Missouri Missouri Health Homes Health Homes Integrating Behavioral Health and Primary Care
Feb 09, 2016
MissouriMissouriHealth HomesHealth HomesIntegrating Behavioral Health
and Primary Care
• Missouri is the first state to amend its Medicaid state plan to implement Health Homes.• Statewide• 36,000 enrolled
• Missouri will have three types of Health Homeso Primary Care Chronic Conditions Health HomePrimary Care Chronic Conditions Health Home
• Federally Qualified Health Centers (FQHCs)• Rural Health Centers (RHCs)• Physician practices
o Community Mental Health Center Health HomeCommunity Mental Health Center Health Homeo Multi-Payer Person Centered Medical HomesMulti-Payer Person Centered Medical Homes
Paving the Way for Health HomesMissouri’s Health Missouri’s Health HomesHomes
• Because addressing behavioral health needs requires addressing other healthcare issues o Individuals with SMI, on average, die 25 years earlier than the
general population.o 60% of premature deaths in persons with schizophrenia are due
to medical conditions such as cardiovascular, pulmonary and infectious diseases.
o Second generation anti-psychotic medications are highly associated with weight gain, diabetes, dyslipidemia (abnormal cholesterol) and metabolic syndrome.
Paving the Way for Healthcare HomesWhy CMHC Healthcare Why CMHC Healthcare Homes?Homes?
Maine Study Results: Comparison of Maine Study Results: Comparison of
Health Disorders Between SMI & Health Disorders Between SMI &
Non-SMI GroupsNon-SMI Groups
59.4
33.9 30 28.628.422.821.716.511.511.1 6.3 5.9
0
20
40
60
80
Perc
ent M
embe
rs SMI (N=9224)Non-SMI …
PrinciplesPrinciples• Physical healthcare is a core
service for persons with SMI
• MH systems have a primary responsibility to ensure:oAccess to preventive healthcareoManagement and integration of medical
care
Cost Savings Analysis ofCost Savings Analysis ofCMHC Clients Enrolled in CCIPCMHC Clients Enrolled in CCIP
Healthcare HomesExpectations: Expectations: We can We can meet themmeet them
Initial PMPM Cost $1,556Expected PMPM Costw/o intervention $1,815
Actual PMPM Costfollowing enrollment w/ CMHC $1,504
Savings $21 million
CMHC Savings Off TrendCMHC Savings Off Trend
Category pre CMHC-CM post CMHC-CM Net Change Percent Change
Pharmacy $39,367,496 $30,154,143 ($9,213,352) -23.4%
General Hospital $23,140,172 $21,546,466 ($1,593,706) -6.9%
CMHC $35,378,951 $37,467,731 $2,088,780 5.9%
Other BH $463,069 $144,434 ($318,635) -68.8%
Clinic $3,549,715 $4,324,452 $774,738 21.8%
Overall $101,899,402 $93,637,226 ($8,262,176) -16.%
Total HealthCare Utilization Per User Per MonthTotal HealthCare Utilization Per User Per Month
Pre and Post Community Mental Health Case Management Pre and Post Community Mental Health Case Management
Months with case management initiated on month 24
CMHC Outcomes comparing CMHC Outcomes comparing admission to annual admission to annual
assessmentsassessments
• Independent Living increased by 33%• Vocational Activity increased by 44%• Legal Involvement decreased by 68%• Psychiatric Hospitalization decreased by 52%• Illegal Substance use decreased by 52%• IN ADDITION- Study shows CMHCs services
substantially decrease overall medical cost
Out Reach Target PopulationOut Reach Target Population
• $25,000 minimum cost for previous 12 months or risk predicted to have high cost
• A diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or recurrent major depression
• Not a consumer of public mental health system in previous 12 months
• Excluded nursing home, developmental disability, hospice and renal failure
• Average cost of group overover $50,000 $50,000 per yearper year
Analysis of Care Management
Physical Health DemographicPhysical Health Demographic
35%35%COPDCOPD34%34%AsthmaAsthma32%32%DiabetesDiabetes11%11%Congestive Heart Failure (CHF)Congestive Heart Failure (CHF)
Analysis of Care Management
Cost Savings Including Cost of Cost Savings Including Cost of InterventionIntervention
• 1298 clients enrolled for over 6 monthso $346 $346 PMPM actual actual cost savings
• $5.4 Million annualizedo $619 PMPM trended cost savings
• $9.6 Million annualized
DM 3700 Progress
Opportunities for Opportunities for Federal Policy Federal Policy ImprovementImprovement
• Push for Deeper Implementation of Parity• Assure that Essential and Benchmark Benefit
includes rehabilitation benefit parity• Allow Safety Net BH Providers access to 340B
pharmaceutical pricing• Prohibit States from not paying for a PC visit and
a BH visit on the same day• Include BH providers in Federal HIT funding
Paving the Way for Health HomesQuestions?Questions?
Website: www.dmh.mo.govClick on Healthcare Home link