News > United Hospital Fund Report Offers Recommendations and Options to Better Manage Care for Patients with Severe Mental Illness and Chronic Physical Health Conditions

A report from the United Hospital Fund’s Medicaid Institute™: concludes that, for Medicaid beneficiaries with chronic physical health conditions and serious and persistent mental illness, the more integration of physical and behavioral health care services the better. The report suggests ways the state can create systems that improve care and reduce avoidable exacerbations of illness that often result in high-cost services.

Developed as part of an ongoing collaborative effort with senior New York State officials with responsibility for physical and mental health services under Medicaid, the report is expected to help inform decisions to move New York away from its current bifurcated system that hinders coordination of physical health services and behavioral health services.

Medicaid beneficiaries with serious and persistent mental illness present significant challenges to the health care system. For example, the report notes, among the chronically ill population the addition of one behavioral health condition doubles medical expenditures for physical health and also doubles both the emergency room visit rate and hospital admission rate.

Titled Providing Behavioral Health Services to Medicaid Managed Care Enrollees, the report presents a list of “ideal elements of integrated care,” which includes such items as an electronic system that shares data with physical and behavioral health providers, standardized protocols and evidence-based guidelines, and mechanisms for rewarding high-quality care and for sharing savings across physical and behavioral care delivery systems. Despite consensus among the interviewed sources on the value of these elements, however, researchers were unable to identify an integrated system anywhere in the nation with all or even most of them.

Researchers did, however, identify promising examples in other states, including the TennCare program, the Governor’s Mental Health Initiative in Minnesota, the Massachusetts Behavioral Health Partnership, and the Washington Medicaid Integration Partnership. The report also looks at Schaller Anderson, Inc., a Medicaid managed care company that is experimenting with integration of physical and mental health services.

In addition, the report discusses two fundamental options for New York to consider for its disabled Medicaid beneficiaries with serious and persistent mental illness: fully capitated health plans, which would integrate physical and behavioral services; and capitated behavioral health organizations, which would remain separate from existing managed care plans. Considerations for both options are outlined.

“New York state officials and other stakeholders are interested in exploring ways to improve care for this challenging population, and we expect this report will help advance discussions,” said Jim Tallon, president of United Hospital Fund. “Solutions won’t come easily, evidenced by the absence of successfully integrated systems nationwide. With progress, however, the quality of life for many Medicaid beneficiaries will improve and we may also realize reductions in Medicaid spending.”

Providing Behavioral Health Services to Medicaid Managed Care Enrollees is available free of charge.

The report was prepared for the Medicaid Institute™: at United Hospital Fund by Melanie Bella, Stephen A. Somers, and Karen Llanos of the Center for Health Care Strategies, Inc.

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.

About the Medicaid Institute™: The Medicaid Institute at United Hospital Fund provides information and analysis explaining New York’s Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program.

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