MissouriMissouri

Health 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 Homes

Missouri’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 Homes

Why 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 28.628.422.821.7

16.511.511.1

6.3 5.9

0

20

40

60

80

Pe

rce

nt

Me

mb

ers 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 Homes

Expectations: 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%COPDCOPD

34%34%AsthmaAsthma

32%32%DiabetesDiabetes

11%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 annualized

o $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 Homes

Questions?Questions?

Website: www.dmh.mo.govClick on Healthcare Home link