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Ozarks Medical Center Behavioral Healthcare Leads Missouri in Enrollment in Statewide Health Home System

Ozarks Medical Center Behavioral Healthcare Leads Missouri in Enrollment in Statewide Health Home System

In 2012, Missouri implemented a statewide Health Home system through a provision in the Affordable Care Act. The Community Mental Health Center Healthcare Home (CMHC HCH) program was designed to integrate care for chronic physical health conditions into a community mental health setting, where individuals with severe mental illness or serious emotional disturbances frequently receive care for their mental health conditions but often have unidentified or untreated chronic health conditions.

A review of Missouri’s Medicaid population in 2008 indicated that individuals who accounted for the highest Medicaid expenditures often had a mental health condition as well as other chronic health conditions. The CMHC HCH is designed to improve client experience of care, improve population health outcomes, and reduce cost of care.

When CHMC HCHs launched in 2012 there were 17,822 eligible individuals auto-assigned in the program statewide. This auto-enrollment was a one-time process, and moved to an opt-in program with an enrollment process for each new eligible individual the CMHC engaged and enrolled for these enhanced services. Enrollment has increased each subsequent year of the program, with a total of 23,541 enrolled as of December 2015. While the 26 CMHC HCHs have experienced different rates of growth, the statewide average is a 20% increase in the number of individuals participating in CMHC HCHs.

OMC Behavioral Healthcare (BHC) has seen an 88% growth in enrollment from 2012 to 2015, which is the highest percentage of growth in the state. In 2012, OMC BHC had 215 clients enrolled. At the end of 2015, that number had grown to 404.

In order to be eligible for CMHC HCH, individuals must have (1) a diagnosis of severe mental illness or serious emotional disturbance; or (2) have a diagnosis of a mental health disorder and substance use disorder; or (3) have a mental health or substance use disorder and one other chronic disease or risk factor. Forty-eight percent of the CMHC HCH adult enrollees have a mental health condition in addition to 2 or more other physical chronic health conditions. In general, CMHC HCH enrollees have 2 to 3 times the rate of diabetes, cardiovascular disease, asthma/COPD, hypertension, substance use disorder, tobacco use, and obesity as the general population.

Children represent 25% or more of the overall HCH enrollment in three agencies: Ozarks Medical Center, Clark Community Mental Health Center, and North Central Missouri MHC. Ozarks Medical Center saw a 441% increase in the number of children enrolled in the program starting with 12 in 2012 and increasing to 92 in 2015. Given the limited number of children who are likely to have a chronic health condition in comparison to adults, these three CMHC HCHs are paving the way for other health homes to follow in addressing the needs of children in their prospective areas.

Missouri defined the goals of the CMHC HCH program in their initial state plan amendment. The goals included reductions in several measures of healthcare utilization such as emergency room use and hospitalizations. Activities such as metabolic screening and hospitalization follow-up have been tracked to measure implementation of the CMHC HCH. In general, the CMHC HCHs have been successful at implementing the health home model as measured by their success at meeting benchmark goals of the program.

CMHC HCHs have met or exceeded 6 of 9 benchmark goals for disease management including:

  • Increased metabolic syndrome screening rates for all CMHC HCH enrollees from 12% at the start of the program to 88% as of December 2015.
  • Increased the percentage of enrollees with diabetes who had controlled blood pressure from 27% to 72%, good cholesterol levels from 22% to 54%.
  • Increased the percentage of enrollees with diabetes who had controlled blood glucose levels from 18% to 61%.
  • Increased the percentage of enrollees with hypertension and cardiovascular disease who had controlled blood pressure from 24% to 67% and good cholesterol levels from 21% to 56%.
  • Increased 72 hour hospitalization follow-up rates from 35% to 49%.
  • Reduced the average number of hospitalizations by 14% and emergency room visits by 19% for enrollees.

There are still areas of opportunity in the CMHC HCH program to improve population health. Some of these areas are challenging and the implementation team and CMHC HCH administration realize they may take more time to reflect significant change. These areas of opportunity include:

  • Increase the percentage of enrollees who are tobacco free, encouraging reporting of tobacco cessation programs and harm reduction (i.e. smoking fewer cigarettes per day).
  • Decrease obesity and extreme obesity in the population as measured by body mass index (BMI), but also report successes in number of people with significant weight loss.
  • Continue to improve data technologies to facilitate population health management and care coordination.
  • Develop a child-focused health home model to address the unique needs and care gaps for children.
  • Determine new goals for population health outcome metrics for the CMHC HCH population through data analysis, targeting subgroups that may need additional supports or interventions.

Missouri CMHC HCHs have successfully implemented and maintained the health home program since January 2012. They have received national recognition for their efforts and continue to help guide other states through health home implementation projects and by sharing the lessons learned in Missouri. They have the opportunity to work towards new population health goals, and continue to improve the systematic transformation of healthcare delivery in Missouri.

OMC Behavioral Healthcare offers efficient and effective mental health services to children and adults including individual, couples and family counseling. In addition, BHC provides psychological testing and evaluation, case management and medication services to help reduce the severity and duration of mental health disorders. Our team of psychiatrist, psychologists, social workers, nurse practitioner, nurses and counselors provide convenient, comprehensive care to keep our community mentally healthy. For more information, contact OMC Behavioral Healthcare at 417-257-6762.

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