The Medicaid Transformation Project, which began last year by focusing on decreasing costs and improving outcomes in emergency care, has turned its attention to behavioral health challenges in the Medicaid population.
Twenty-eight health systems will drive the widespread use of new solutions for untreated depression, teen suicide, post-traumatic stress disorder and mental illness.
The Medicaid Transformation Project is led by AVIA, a network for health systems, and Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services, and founder and general partner of Town Hall Ventures.
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WHY THIS MATTERS
The national project is aimed at developing financially sustainable solutions to improve the health of underserved individuals and to save providers money.
Health systems spend an average of $23,400 more for Medicaid-eligible patients' acute behavioral needs than on other populations, according to the MTP.
In working together, health systems can look at, or create, digitally enabled care models that work and scale them across the entire population in a way that individual systems can't, said David Smith project executive for the Medicaid Transformation Project Executive, AVIA. Barriers for one system may have already been addressed by another.
"We'll identify key areas of opportunities by providers and look at, 'Where did we already solve for this in a patient engagement way?'" Smith said.
The project has so far analyzed more than 150 digital innovations in behavioral healthcare to create a shortlist of 11 solutions and current best practices. The health systems will evaluate and implement those solutions that can improve crisis intervention, school-based health services and care management.
"All of the participating health systems underwrite their involvement," Smith said.
Of the nearly 75 million Americans who rely on Medicaid: 10 million experienced a mental health illness as of 2016; about 35 percent of those with a serious mental illness are not receiving mental health treatment; and more than 25 percent of teens are impacted by at least mild symptoms of depression.
Untreated depression puts teens at a higher risk to die from suicide, misuse drugs or alcohol, do poorly in school, or to run away.
Serious mental illness leads to $193 billion in lost earnings in the United States annually and spending on Medicaid beneficiaries with mental health needs is nearly four times greater than for peer beneficiaries.
The MTP began in the summer of 2018. Its initiatives focus on four challenges: behavioral health, women and infant care, substance use disorder and avoidable emergency department visits.
Phase I's emergency department initiative included 20 health systems that looked at lowering unnecessary utilization, improving care at the point of discharge and connecting patients to the right resources with coordinated networks and social services.
"We have seen a handful of systems contract or currently deploy models; about 30 other instances where a health system has been able to link to a solution," Smith said. "Much of this work has to be malleable enough to address individual needs."
In just five months, participating health systems accelerated the development of 35 capabilities to enhance community care and reduce unnecessary emergency department visits, MTP said.
The project's next phase will focus on maternal and infant care, followed by substance and opioid use.
Barriers to implementation can include payment and regulatory challenges.
PwC Health Research Institute reported that CMS demonstrations could expand Medicaid reimbursements for inpatient and residential care, reduce visits to emergency departments and lead to a greater focus on community care options.
CMS has loosened restrictions on the Institution for Mental Diseases exclusion several times in recent years, with a current demonstration offering more flexibility, MTP said.
Historically, the exclusion has barred Medicaid from paying for treatment in mental health facilities with more than 16 bed, to prevent states from "warehousing" people in facilities using federal funds.
"As jarring as the national behavioral health statistics are, they only serve as the tip of the iceberg for the long-term consequences that we risk if we don't take wide-reaching, decisive action to address this crisis today," said Andy Slavitt, chair for the Medicaid Transformation Project, former Acting Administrator of CMS, and general partner at Town Hall Ventures. "Twenty-eight healthcare organizations have stepped up to proclaim with a singular, unmistakable voice that enough is enough. Within the next year, I expect dozens of new positive initiatives to launch. Within five to seven years, we could spark the transformation the country needs."
Medicaid Transformation Project Members include:
• Advocate-Aurora Health in Chicago and Wisconsin
• Baylor Scott & White Health in Dallas
• Dignity Health System in San Francisco
• Geisinger in Danville, Pennsylvania
• Providence St. Joseph Health in Renton, Washington
• Allina Health, Minneapolis
• Arkansas Children's Hospital, Little Rock, Arkansas
• Ballad Health, Johnson City, Tennessee
• BayCare Health System in Clearwater, Florida
• BJC Healthcare, St. Louis
• Boston Medical Center, Boston
• Carilion Clinic in Roanoke, Virginia
• Cedars-Sinai in Los Angeles
• Children's Hospital Colorado, Aurora, Colorado
• Children's Hospital of Wisconsin, Milwaukee
• Christiana Care Health System, Wilmington, Delaware
• Frederick Regional Health System, Frederick, Maryland
• Froedtert & the Medical College of Wisconsin, Milwaukee
• Henry Ford Health System, Detroit
• Jefferson Health, Philadelphia
• Memorial Hermann Health System, Houston
• Navicent Health, Macon, Georgia
• OSF HealthCare, Peoria, Illinois
• Presbyterian Healthcare Services, Albuquerque, New Mexico
• Rush University Medical Center, Chicago
• Spectrum Health, Grand Rapids, Michigan;
• University Hospitals, in Cleveland
• UVA Health System, Charlottesville, Virginia
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