The report “Financing and Policy Considerations for Medicaid Health Homes for Individuals with Behavioral Health Conditions” indicates that individuals when faced with serious mental illness and have limited financial means are at a higher risk for premature death.
This is due in part to limited access to quality primary care and their reliance on emergency departments as a primary source of care. The report was developed for the SAMSHA-HRSA Center for Integrated Health Solutions by Health Management Associates.
Also, according to recent state studies, Medicaid beneficiaries with mental health illnesses have higher rates of co-occurring physical health conditions resulting in higher total Medicaid costs. For the past two decades, Medicaid programs have become an important payer of behavioral health services. Nationally, Medicaid is the single largest payer for mental health services in the U.S. and the nation’s largest purchaser of antipsychotic medications.
In July 2013, CMS approved Medicaid health homes in Alabama, Idaho, Iowa, Maine, Missouri, New York, North Carolina, Ohio, Oregon Rhode Island, Washington, and Wisconsin. Five of the states Missouri, New York, Ohio, Oregon and Rhode Island include serious and persistent mental health conditions or substance use disorders as eligible chronic conditions under their health home benefit.
Missouri uses CyberAccess, a web-based EMR to capture Medicaid claims data for the state’s Medicaid program referred to as MO HealthNet which is accessible to enrolled Medicaid providers that includes community mental health centers, primary care practices, and schools.
Currently CyberAccess offers claim encounter data, cardiac and diabetic risk calculators, chronic health condition awareness, a drug information library, an online tool to create a personal health plan, plus discussion lists to use with healthcare providers.
In Missouri, the state mental health authority provides monthly electronic monitoring reports going to each health home provider via a contracted data analytics contractor. The report enables health homes providers to know whether a patient’s care complies with the state’s expectations on clinical standards.
Reports are also available to community mental health center health homes on a monthly basis related to prescription drug adherence, behavioral health pharmacy management, and disease management.
Missouri’s community mental health organization health homes also receive health utilization profiles from the state for the Medicaid fee-for-service population and information from the two Medicaid managed care organizations operating in the state.
Health homes providers are also slated to receive limited information on historic utilization and medication reconciliation. The community mental health organizations and other entities serving as health home providers are also exploring the capabilities of the state’s HIE called CurrentCare to obtain hospital admission and discharge transfer data, lab results, and filled prescriptions.
The state is still progressing towards optimal adoption of HIT capabilities as the CurrentCare HIE platform will continue to deploy HIT capabilities to support the state’s health home programs.
To view the complete report, go to www.integration.samhsa.gov/integrated-care models/Health_Homes_Financing_and_Policy_Considerations.pdf.