Integrating Health Care for High-Need Medicaid Beneficiaries With Serious Mental Illness and Chronic Physical Health Conditions at Managed Care, Provider, and Consumer Levels

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Objective: Policies supporting value-based care and alternative payment models, notably in the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act of 2015, offer hope to advance care integration for individuals with behavioral and chronic physical health conditions. The potential for integration to improve quality while managing costs for individuals with high needs, coupled with the remaining financial, operational, and policy challenges, underscores a need for continued discussion of integration programs’ preliminary outcomes and lessons. The authors describe the early efforts of the HealthChoices HealthConnections pilot program for adult Medicaid beneficiaries with serious mental illness and co-occurring chronic conditions, which used a navigator model in 3 southeastern Pennsylvania counties. Method: The authors conducted a difference-in-differences analysis of emergency department (ED) visits, hospitalizations, and readmissions using Medicaid claims data and collected data about program implementation. Results: ED visits decreased 4% among study group members (n = 4,788) while increasing almost 6% in the comparison group (n = 7,039) during the intervention period (p = .036); there were no statistically significant differences in hospitalizations or readmissions. This pilot demonstrated the promise of nurse navigators (care managers) to bridge gaps between the physical and mental health care systems, and the success of a private-public partnership developing a member profile to share behavioral and physical health information in the absence of an interoperable health information technology system. Conclusions and Implications for Practice: The implementation lessons can inform state Medicaid Health Home models as well as accountable care organizations considering incorporation of behavioral health care.

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