Integrated Healthcare in Indiana: Impact on Cost

1. Integrated Healthcare in Indiana: Impact on Cost Dr. Lynn Bradford, PhD, HSPP Director of Behavioral Health

2. HealthNet Integrated Care • 1228 RIDs Examined after 5 Statistically Extreme Outliers were Removed • All Visit Types are Included • Pharmacy is Excluded

3. Midtown and North Shore Integrated Care • 68 RIDs Examined after 2 Statistically Extreme Outliers were Removed • All Visit Types are Included • Pharmacy is Excluded

4. Other Cost Data on Impact of Integrated Care Intermountain Healthcare

5. Intermountain Healthcare: Mental Health Integration Program Based in Salt Lake City Utah , nonprofit integrated delivery system Program has been in existence for 10 years Team-based, includes PCP’s and their staff Integrated with BH professionals, community resources, care management, and the patient and family Reiss-Brennan, B.; Briot, Pascal C.; Savitz, Lucy A.; Cannon, Wayne (2010). Cost and Quality Impact of Intermountain’s Mental Health Integration Program. Journal of Healthcare Management. 55:2, 98-113

6. Intermountain Healthcare: Mental Health Integration Program Program is implemented at the clinic level and integrates BH care as part of routine primary care Evidenced-based, team –oriented care process Provides social and medical infrastructure for managing the complexity of chronic disease Designed to fill the care gap between what patients and families should receive and the care they actually receive

7. Intermountain Healthcare: Mental Health Integration Program Program promotes 3 primary care practice changes: improve the detection, monitoring, stratification, and management of depression and other mental health conditions reinforce ongoing relational contact with patients and their families to promote adherence and self-management match and adjust treatment and management interventions if there is complexity and inadequate response

8. Intermountain Healthcare: Mental Health Integration Program Data on Impact of the program on patient utilization and insurance cost of medical services In the 12 months after a patient was diagnosed with depression, cost of care increased in 73% an integrated clinic; in comparison, the cost of care increased 100% in the usual care clinic For patients with complex cases, cost of care increased 8% in an integrated clinic and 90% in a usual care clinic Patients in an integrated clinic had lower utilization of ER services Their results strongly suggest that integrated care provides greater access to needed care and reduces cost

9. Other Cost Data on the Impact of Integrated Care County Medical Services Program Indigent Adults in Rural California

10. County Medical Services Programwww.ibhp.org (Integrated Behavioral Health Project) February 2011 report on outcomes from the Behavioral Health Pilot Project 2008-October 2010 Served 2339 participants, 1313 in the evaluation study cohort

11. County Medical Services Program 56.6% reduction in number of inpatient psychiatric days per thousand for pilot group Control group had a 71.4% increase in inpatient psychiatric days per thousand Pilot and control groups had the same decrease in medical admissions but the number of psychiatric admissions decreased 57.9% for the pilot group compared to 22.4% for the controls

12. County Medical Services Program Inpatient PMPM costs decreased 37.1% for the pilot group and increased 6.6% for the control group On a PMPM basis, ER visits decreased 12.3% for the pilot group and increased for the control group 7.8% Rate of growth in costs was roughly the same for both groups during the study period Total medical costs were lower for pilot participants

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