebehavioralhealthdiagnosis,treatment,andcarecoordinationarealsoessentialforthosewithphysicalhealthconditionscompoundedbybehavioralhealthissues.Thisisespeciallycriticalforchronicconditionswheremedicationadherenceandotherbehavioralfactorsdirectlyimpactoutcomes.
Forexample,thereisa200%highermortalityforindividualswithdiabetesanddepressioncomparedtothosewhoonlyhavediabetes.Thispopulationalsohasa2-3foldincreasedriskoffuturecardiaceventsforindividualswithcoronaryarterydisease(CAD)anddepressioncomparedtothosewithout.39Recentstudieshavealsoshownthatindividualswithmajordepressionwhoarerecoveringfromstrokesorheartattackshaveamoredifficulttimemanagingtheirillness,andhaveahigherriskofdeathinthefirstfewmonthsafteraheartattack.40
Onecurrentmeasureofsystemperformanceforcarecoordinationispromptcommunity-basedfollow-upafterdischargefromhospitalizationforabehavioralhealthdiagnosis.CurrentHealthcareEffectivenessDataandInformationSet(HEDIS)scoresshowthatmorethan47%ofcommercially-insuredindividuals,55%ofMedicaidenrollees,and64%ofMedicareenrolleesdidnotreceivefollow-upcarewithin7days.41Thislackoffollow-upcausesagapinthecarecontinuum,andcanpotentiallyleadtorelapse,crisis,orreturningtotheemergencydepartmentandhospitalforcare.42
Summary
Behavioralhealthconditionshaveapronouncedimpactonhealthstatus,healthoutcomes,andresourceutilization.Individualswithphysicalhealthconditionscompoundedbybehavioralhealthissuesaremorelikelytobesuper-utilizersofhealthcareresources.43Thosewithundiagnosedand/oruntreateddisordersaremorelikelytobehospitalizedandtousetheemergencydepartment.44Inaddition,lackofintelligentintegrationandcarecoordinationincreasesthelikelihoodofcomplicationsandpoorhealthoutcomesforindividualswithchronicconditions.Withgrowingevidenceaboutthese
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effects,payersandhealthplansneedenhancedtoolstooptimizetheirbehavioralhealthdeliverysystem.45
III. TheRoleOfBehavioralHealthOptimizationInPopulationHealthManagement
Withthegrowingunderstandingoftherelationshipbetweenindividualbehavioralhealthconditionsandhealthcareresourceuse,healthplansandpayersareadoptingawiderangeofstrategiestooptimizetheperformanceofthebehavioralhealthsystemtoimproveindividualoutcomes.46Thiswiderangeofstrategiesisfocusedonaccess,engagement,qualityimprovement,andcarecoordination.Toolswhichprovideenhancedanalyticcapabilities,suchasthosewhichallowforaccuratepopulationsegmentation,arecriticaltothesuccessoftacticsfocusedonoptimizingthebehavioralhealthservicesystem.
Healthplansareadoptinginnovativestrategiesfocusedonimprovingtheeffectivenessofbehavioralhealthservices.Includedinthesestrategiesarethosewhichincreaseengagement,improveaccess,andensurequality.Strategiesforimprovingcoordinationofcareforpopulationswithcomorbidconditionshavebeenofaparticularinterest. Moreandmoreresearchisshowingalinkbetweencarecoordinationandvalue.
Effectivestrategiesrequiretheabilitytoidentifyandsegmentpopulations,definepopulation-specifictherapeuticapproachesandvenues,enablecarecoordinationandmonitortreatmentadherence,aswellasidentifyindividualsforspecifictargetedinterventions.Thispracticeofintelligentintegrationincorporatingpopulationsegmentationbasedonbehavioralhealthriskassessmentisafoundationaltoolinthebestpracticesapproachtopopulationhealthmanagement.
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Examplesofthesestrategiesincludeinnovativeandspecializedintegratedcarecoordinationinitiatives,personalhealthnavigatorprograms,enhancedaccesstotech-enabledservices,medicationreviewinitiatives,specializedemergencydepartmentdiversionprograms,andprovidergainsharingwithincentivesfocusedoninnovativetreatmentmodelsandoutcomes.
