Ohio Medicaid Health Homes for Those with Serious and Persistent Mental Illness
Ohioans with Serious and Persistent Mental Illnesses (SPMI) experience rates of somatic physical health morbidity and mortality that far exceed those of the general population. State and national research has revealed that the years of life lost attributable to this common co-morbidity are significant. Causes of high morbidity and premature mortality are often preventable and treatable medical conditions associated with modifiable risk factors such as obesity, poor nutrition, lack of exercise and smoking.
The Ohio Department of Mental Health (ODMH), in conjunction with Case Western University, investigated the causes of deaths of seriously mentally ill consumers who died between 2004 and 2007 and who were served by the Ohio state-operated psychiatric hospitals and/or community-based mental health programs (pending publication). When compared to decedents in Ohio's general population over the study's time frame, only 32% of the seriously mentally ill consumers were 65 years or older at the time of their deaths, compared to 75% of the general Ohio population.
An earlier Ohio study examined mortality and medical comorbidity among patients with serious mental illness admitted to an Ohio public mental health hospital between 1998 and 2002. Heart disease (21%) was the leading cause of death. The mean age at death for decedents with Ohio public mental health hospital admission was 47.7 years, corresponding to an average of 32 years of potential life lost per patient (Miller et al., 2006).
In a recent study funded by the Northeast Ohio Medical University's BeST Center and the Health Foundation of Greater Cincinnati and conducted by Health Management Associates and the Ohio Colleges of Medicine Government Resource Center it was found that in Ohio:
- Adults with serious mental illness (SMI) represented about 10% of the Medicaid population and 26% of total Medicaid expenditures.
- The rate of co-occurring chronic physical health conditions is higher among individuals with SMI and particularly among individuals with schizophrenia and psychosis.
- Adults with SMI have approximately twice the rate of hospitalization and ED visits for many ambulatory care sensitive conditions including diabetes, COPD, pneumonia and asthma.
- Adults with schizophrenia have over twice the rate of hospital emergency department (ED) visits for hypertension and diabetes.
In addition to the statistics above, it is widely known that behavioral health treatment approaches can contribute to high risk health conditions: second generation anti-psychotic medications are highly associated with weight gain, diabetes, abnormal cholesterol levels and metabolic syndrome. We also know that treating illness is not enough.
Creating linkages to other medical, wellness and preventive services are as important as mental health treatment and rehabilitation. In order to truly improve outcomes and the quality of life for the individuals with SPMI, it is important to focus more attention on the general health care problems that interfere with recovery.
With this in mind, Ohio plans to establish Medicaid health homes for beneficiaries with serious and persistent mental illness (which includes adults with SMI and children with SED), initially using a regional approach. More specifically, Ohio's Community Behavioral Health Centers (CBHCs) will be eligible to apply to become Medicaid health homes for Medicaid beneficiaries with SPMI. The goals of Ohio's CBHC health homes for those with SPMI are aligned to those of CMS: improve the integration of physical and behavioral health care; lower rates of hospital ED use; reduce hospital admissions and re-admissions; reduce healthcare costs; decrease reliance on long-term care facilities; improve the experience of care, quality of life and consumer satisfaction and improve health outcomes. In addition, we expect to achieve better care coordination and management of health conditions as well as increase the use of preventive and wellness management services.
In November 2011, the Ohio Department of Mental Health and the Ohio Department of Job & Family Services launched the health homes initiative with a kick-off meeting in which representatives from the provider community, county boards, and consumer advocates participated. During this meeting, the department announced that the following 6 work groups will convene before the close of 2011 to develop recommendations for the implementation of Medicaid health homes for individuals with serious and persistent mental illness in Ohio:
- Documentation, Billing & Other Regulatory Requirements
- Reimbursement
- Health Information Technology/Health Record Integration/Treatment Plan Integration
- Staffing Arrangements & Team Composition
- Consumer/Family Engagement and Buy-in
- Quality Improvement: Performance Measures & Outcomes
Reference: Miller, B., Paschall, B., Svendsen, D. (2006). Mortality and Medical Comorbidity Among Patients with Serious Mental Illness. Psychiatric Services, 57: 1482-1487.