In modern medicine, physical health and mental health are often on two separate tracks while seeking treatment and health insurance reimbursement. And it becomes difficult to maintain your physical health while you are suffering mental health issues.
So, some Medicaid programs are trying to blend the coordination of care for patients with both physical and mental health issues, hoping that it might help save money and lives.
Tennessee’s Medicaid program, aka TennCare, has over 100,000 patients who have both physical and mental health issues. They have had a psychiatric inpatient, along with an official mental health diagnosis such as depression or alcohol addiction. Their mental health condition might be treatable with medication and counseling, but without those treatments, their physical health is holding back.
Psychiatrist and internist with Cartesian Solutions in Minneapolis Roger Kathol said, “They’re high-use patients. They’re not necessarily high-need patients.” He consults with hospitals and healthcare plans that have been trying to integrate both physical and mental care.
Kathol explained, “So, essentially, they don’t get better either behaviorally or medically, because their untreated behavioral health illness continues to prevent them from following through on the medical recommendations.”
For instance, your high blood pressure will never be managed or controlled if your active addiction keeps you from taking the necessary medication.
However, coordinating mental and physical care presents some business challenges because two different entities pay the bills within Medicaid programs. For these reasons, TennCare has started offering incentives to reward teamwork.
In December 2016, TennCare’s interdisciplinary program, aka Tennessee Health Link, was launched, which paid out more than $7 million in bonuses to mental health providers who helped patients in care associated with their physical health as well.
Mental health providers are eligible for up to 25 percent of what is calculated as the savings to the Medicaid program.
According to several studies, this type of coordination care could help TennCare to save hundreds of dollars per patient, every year. While there is a strong financial saving with coordination care, it could also help in saving lives. In addition, some studies have found that patients who receive both mental and physical care tend to die young. Director of health care innovation at Centerstone Mandi Ryan said, “They’re not dying from behavioral health problems. They’re dying from a lack of preventive care on the medical side.”