Summary47
Toimprovethehealthoutcomesandreduceunnecessaryuseofhealthcareresourcesforindividualswithcomorbidbehavioralandphysicalhealthconditions,healthplansareimplementingawidearrayoftargetedpopulationhealthmanagementstrategies.Withtheincreaseininnovations,pinpointingtheindividualsforwhichagivenstrategyisbestiscriticaltooptimizingthatindividual’sbehavioralhealthstatusandtheiroverallhealthstatus.Assuch,thesestrategiesdependonanalytictoolsforsuccess,suchasthosewhichallowaccuratepopulationsegmentation.
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IV. BehavioralHealthRiskAssessmentForPopulationSegmentation:TheFirstStepInBehavioralHealthOptimizationInPopulationHealthManagement
Proactivelysupportingtheneedsofhigh-riskindividualsiskeytoimprovingpopulationhealthandreducingunnecessaryhealthcarespending.Foramaximumreturnonstrategiestosupporttheseindividuals,accurateandtimelymatchingofspecificindividualstospecificinterventionsisessential.Forsuccessfulpopulationhealthmanagement,findingtheappropriatestrategy-individualmatchisthegoalofpopulationsegmentationusingbehavioralhealthriskassessment.
ThePopulationHealthManagementFramework
Populationhealthsegmentationhappenswithintheoverallcontextofbestpracticepopulationhealthmanagement.Broadly,thepopulationhealthmanagementframeworkincorporates:50,51
• Definingthepopulationandproblemfirst.Forexample,apopulationmaybedefinedasindividualswithchronicmedicalconditionswhohavecomorbidSMI.Theproblemisdisease-based,fragmented,uncoordinatedcareresultinginsub-optimaloutcomesfortheindividualandsubstantiallyhighercosts.
• Leveragingthepowerofclinicalandfinancialdatafrommultiplesystems.Thisdatahelpsidentifywhichspecificindividualsfallintothedefinedpopulation;gaugetheprevalenceofthedefinedproblemamongthispopulation;observeadditionalbarriers,gaps,unmetneeds,andrisksexperiencedbythedefinedpopulation;andinformtheadoptionofcaremanagementstrategiestomeetthegaps,needs,andrisksobserved.
• Transformingdataintoactionableinformation.Informaticsanddataanalytictoolsorganizeaggregateddatasetsintoactionableinformationtodrivepopulationhealthstrategyandempowerthecaremanagementprocess.Informationiseffectivewhenitistransparentandaccessibleacrossthecareteam;timely,allowingaswiftreactiontochangingrisks;andrelevanttospecificquestionsthatinformclinicaldecision-making.Inthisbestpracticeapproach,greaterinformationtransparencycreatesaccountability.
• Makinginformation-drivenclinicaldecisions.Atitsfoundation,populationhealthmanagementrequirestheuseofinformationtopredictfuturerisks,andthenrequiresthedevelopmentofcaremanagementapproachesthatmitigatethoserisks.Information-drivendecision-makingenhancescomprehensivecaremanagement,improvesthequalityofcare,improvesindividualhealthoutcomes,reducesavoidableandpreventableutilization,andhelpspredictfuturecosts.
• Continuouslyseekingimprovement.Populationhealthsegmentationstrategiesarepartofstandardpractice,andshouldbecontinuouslymeasuredforperformanceandsuccess.Thisincludesevaluatingriskassessmentmethodologyandriskidentification;timelinessofinformation;relevance
Toaddresstheneedsofhigh-riskconsumersinhealthplans,particularlythosewithcomorbidbehavioralhealthandphysicalhealthconditions,anumberofinnovativeapproachesareemerging.Formaximumeffectiveness,thesestrategiesdependontheabilitytoidentifytheappropriateindividualsforspecific,targetedinterventions.Thisabilitytodointelligentintegration,incorporatingpopulationsegmentationbasedonbehavioralhealthriskassessment,isafoundationaltoolinpopulationhealthmanagement.
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ofinformationtospecificcaremanagementdecisions;andeffectivenessofcaremanagementstrategiesatboththeaggregateandindividuallevels.
