Mental Health Initiatives

For Unfunded People

Delia Rochon

Community Benefit – Mental Health

November 2008

Co-location of Services

Pharmacy Percentage of patients refilling medications improved from 75 – 99%

(Midtown Clinic)

99% of patients pick up Rx’s when prescribed at on-site pharmacy (4th Street Clinic)

Coordination of psychotherapy and psychotropic medication on site (Doctors’ Volunteer Clinic)

Funding for Unfunded People

Historically, CMHC could use efficiencies in their Medicaid operations to extend services to unfunded or under-funded clients including IP service

In 2004, this practice was disallowed, and all Medicaid funds needed to be expended on Medicaid clients only

Funding for Unfunded People

Utah’s mental health system lost access to over $7 million in federal fund that had been available to provide services to non-Medicaid population.

Thousands of Utah residents were unable to access to services because they did not meet the requirements to qualify for Medicaid, increasing the service gap for uninsured and underinsured population.

Uninsured Utah Adults In Need of Mental Health Treatment

1 Adults in Utah

1,748,321

2 Number of adults without insurance

290,221

3

The number of uninsured Utah adults who have serious psychological distress and need treatment according to a national survey (11.95%)

34,681

4 48% receive some services: ER visits, health clinics, etc 16,6475 52% do not receive any treatment at all 18,034

DSAMH 2006 Report

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2000 2001 2002 2003 2004 2005

Number of Cases Presenting at ER

Number of Cases Admitted

Cases Presenting & Admitted Totals 2000 - 2005

Behavioral Health - UHA 2006 Report

$-

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

2000 2001 2002 2003 2004 2005

Uncompensated Care Presenting to ER

Uncompensated Care Admitted

Behavioral Health - UHA 2006 Report

Uncompensated Care Totals 2000 - 2005

Strategies to Increase Capacity and Quality of Mental Health Care

Identify and/or establish partnerships between community clinics and healthcare facilities to provide transitional care to discharged patient needing follow up

Identify innovative strategies to provide mental health care in cost effective settings

Document processes, evaluate, and share results

Partnerships

Midtown Clinic, McKay-Dee Hospital, Weber HS

4th Street Clinic, LDS Hospital, Valley Mental Health

Wasatch Mental Health, Utah Valley Regional Hospital

Central Utah Counseling Center, Sanpete Valley Hospital, Gunnison Hospital

Doctors’ Volunteer Clinic, Dixie Regional

NAMI, Salt Lake County, Health Clinics of Utah, Midvale Family Health Clinic , State Division of Mental Health, University of Utah

Best Practices

Case management

On-site eligibility coordinator

Co-location of services

Timely follow up care

Documentation of processes, measurement/evaluation

Co-location of Services

Primary Care Universal screening of all health care patients for mental health care

needs has been implemented, and mental health care has been assigned according to the severity of symptoms. (Whole Health Project)

Close collaboration between medical providers, mental health providers and pharmacy staff. (4th Street Clinic)

Integrated mental health and primary care services. (Doctors’ Volunteer Clinic)

Timely Follow Up Care

Patients seen within 48 hours after first call (4th Street Clinic)

Patients seen within a week from discharged: 82% of patients discharged from IP receive follow up care at the clinic 48% of patients discharged from ER receive follow up care at the clinic

(Doctors’ Volunteer Clinic)

Documentation of Processes

Wellness Recovery Clinic (WRC)UVRMC Transition Liaison- Pilot Project

Inpatient Nurse Manager &Unit Secretary notified

WRC/Inpatient Liaison (WRCCase Manager) notified of

eligible patientsRegular Inpatient

protocols & procedures

Regular Inpatientprotocols & procedures

Test Group(Cont. on Page 2)

Control Group(Cont. on Page 2)

Yes No

NoYes

Preliminary screen for program eligibility 1. Unfunded? 2. Resident of Utah County

WRC Case Managerrandomly assigns to

Test Group orControl Group

WRC Case manager screens for WRC eligibility -Diagnosis? -Not primarily substance abuse -200% of poverty level or below

Unfunded patient admitted to UVRMC Inpatient Unit

Collaboration on Medical & Psychiatric

Collab

oration on

Med

ical &

Psych

iatric

Measurement/evaluation

Health outcomes Consistent use of evaluation tools such as OQ-45, PHQ9, Clinical Global

Impressions Scale

Recidivism

Cost-effectiveness