Modern Medicaid Alliance Featured Medicaid Solution: Missouri Community Mental Health Center (CMHC) Healthcare Homes Program
A 2011 report commissioned by the National Association of State Mental Health Program Directors revealing that adults suffering from a serious mental illness were dying, on average, 25 years earlier than the general population. According to estimates, 70 percent of individuals dealing with a significant mental disorder or substance abuse disorder have at least one chronic health condition, 45 percent have two, and nearly 30 percent have three or more – each prevalence far exceeds that in the general population.3State of Missouri health and Medicaid officials were concerned about this important issue of premature, yet preventable mortality and decided to pursue a collaborative solution that could positively impact Missouri state residents suffering from serious mental illness.
The solution implemented – called the Missouri community Mental Health Center (CMHC) Health Home Program – sought to deliver integrated mental health care – as well as care for various other chronic health conditions – through the state’s 29 community mental health centers to state residents living with serious mental illness.
As of January 2016, more than 24,000 adults, seniors and children served by Medicaid were enrolled at 120 partner sites (e.g., independent CMHCs, hospital-owned centers and federally qualified health centers) across the program’s 29 community mental health centers, which are functioning as “health homes”. All enrolled adults have a serious mental illness, and children and youths enrolled in the program have a serious emotional disorder.
The Missouri CMHC Healthcare Homes Program has brought about dramatic improvements in care for individuals with serious mental illness through implementing and maintaining a multitude of care interventions, a pay-for-performance financing structure for participating providers, and data sharing across care and program partners. In addition to carrying out traditional behavioral health case management activities, each program location has primary care nurse liaisons on site to help educate behavioral health staff about general medical issues and train case managers in recognizing and managing chronic medical conditions. Case managers can provide services such as assisting with medication adherence, scheduling appointments, obtaining a primary care provider, and they coordinate care across providers and between clinic visits on behalf of the individuals they support.
In the first year of implementation, significant reductions in hospitalizations and emergency room visits as a result of the Missouri CMHC Health Home Program resulted in a reduction in health care costs per member and the program also achieved significantly improved clinical health outcomes for Medicaid beneficiaries with behavioral disorders. In addition to reducing hospital and emergency room visits by more than 30 percent, the program has dramatically increased the number of participants who are within the normal range for health measures relating to diabetes and cardiovascular disease and who are receiving screening for metabolic syndrome, and has maintained medication adherence rates for participants of about 85 percent throughout the course of the program.
For Missouri, Medicaid works.
“The program was set up for success because we went all in – it wasn’t a demonstration program and that allowed the state to make systemwide policy and regulatory changes relating to payment and billing for services, how we defined various services. We also had the healthcare providers and Medicaid in the room making decisions with us and we worked supported providers to ensure that they had what they needed to move the trend line steadily in the right direction.” – Dr. Joseph Parks, former Director of Missouri Division of Comprehensive Psychiatric Services, former Missouri Medicaid Director and current medical director at the National Council for Behavioral Health.