PopulationSegmentationUsingBehavioralHealthRiskAssessment:TheFirstStepInPopulationHealthManagementStrategy
Populationsegmentationusingbehavioralhealthriskassessmentisanimportantstepinidentifyingpopulationhealthmanagementimprovementopportunities–andmatchingthepopulationtotheappropriateintervention.52Thisprocessusesavailabledatatoidentifyspecifichealthrisksforindividualsthatarelinkedtofuturespending.53
Simplemodelsforpopulationsegmentationinpopulationhealthmanagementprogramshavemostoftenuseddemographicsandself-reportedhealthstatusinformation.Moreadvancedmodelsincorporatediagnosesandmedicalconditions,treatmentandprescriptionutilization,and/orprevioushealthspendingpatterns–oftenfocusedexclusivelyonmedicalcare.54
Themanagementissueisthattheseriskstratificationmodelstypicallyunderestimatecostsofcareforindividualswithbehavioralhealthconditions,whileoverestimatingcostsofcareforindividualswithoutbehavioralhealthconditions.55Thisisasignificantbecausebehavioralhealthissuesarehighlyprevalent,complex,andcostly-andahighproportionofsuper-utilizerindividualshaveoneormorebehavioralhealthconditions.56Theseissuescanbeaddressedbymodifyingtraditionalriskstratificationmodelstoincludemorebehavioralhealthfactorstosupportimprovementsincostpredictions.57
Enhancedanalytictoolswhicharedesignedtoassessbehavioralhealthriskcanbeusedtoaddresstheeffectsofbehavioralhealthconditionsonindividualhealthoutcomesandspending.Intheseadvancedapproaches,additionalcharacteristicsofindividuals–suchasprimaryandsecondarydiagnoses,mentalillnessseverity,medicalconditions,ethnicity/minoritystatus,language,andsocio-economicstatus(loweducation,lowerincome,homelessness,unemployment,etc.)–canbeincorporated.58,59
Summary
Forpopulationhealthmanagementstrategiestobemosteffective,populationsegmentationiscriticaltomatchingindividualstohealthmanagementsupports.Whileahighproportionofsuper-utilizershavebehavioralhealthdisorders,thepopulationhealthmodelsdevelopedformedicalcaredonotsufficientlyexplainthevarianceintotalhealthcarecostsforpopulationswithbehavioralhealthconditionssincemedicalmodelsdonotincorporatesufficientbehavioralhealthdata.Asaresult,traditionalmedicalmodelsunderestimatetotalhealthcarecostsforindividualswithbehavioralhealthconditions,andoverestimatecostsforthosewithoutthem.60Thiscanberesolvedbysupplementingtraditionalapproacheswithbehavioralhealthdatatoaccuratelyestimatetotalhealthcostsandidentifyindividualsmostat-riskforhighresourceutilizationandcosts.
Tomakepopulationhealthmanagementstrategiesforindividualswithbehavioralhealthdisordersmoreeffective,enhancedanalytictoolsfocusedonassessingbehavioralhealthriskmustbeusedtoaddresstheeffectsofbehavioralhealthconditionsonindividualhealthoutcomesandspending.
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V. CaseExampleOfBehavioralHealthRiskAssessmentInPopulationSegmentationInitiatives61
ThiscasestudydescribestheMissouriCommunityMentalHealthCenter(CMHC)HealthcareHomeModelexperience.
DefinitionofHealthHomes
InMarch2010,Section2703oftheAffordableCareAct(ACA)allowedstatestoamendtheirMedicaidstateplanstoprovideHealthHomesforenrolleeswithchronicconditions,creatingtheopportunityfortheMissouriCMHCmodel.TheHealthHomemodelprovideshealthservices,preventiveandhealthpromotionservices,andmentalhealthandsubstanceabuseservicestoindividualswithchronicconditionsusingawholepersonapproach.Ideally,thehealthhomeachievespopulationmanagementthroughcomprehensivecaremanagement,empowermentoftheindividual,team-basedcare,andpromotionofwellnessandhealthylifestyles.
MissouriHealthcareHomePurpose,PhilosophyandApproach
MissourichosetoestablishCMHCHealthcareHomesafterrecognizingthatindividualswithmentalhealthconditionstendtohavehigherhealthcarecostsduetocomorbidphysicalhealthconditions.Theyconcludedthat,inadditiontobehavioralhealthneeds,otherhealthcareissuesmustbeaddressedinordertoimproveoverallwholepersonhealthwhilereducinghealthcarecosts.Afteridentifyingthatleadingcontributorstopoorhealthoutcomesandhighercostswerepreventablecauses,MissourichosetocreatetheCMHCHealthcareHomestoaddressgeneralhealthissues,wellness,andpreventionalongwithbehavioralhealthissues.Thegoalwastoimprovenotonlyhealthoutcomes,butthequalityofcare.
