Pennsylvania Medicaid Project Improves Care for SMI Population
Mental Health Weekly October 8, 2012
As states continue to struggle to find ways to cut costs and improve the quality of care for Medicaid beneficiaries with serious mental and physical health care needs, a Pennsylvania-based integrated care pilot program for adult Medicaid beneficiaries with serious mental illness (SMI) and co-occurring physical health conditions has resulted in the reduction of inpatient hospital admissions and emergency room visits.
The Serious Mental Illness (SMI) Innovations Project is a two-year pilot, which commenced in 2009, with the goal to improve quality and decrease spending for high-need, high cost Medicaid beneficiaries. The project is part of a national initiative, “Rethinking Care Program,” coordinated by the Center for Health Care Strategies (CHCS), a nonprofit health
policy resource center with support from Kaiser Permanente.
The program included two pilots in the Southeastern and Southwestern parts of the state. Each pilot was a collaboration between physical health managed care organizations, behavioral health managed care organizations, and county behavioral health offices. The partners in each region designed their own programs, guided by a common framework of key elements of an integrated system of physical and behavioral health care, and developed by the Pennsylvania Department of Public Welfare (DPW).
“The state gave us the flexibility to develop unique programming to each county, based on our population and local needs, to design our program as long we met the pillars set forth in the initiative by the DPW: provider engagement and medical home, data management, coordination of hospital discharge, pharmacy management, appropriate emergency use for behavioral health treatment, and alcohol and substance abuse treatment,” said LeeAnn Moyer,
deputy administrator for the Montgomery Office of Behavioral Health, who participated in the Southeastern region pilot.
The Montgomery partnership in the Southeast region includes Bucks County, Delaware County and Montgomery
County, Keystone Mercy Health Plan, and Magellan Behavioral Health of Pennsylvania, Inc., said Moyer. “The five of us developed an innovative approach for consumers with serious mental illness who have high chronic comorbid physical
health conditions,” Moyer told MHW.
Their partnership was referred to “Healthy Choices, Healthy Connections [HCHC],” she added. Partnership members work with five of the Southeastern county’s largest behavioral health agencies - Central Montgomery MH/MR, Creative
Health, Abington Hospital, Penn Foundation, and Northwestern Human Services of Montgomery County - developed Wellness Recovery Teams to work with high-risk individuals, she said. The teams included an RN and a behavioral
health clinician. “They delivered services to our at-risk members as identified through our plans,” said Moyer.
Overall, the county had between 900-1,000 participants in the two-year pilot in Montgomery County, Moyer said. The following outcomes represent a smaller study county officials conducted with 150 program participants:
• 11 percent reductions in emergency room usage.
• 56 percent reduction in physical health inpatient admission.
• 43 percent reduction in mental health inpatient admission.
Additionally, consumer satisfaction teams of peers (Hope Works) conducted participant satisfaction surveys. The results from the 94 percent of participants who responded to the survey felt the services were effective, she said. Additionally, 83 percent said they had a better understanding of their medications, said Moyer.
Moyer, who attended the Medicaid Managed Care conference on Oct. 4-5 in Washington, D.C., noted that the one of the speakers, Barbara Edwards, director of Disabled & Elderly Health Programs Group, Center for Medicaid and CHIP Services, discussed how plans need to expand long-term support services, (i.e., respite programs), and address
the needs of the SMI population with improved integrated care.
“Edwards said the essential supports and support services are helping to keep consumers with higher level of care needs out of hospitals and emergency rooms, which is what our program, Pennsylvania’s (SMI) Innovations Project shows,” said Moyer. Meanwhile, the county is currently working with Keystone Health as a partner and is looking to expand with other health plans in the Southeast region that are not currently involved in the project, said Moyer.
An evaluation of the SMI Innovations Project by Mathematica Policy Research revealed that although outcomes
varied across the two regions, both pilots were successful at reducing the rate of mental health hospitalizations,
all cause readmissions and emergency department visits.