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Healthcare Reform: Advancing the Business Case for Integrated Care

Healthcare Reform: Advancing the Business Case for Integrated Care. Co-Morbidity is the Rule Rather than the Exception.

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Healthcare Reform: Advancing the Business Case for Integrated Care

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  1. Healthcare Reform: Advancing the Business Case for Integrated Care

  2. Co-Morbidity is the Rule Rather than the Exception When mental and medical conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased costs. The pathways causing co-morbidity of mental and medical disorders are complex and bidirectional. Medical disorders may lead to mental ones, mental conditions may place a person at risk for medical disorders, etc. Models that integrate care to treat people with mental health and medical co-morbidities have proven effective. Despite their effectiveness, these models are not in widespread use. THE SYNTHESIS PROJECT, RWJ, FEBRUARY 2011 2

  3. Percentages of Adults with Mental Disorders and/or Medical Conditions National Comorbidity Survey Replication, 2001-2003 3

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  5. The Business Case • The Business Case for Bi-directional Integrated Care • Mental Health and Substance Use Services in Primary Care Settings and Primary Care and Specialty Mental Health and Substance Use Settings • Barbara Mauer and Dale Jarvis, June, 2010. • 3 versions….39 pages, 8 pages, 2 pages 5

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  7. The Business Case • Tool Kit for Promising Practices for Financing Integrated Care in the California Safety Net • by Dale Jarvis and John Freeman • June, 2011. 55 pages. • Jarvis and Freeman identify the top ten barriers to getting paid for integrative care, as well as strategies for overcoming these barriers. 7

  8. US Healthcare Payment System is a Disaster • A 1930s design developed to treat acute illness, although today 2/3 of health care costs are for chronic illness • Compensation for procedures (very profitable), but not for good diagnostic processes or primary care • Compensation for time or cost, but not for outcomes or value • Virtually no integration which is needed to properly diagnose complex diseases and treat patients with multiple chronic illnesses --Christianson, The Innovator’s Prescription 8

  9. The Wrong Business and Treatment Model “We waste a huge amount of money on the most nuttily cumbersome administrative system in the world.” --Christianson “The reason the system is a money drain is not that it’s so successful, but that it’s fragmented, disorganized, and inconsistent. It’s neglectful of low profit services like mental health care, geriatrics and primary care, and almost giddy in its overuse of high cost technology such as radiology imaging, brand name drugs, and many elective procedures.”--Atul Gawande . 9

  10. Two Major Drivers of Change • The Affordable Care Act (government as an accelerant) • Disruptive Innovation in the US Healthcare System (market forces) 10

  11. Barriers for Implementing Integrated Programs Integrated Claims Issues Information Summary • Initial Draft: August 23, 2011, Completed December 8, 2011 Same Day Billing • The CMHC’s have had great difficulty collecting if two or more services are billed on the same day. E&M Codes Billing • Those CMHC’s not affiliated with a hospital have had difficult collecting on E&M code billing. 11

  12. Barriers for Implementing Integrated Programs Recommendations of Integrated Models for Behavioral Healthcare organizations: • Initial Draft: August 23, 2011, Completed December 8, 2011 • The discussion focused primarily on how a Behavioral Healthcare organization can bring “in house” primary medical care services so that their clients can have the benefit of integrated care and “one stop shopping” for needed BH and Medical services. • 1. Behavioral Healthcare Organization and FQHC (OR) Physician Practice Partnership – • 2. CMHC Contract/Hire Medical Practitioner(s) to Provide Medical Care on Location (or) Create Separate Medical Clinic 12

  13. Using the Business Case to Create Change It is recommended that the Indiana Council/BHMI: • Work closely with representatives from Missouri and Rhode Island to promote the specialized medical homes in Indiana. • Work with OMPP and the 3 MCOs to determine total medical costs on our patients. With this data, we can prove that total medical costs can be reduced through innovative case management models. • Begin hot-spotting (see Gawande’s article on this topic) to identify clients who are excessive users of high cost medical services, the hospital, the emergency room, and expensive specialists. Develop special programs in order to promote integration, compliance, and wellness. 13

  14. Using the Business Case to Create Change It is recommended that the Indiana Council/BHMI: • Develop a task force to closely examine all of the grant opportunities coming out of the health reform bill, so as to be perched to seek these grants either individually or through regional consortiums of mental health centers. • Utilize our 4 SAMHSA grant programs (Centerstone, Adult and Child, Mid-Town, and Regional) to take lead in promoting specialized integrated health facilities that are funded by Medicaid and insurance. • Work with all of the major primary care groups throughout Indiana to promote onsite integration of our therapists and case managers in their primary care health homes. 14

  15. Using the Business Case to Create Change • . 15

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