StateofMissouriHealthHomeInitiatives
In2011,MissouriwasthefirststateinthenationtoreceiveapprovalofaMedicaidStatePlanAmendment(SPA)establishingHealthHomesunderSection2703oftheAffordableCareAct.MissourihastwotypesofHealthcareHomes:PrimaryCareHealthHomesandCMHCHealthcareHomes.EffectiveJanuary2012,Missouriauto-enrolled17,882individualsinto28CMHCHealthcareHomes(thesubjectofthiscasestudy).Thesehealthhomesreceivedan$80.31permemberpermonthreimbursement(PMPM).
TargetPopulations,CharacteristicsAndCostsOfIndividualsEnrolledInMissouriHealthcareHomes
Missouri’sCMHCHealthcareHomestargetedindividualswithmentalillness,substanceusedisorders,andchronichealthconditionsincludingdiabetes,cardiovasculardisease,COPD/asthma,overweight(BMI>25),tobaccouse,anddevelopmentaldisability.Thefollowingshowstargetpopulationbycondition:
TheMissouriteamobservedtheleadingcontributorstopoorhealthoutcomesandhighercostswerepreventablecauses
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• 89%haveaseriousmentalillnesso 36%withMajorDepressiono 30%withSchizophreniao 28%withBipolarDisordero 16%withPostTraumaticStressDisorder
• ~25%withCOPD/Asthma• >than25%withDiabetes• 35%withHypertension• 81%withaBMI>25• Atleast50%reportsmoking• ~50%ofadultshaveahistoryofsubstanceabuse
TheImportanceOfPopulationHealthManagementInTheCMHCHealthcareHomeSetting
PriortotheACA,Missourihadidentifiedpopulationhealthmanagement,expandedservicesforindividualslivingwithbehavioralconditions,andtheintegrationofbehavioralandphysicalhealthcareasimportanttoimprovinghealthcareoutcomesandcosts.Theyinitiatedkeystepstobettersegmentandservehigh-riskpopulationsthroughtheuseoftechnology,aswellasastructuredapproachtocareintegrationandcoordination,whichbecamethefoundationforwhattheyidentifiedasthenextlogicalstep–theMissouriCMHCHealthcareHome.
SuccessFactors,Technology,Metrics,andReports
Byincorporatingtechnologythatallowedcareteamstotakea360-degreeapproachtomembercareanddecisionmaking,consideringsocialservicesandsupportsinadditiontomedicalandbehavioralhealthneeds,careteamsareabletoidentifythehigh-riskindividuals.Monthlyreportsallowcaremanagersto“flag”individualsandprioritizeappropriateinterventions.Onanindividuallevel,someinterventionsmayberequiredtoaddressimminentlyharmfulneeds.Onanaggregatelevel,selectinterventionsmayimpactthecareofalargerpopulation.TechnologythroughouttheCMHCHealthcareHomesenabledprovidersandcareteamstoaccessaweb-basedMedicaiddatasystemwhichincluded:
• patienthistoriesbasedonMedicaidclaims;• ametabolicscreeningdatabase;• caremanagementreportsbasedonpaidMedicaidclaimsdata;• medicationadherencereports;and,• behavioralhealthpharmacymanagementreports.
Withoutintegration,careteamswouldnothavehadaccesstocompletecarerecords.Thedisparatedatafrommultiplesourceswouldhavepreventedtheteam’sabilitytoaccuratelyidentifytheindividualsandpopulationsconsideredhigh-risk.
ImpactofCMHCHealthHomes
ThecombinationofinnovativeprogramswithenablingtechnologyresultedinatotalMedicaidcostsavingsof$2.4million.Morethanjustcostsavings,theintegratedapproachresultedinbettercare:62
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• Overallimprovementinhospitalfollow-upafterdischarge(upfrom33%to66%ofallhospitaldischarges)
• Overallimprovementinmedicationreconciliationonhospitaldischarge(upfromapproximately25%to60%ofallhospitaldischarges)
• Reductionof12.8%inhospitaladmissions/1000• Reductionof8.2%inemergencydepartmentvisits/1000• ImprovementinmedicationsbeingfilledbyindividualsintheCMHChealthhomes,when
comparedtothestateoverall(asdeterminedbyamedicationpossessionratioofatleast80%inthequartersbeingevaluated).Between80-84%ofindividualsintheCMHChealthhomesareadherentbasedonthiscriterion.
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VI. References
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