Contact: Kara Gavin, [email protected], 734-764-2220
Treating the whole person:
U-M Health System, Washtenaw County launch nation's first program linking mental health, physical health for Medicaid and indigent patients
ANN ARBOR, Mich. - In a pioneering effort to bridge the chasm between mental and physical health care for Medicaid recipients and indigent patients, the University of Michigan Health System and Washtenaw County Board of Commissioners have launched a new program that may become a model for the state and the nation to follow.
The $50 million program, called the Washtenaw Community Health Organization, aims to streamline care for thousands of local residents through improved coordination. It brings together the Health System's medical and psychiatric services, and the mental health and substance abuse services provided by Washtenaw Community Mental Health.
The new system will attempt to overcome the current disconnect between mental and physical health care providers. It will make it easier and more cost-effective for persons with a mental illness, an addiction or a developmental disability to receive primary and specialty care at U-M facilities for their medical problems. It will also help U-M patients who qualify for CMH services to get treatment for mental health problems.
"This initiative addresses an immediate, dire need for better and more seamless care for those who often fall between the cracks in the public health care system," says Gilbert S. Omenn, M.D., Ph.D., U-M executive vice president for medical affairs and CEO of the Health System. "At the same time, it satisfies the state's desire to improve choices for consumers and change the way publicly funded mental health services are provided."
Washtenaw CMH director Kathy Reynolds adds, "This partnership brings together public institutions to take responsibility together for the taxpayer dollars that help some of our county's most vulnerable people. We hope to show that the health care system can see these consumers as 'whole people,' and care for them in a way that makes more sense for everyone."
And, says David Neal, M.S.W., head of the Social Work in Psychiatry division of the Psychiatry Department in the U-M Medical School, "if it can work in Washtenaw County, it can work anywhere where medical and behavioral health providers have the will to join hands."
By bridging the gap between physical and mental health for public consumers, the new initiative aims to overcome a separation that has grown in the years since state-funded mental health services moved from inpatient institutions with their own physical health infrastructure, to community-based programs coordinated by county CMH organizations.
The project takes on the tendency of providers to "cost shift," or steer indigent consumers to other services rather than bearing the cost of care themselves. This practice has caused some people to avoid seeking treatment for fear of red tape, causing their problems to worsen. A lack of coordination between providers has also allowed conflicts to arise between care decisions.
The new system will tie together CMH and UMHS services with a single path to information, appointments and referrals. It will try to win the trust and cooperation of consumers by maintaining their relationships with their providers and improving customer service.
The project is made possible by legislation sponsored by state senators Beverly Hammerstrom (R-District 17) and Alma Wheeler Smith (D-District 18), and signed by Governor John Engler. It enables the formation of the Washtenaw Community Health Organization, to be founded and funded by UMHS and Washtenaw CMH as a new governmental entity.
"I was very pleased to introduce Senate Bill 1006 to help facilitate this wonderful collaboration of resources for the citizens of Washtenaw County," says Hammerstrom. "I have no doubt mental health consumers will benefit from this arrangement and that the U-M - Washtenaw CMH partnership will become a model for other communities."
The new organization will contract with the two partners for the services of existing staff, including unionized employees. Members of the U-M schools of social work, nursing and public health will also participate. A 12-member board will oversee the organization, with six members appointed by the county and six by the U-M. All were selected for their qualifications and interest in improving care; several are direct or indirect recipients of mental health services. A complete list is available on request.
The project's managed care structure fits well with the Michigan Department of Community Health's plan to fund mental health services in the same way it funds medical care by 2003. The state has already begun to reimburse mental health providers for services according to a fixed (capitated) fee structure, and will soon ask them to assume total risk for cost overruns while competing against both the public and private sectors to provide services.
Says Michigan Department of Community Health director James Haveman, "As our state proactively seeks to improve quality and access for public health consumers while containing costs, this innovative program will set an example for other community mental health boards throughout Michigan."
The U-M already covers about half of Washtenaw County's 11,000 Medicaid recipients through its non-profit M-CARE managed care plans, and another 126 under the MIChild program for underprivileged children. The Michigan Center for Diagnosis and Referral (M-CDR), part of the U-M Psychiatry Department, coordinates the Health System's mental health care admissions and referrals for these and other consumers. In addition, UMHS cares for about 1,000 indigent uninsured people each year through its Washtenaw Health Plan.
Though the U-M already provides both mental and physical care to many Medicaid and indigent consumers, there has been no way to coordinate that care, nor to ensure that consumers follow up on referrals to other services within or outside the Health System. The new program will allow Health System staff to track patients' use of U-M and county services through the online CareWeb patient information system. This may help reduce costs by allowing physicians in different systems to know what tests, medications and other treatments have already been provided to a patient by others.
Meanwhile, the Washtenaw CMH - one of Michigan's 49 CMHs - serves thousands of residents with mental illnesses, emotional disorders, developmental disabilities and substance abuse problems. Now, under the new program, physical health services may be made available on site at some of its community-based mental health service sites.
In addition to encouraging providers to communicate, improving patient access and care, and containing costs, the new project will allow U-M researchers to study what works and what doesn't when it comes to caring for this population.
Says medical director Tom Carli, M.D., clinical associate professor of psychiatry at the U-M, director of the M-CDR and director of the UMHS Medical Management Center, "This will make it easier to find the best ways to improve care while containing costs. We'll be able to analyze the cost of medications, look at how well certain therapies work, examine connections between mental and physical conditions, and determine which diseases and disorders have the highest treatment costs and opportunities for better management."
###
RSS