Yesterday, we focused on a recent analysis showing that untreated mental illness costs us roughly $1,000 per citizen per year in additional costs (see The Cost Of Untreated Mental Illness? $1,000 Per Citizen Per Year) – at least in Colorado. The analysis, conducted by Rocky Mountain PBS I-News and reported on by the Community Radio of Northern Colorado, focused on a range of costs of untreated mental illness – with the largest proportion due to the increased medical costs of Medicaid enrollees with mental health problems.
The analysis focused on the concept of the “superutilizer” – “people who overuse emergency departments and hospital inpatient services, making more visits to those facilities in a month than some people make in a lifetime” (see ‘Super-utilizers’ place huge burden on health-care system). The data show that 33% of “superutilizers” of resources have behavioral health claims – and the Medicaid medical expenses associated with mental illness reached an estimated $2 billion in 2013. And, we’ve had substantial coverage of the disproportionate spending on a relatively small portion of the population – Five Percent of Americans Responsible for Half of U.S. Health Spending, The Marketing Challenge Of The 5% & The 95%, and The Answer Is….
In Colorado, mental illnesses collectively, make up the most prevalent conditions among Medicaid clients who frequent the emergency room (ER) six times or more in a span of 12 month, according to a survey of the state’s seven regional Medicaid administrators. In addition, 14% of the frequent ER users in central Colorado counties and 18% in the state’s southeastern counties have a primary diagnosis of mental illness – a diagnosis more common than any other cause. The most common “superutilizers” are people with mental illness who are non-compliant with medication, have co-occurring substance abuse disorders, and who come (and return to) unstable environments. This data in the Colorado report is supported by other analysis of emergency room utilization – see Predictors of Emergency Department Super-Utilizers, and ‘Super-utilizers’ place huge burden on health-care system.
The article points to the need to have a “coordinated” approach to services and supports – including physical health, mental health, addictive disorders, and social support needs – for this population. This functionality is emerging in medical homes – or more specifically, behaviorally-focused medical homes or health homes. The health home initiative is getting great traction with 27 states operating or planning to launch Medicaid health homes (see 27 States With Medicaid Health Homes Initiatives; Over 1,000,000 Complex Consumers Enrolled As Of March 2014). Our OPEN MINDS Industry Library has a number of new resources available on the health home concept:
- How Are Medicaid Health Homes Reimbursed For Services?
- A Health Home Update – Health Homes Go Private
- State Health Home CMS Proposal Status (Effective February 2014)
- State-By-State Health Home State Plan Amendment Matrix: Summary Overview (Updated February 2014)
- States’ Policies for Health Homes For Dual Eligibles Face Challenges
- Health Homes Go Private!
- Health Homes For Children
- What Matters In Making Health Homes Sustainable
- Meeting The Challenge With Health Homes
- Developing Health Homes To Effectively Serve Medicare-Medicaid Enrollees: Technical Assistance Brief
For more on health homes, stay tuned for our future coverage of two great sessions coming up at the 2014 OPEN MINDS Planning & Innovation Institute. The first will be, A Health Home Update: Where Are Payers & Policymakers With Health Homes? featuring Paul A. Choquette, M.A., Senior Healthcare Delivery Systems Specialist, Xerox State Healthcare Rhode Island Executive Office Of Health & Human Services; Dorn Schuffman, Senior Consultant & Coordinator Primary/Behavioral Health Care Integration Unit, Missouri Dept. Of Mental Health; and John F. Talbot, Ph.D., Vice President for Integration Product Development, Jefferson Center for Mental Health. And, the second is, The Inside Perspective On Health Homes: Learning From The Experience Of Provider Organizations Who Are Making It Work, featuring Jennifer Moses, Chief Executive Officer, Zepf Center; Kimberly Yeagle, MSW, LCSW, Healthcare Home Director, Burrell Behavioral Health; Michelle Taylor, MS, Director of Program Evaluation, NRI Community Services, Inc.; John F. Talbot, Ph.D., Vice President for Integration Product Development, Jefferson Center for Mental Health.