Integrating mental and physical health care lowers cost in pilot project

    A Pennsylvania pilot project has found that integrating mental and physical health care can help reduce emergency room visits and healthcare costs for Medicaid patients.

    Medicaid patients who have chronic health issues such as diabetes and serious mental health issues have some of the highest rates of ER visits and healthcare costs.


    The two-year pilot program called Serious Mental Illness (SMI) Innovations Project, sought to reduce those numbers by connecting and integrating mental and physical healthcare — two services that are usually doled out in separate silos.

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    “Previously, staff in the behavioral health agencies only had the behavioral health information for these individuals,” said Allison Hamblin of the Center for Healthcare Strategies, who helped facilitate the pilot project. “And now they were getting a full slate of information on their medical diagnoses, contacts for their medical providers and a snapshot of the services these consumers used.”

    One thousand people participated in Southeastern Pennsylvania, granting their behavioral health providers this access to their other medical records. They also had a personal care coordinator who kept all of the info straight, and looked out for potential problems such as drug interactions.

    David Kelley, Chief Medical Officer for Pennsylvania’s Office of Medical Assistance Programs, said the care coordinators helped inform patients figure out when they really needed to go to the emergency room. He added that when appropriate, they also helped them to see their regular provider, instead of using the emergency room.

    Allison Hamblin gave another example of how this integrated care model works. If a person who has schizophrenia is hospitalized for a serious heart condition, it is quite possible that hospital staff will notice the mental illness and start administering medications for that as well — but not using the same drugs the patient was previously taking.

    “That individual given everything that is going on may not even realize that their medication has been changed,” said Hamblin, “and with this program there is now an accountable person, with this navigator, who can recognize this medication situation.”

    Hamblin says medication switches are common and often result in severe mental health problems and hospitalizations.She says the study found double-digit reductions in ER visits, healthcare costs and re-admissions to hospitals.

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