2013 Program Award
This innovative project represents a seismic shift in how Medicaid has traditionally been administered. Instead of waiting for mentally ill individuals to use the healthcare system on their own, the State identified very sick individuals who are not getting the right care and went out to find and engage them.
The Missouri Department of Mental Health (DMH), in partnership with MHN, and through its administrative agents and six affiliate agencies, reached out to Medicaid recipients with a serious mebntal illness, but were not currently clients of DMH and were high-cost Medicaid recipients with chronic medical conditions. The team changed the care delivery model from the old model of expecting a person to make an appointment if they want care, to a new model of outreach to high cost, high risk individuals that the payer (DMH-MHN) selected for services. A data-analytic enrollee selected process was created. The team developed an outreach tool kit for providers. Locating clients was the #1 barrier due to incorrect addresses and phone numbers. Identifying them on paper was the easy part. Finding and engaging them in services proved much more difficult. State mental health workers found the best way to find this group was in person — at their medical appointments, or often in abandoned buildings or parks frequented by the homeless. The effort provided challenging, but successful.
Obtaining a healthcare home — a primary care of behavioral health provider responsible for overall coordination, assisting in scheduling and keeping medical care appointments, prevention and wellness services, and facilitating adherence to medications were key strategies used for improving care and reducing costs. These high-cost, high-risk individiuals wer enrolled in the Community Psychiatric Rehabilitation (CPR) Program and referred to a substance abuse treatment program, if appropriate, and provided care coordination and disease management services for both their behavioral health and medical conditions. Community mental health providers were extremely effective in improving care and the general medical conditions of this population.
The DM 3700 Program is not only dramatically improving lives; it saves millions of dollars for the State.