To address quality issues and potentially reduce spending in the long term, some state Medicaid programs are creating programs to integrate physical and behavioral health services. Studies show that chronically ill patients with behavioral comorbidities, such as substance abuse or mental health problems, tend to experience significantly higher medical costs than those without, and that treating these mental health and substance abuse issues can lower health care costs for these patients overall.[1] One established program, the Washington Medicaid Integration Partnership (WMIP), has already documented success.
Washington State defines service integration as "bringing different Medicaid-funded health care services together in a coordinated, client-centered framework" to improve patient services and satisfaction.[2] The WMIP is a demonstration project that began in January 2005 and is currently serving 2,700 Medicaid enrollees who are eligible for supplemental security income (SSI) in Snohomish County.[3] The goal of WMIP is to integrate managed care services in mental health, drug and chemical dependency treatment, and medical care.
A recent evaluation conducted by the Department of Social and Health Services (DSHS), with support from the Center for Health Care Strategies, found that 40 percent of patients included in this demonstration felt their care was better coordinated than before enrolling with WMIP's managed care contractor, Molina Healthcare of Washington. In addition, 24 percent reported that services provided by the health plan improved in that there were fewer delays while waiting for approval for care, shorter waiting times for appointments for routine care, and better customer service and less paperwork. It should be noted that 7 percent of clients thought their care coordination had declined. Levels of reported satisfaction with Molina were lower in terms of accessing assistance by phone during office hours, getting help for an injury or condition that required immediate care, and prescription drug coverage.
DSHS estimates that the state reaps significant savings from integrating services. A recent DSHS study found that, by integrating mental health treatment with medical care, up to 50 percent of the cost of such treatment was offset. Adding psychotropic medication into the mix offset costs by up to 64 percent.[4]
According to Alice Lind, WMIP program manager, there has been some interest by other counties in becoming demonstration sites, based on the success in Snohomish County. Additional counties may be added in 2008.
References
[1] Olfson, M., et al., Mental Health/Medical Care Offsets: Opportunities for Managed Care, Health Affairs March/April 1999, 18:2.
[2] Innovative Medicaid Integration Pilot Project Shows Improvement Over Two Years, DSHS press release, January 26, 2007.
[3] The demonstration is budgeted to enroll up to 6,000 individuals. Outreach efforts are being conducted to increase enrollment, including auto-enrollment and mailings to dual Medicaid-Medicare eligibles.
[4] "Integration of Medicaid Services to Improve Health Outcomes," DSHS Fact Sheet, January 2007.
