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Fragmented care leads to higher costs

Maine study examines costs associated with behavioral health disorders

A complex conditions project in Maine has found that behavioral health disorders have as much impact on medical costs as having three chronic medical conditions and that fragmentation of care leads to higher overall costs.

Details of the Maine Multiple Complex Conditions Project (MMCCP) were shared during a presentation at a one-day conference held by Maine Quality Counts in April for healthcare stakeholders.

[See also: Integrating primary care and behavioral health offers opportunities]

The MMCCP, done in partnership with the Maine Department of Health and Human Services and the University of Southern Maine Muskie School, studied more than 63,000 long-term Medicaid members in Maine. Nearly half of the cohort (48.9 percent) has a behavioral health disorder.

"One of the misperceptions with the behavioral health group is that the cost to the system is more associated with behavioral health costs," said Leticia Huttman, recovery manager of the state's Office of Substance Abuse and Mental Health Services. But what the researchers found, she said, was that most of the expenditures for Medicaid beneficiaries with behavioral health disorders and medical co-morbidities were for the medical, not the behavioral health, services.

"The impact on medical cost was really the same has having three chronic medical conditions," she said.

And fragmented care, particularly fragmented primary care, adds to those costs.

[See also: Colorado pilot tests payment model to make behavioral health-primary care integration financially viable]

"Fragmented care is a major driver of cost and complications," said John Devlin, MD, associate professor at Tufts University School of Medicine and director of the diabetes center at Mercy Hospital in Portland, Maine.

The study found a 25 percent increase in medical costs for beneficiaries receiving fragmented care and 16 percent more visits to the emergency department with fragmented primary care.

To improve health outcomes and control costs in patients with behavioral health disorders and chronic medical conditions, the researchers concluded, it is imperative to have physician-directed continuity of care.

Getting that sort of continuity of care between the behavioral health and primary care worlds is not an easy task, though, said Benjamin Crocker, MD, medical director of APS Healthcare, a healthcare solutions provider with a contract with Maine's DHHS.

The disconnect between primary care and behavioral health often means duplication of services for a single patient and a lack of communication about treatment plans, said Crocker.

"As long as we have this fee-for-service system … where, basically, if you show up you're expected to see X number of patients and get the documentation done so the lights are on, doing the integrated work often really feels like its coming out of your hide. … it often just doesn't get done," he said.

Crocker said to eliminate the care fragmentation between primary care and behavioral health, particular staff people should be designated to make the communication happen and that co-locating the practices would better facilitate communication and sharing of resources.

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