Connect behavioral and medical health to better serve dual eligibles


As the fragmented healthcare system starts to see chronic illness and mental conditions collide, integrated behavioral and medical health is key to streamlining care and curbing costs for the dual-eligible patient population, psychiatrists from WellPoint and Molina Healthcare told an audience last week at the AHIP Institute in Seattle.

In fact, a June Health Affairs study found nearly half of the under-65 dual-eligible population has severe mental disorders. And that group costs nearly twice as much as young dual eligibles without a mental disorder, FierceHealthPayer previously reported.

Caring for dual eligibles becomes even more difficult thanks to inertia in the mental health sector around moving beyond "fern and lamp" treatment to address co-occurring medical issues, Ken Hopper, M.D., director of the Western Regional Medical Group for Amerigroup, told the AHIP Institute audience.

However, the marketplace is moving toward integrated care. "Integrating behavioral health expertise into the medical setting is where it's at," Hopper said. That integration must be a two-way street so that medical care is possible in behavioral health and vice versa. 

At Amerigroup WellPoint, Hopper applies architectural advisement to figure out how best to connect behavioral and medical health. "We go down the list of activities that have been shown to be fruitful and try to be an adviser," said Hopper. It's helping the provider community rather than funding it, he explained.

Care coordination is key to successfully meeting the mental and physical health needs of costly dual-eligible members. "Providing the glue between the pieces" not only makes sense but also signifacntly affects costs, Hopper said.

Taft Parsons III, M.D., the vice president of behavioral health plans at Molina, focused on coordinating care for depression, one of the most common conditions primary care providers encounter and are expected to be able to manage. "Not addressing it is costly from the behavioral health and medical standpoint," Parsons said.

He highlighted a study of 1,800 depressed patients in which behavioral health specialists were integrated into primary care clinics and acted as liaisons to the psychiatrists. That coordination led to a 50 percent drop in depression, higher satisfaction levels and, over four years, cost reductions of $3,300 per person.

To deliver dual-eligible care that can achieve such triple aim results, Parsons said payers must look at the whole population and screen for depression and other mental health issues. And behavioral health providers and primary care providers must find ways to treat patients collaboratively. Once that happens, payers need to monitor those outcomes to ensure evidenced-based care. "It does us no good if people are getting a lot of care that's ineffective," he said.

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