Safety net clinics look to integrate mental health services
11/20/2013 6:00 PM
08/08/2014 10:20 AM
For many area safety net clinics, the next big step in delivering care is to integrate medical and behavioral health services.
One way to do that is through the creation of Medicaid-funded health homes.
“A health home is not so much a place as it is a concept of care delivery,” said Matthew Schmidt, executive director of Health Ministries Clinic in Newton.
“The concept is built on close coordination among various medical providers, so like chronic conditions can be prevented or managed through better management,” Schmidt said. “The goals around that involve improved outcomes and lowered cost.”
The health home initiative is a part of KanCare, the state’s privatized Medicaid system, and could affect up to 36,000 people statewide, according to state officials.
But providers still have a lot of unanswered questions, including how the Medicaid-funded plans will be structured and how much providers will be reimbursed for services from the three KanCare managed care companies: United Health Care, Amerigroup and Sunflower, a subsidiary of Centene.
What providers do know is that several services will have to be covered, including health promotion, care management and transitional care, patient and family support and referrals to other community and social services.
Last month, the state announced it would delay its Medicaid-funded mental health initiative until July. It was scheduled to start in January.
Becky Ross, coordinator of Medicaid initiatives for the Kansas Department of Health and Environment, said there are several reasons for the delay, including not wanting to cause confusion because KanCare open enrollment is also in January.
The state also wants to finalize rates and maximize federal planning money for the program. It is using about $250,000 in federal funds to help providers plan for electronic health records, which are an integral part of an integrated approach for treating behavioral and medical issues, Ross said. If the program were implemented in January, some funds would be lost, she said.
The state hopes to expand health homes to include Medicaid-eligible people with chronic conditions such as asthma, diabetes and heart conditions. Ross says officials do not currently have an estimate for the number of people with chronic conditions who could be affected.
Dave Sanford, GraceMed chief executive officer, says the state was wise to delay the implementation until July.
“We learned from the (federal health insurance) marketplace website that if you’re not ready, don’t start,” Sanford said. “People build up expectations and want to be a part of something, but you want it to work well.”
GraceMed doesn’t currently offer behavioral health services, but Sanford says it is working on a plan for 2014 to bring primary care services to Comcare, which is Sedgwick County’s community mental health center.
Next year, Sanford said, GraceMed also wants to have a behavioral health specialist at its main clinic.
In Newton, Health Ministries is working to have three different groups at the same location at 219 S. Pine to better integrate care. The groups would include Health Ministries, Prairie View and the Harvey County Health Department.
“The question is, ‘How can we create an environment where people can get more of what they need in one place?’ ” Schmidt said.
For example, if a woman comes into the clinic for help managing her diabetes and the medical provider picks up on signs that she may be depressed, the providers can take more of a team approach and discuss with the patient how the depression may be affecting her management of diabetes and vice versa and work on a plan to address both with the help of a clinical social worker, he said.
“Those are the kinds of things we’re doing because we believe they work,” Schmidt said.
Integrating care can help eliminate the stigma around visiting mental health professionals, said Teresa Lovelady, CEO at the Center for Health and Wellness.
In the past, the Center for Health and Wellness would refer patients who needed behavioral health services to other providers like Comcare or the Wichita State psychology program.
When they referred patients to other providers, many patients never showed up for their appointments, Lovelady said. By integrating medical and behavioral health services, patients can receive care more quickly.
Last January, the clinic brought on a physician assistant who is dually licensed as a psychotherapist and, since July, the clinic has partnered with Ember Hope, formerly YouthVille, to provide a therapist on site.
The health home program will likely bundle rates for the different providers based on the number of patients per month, Ross said.
Under the current Medicaid plan in Kansas, providers say they can’t get reimbursement for the initial mental health care services that patients may get when they come in for an appointment with a primary care provider.
“We’re not currently able to bill (Medicaid) for the behavioral health consult time in that appointment, but we’ve chosen to do it anyway because it’s the right thing to do,” Schmidt said.
In order to pay for those services, many clinics, including the Center for Health and Wellness and the Health Ministries Clinic, have received grants from the Sunflower Foundation, which was created as part of a $75 million settlement in 2000 to resolve lawsuits about the Blue Cross and Blue Shield of Kansas’ charitable assets, according to the foundation’s website.
The foundation has invested almost $2 million for 37 providers across the state to integrate primary care and behavioral health, said Billie Hall, Sunflower Foundation president and CEO.
“Our health care system has always treated those areas as separate systems,” Hall said. “This is a real testament to these providers. It’s a pretty radical change from how we’ve received health care our entire lives. It requires them to be very nimble in how they approach care with patients.”
Once the health homes are in place, the ideal billing situation for providers, Sanford says, would be for the medical provider and the behavioral health provider to be able to bill for same-day treatment at full rates.
The cost savings, he says, will be long term with fewer emergency room visits and consistent preventive care for high-risk patients.