Mental health centers to coordinate all medical care for their patients starting Jan. 1

Next year the Community Counseling Center in Cape Girardeau will use a delivery concept set out in the federal health care reform law with hopes of improving care for low-income patients while saving money.

Missouri is the first state to be approved by the Center for Medicare and Medicaid Services to use the Health Home model. Twenty-seven mental health facilities in Missouri, including the Community Counseling Center and Bootheel Counseling Center in Sikeston, have applied to become Health Homes.

Beginning Jan. 1, as Health Homes, the centers will coordinate all medical care for their clients, including primary, acute, behavioral health and long-term medical services for Medicaid patients who have a behavioral health disability. That can include substance abuse or mental health conditions.

Right now in Missouri, the Health Home model is only being used by mental health facilities. However, under the Patient Protection and Affordable Care Act passed in 2010, it may be used by health care providers who treat patients with any type of chronic health condition. Mental health is one example of a qualifying chronic health condition. Others include diabetes, heart disease and high blood pressure.

"These individuals are most likely to be high users of hospital emergency rooms and nursing homes because of their health conditions. The Health Home is designed to reduce nursing home and hospital emergency room use and help keep these individuals in their homes and community," said Bob Bax, spokesman for the Missouri Department of Mental Health. "The goals are to provide better care, improve health care outcomes and reduce costs."

People with mental illness typically don't receive good primary medical care, said John Hudak, executive director of the Community Counseling Center. By using the Health Home concept, his staff will work with primary care physicians and nurses to tend to clients' general physical health in addition to their behavior health, Hudak said.

"One of the things we're very aware of is that persons with mental illness, for whatever reason, they have greater problems with their primary health care than most people in the population," Hudak said. "In fact, one of statistics that was used to support this initiative is that folks who have chronic mental illness typically die 25 years sooner than their counterparts in the general population."

Sometimes it's more difficult for patients with mental illnesses to understand the instructions given to them by their primary care physicians. The Health Home concept will allow counseling center staff to work with primary care providers, Hudak said. The center will hire a consulting primary care physician to work with its four nurses already on staff.

"A lot of our clients with mental health issues need reinforcement to go to their doctors and get yearly checkups. Many financially are not able to connect with a primary care physician," said Terri Ciscon, Health Home director for Community Counseling Center and a registered nurse. "Our nursing team will be assigned a caseload and will connect with those clients to help keep them on track for appointments."

The nurses will also help educate clients about their overall physical health.

"Before, there was nothing to do with physician health here for patients with mental health problems. Our caseworkers were not connected with the physical health aspect. Now, there is somebody who will be the go between," Ciscon said.

Many mental health patients who don't have good access to primary health care end up going to local emergency rooms for treatment, she said. Visits to the emergency room are much more expensive than a visit to a primary care physician's office, Ciscon said.

In addition to Cape Girardeau, the Community Counseling Center operates facilities in Perryville, Ste. Genevieve, Fredericktown and Marble Hill. Last year, the facility saw 7,800 patients in the five counties it serves, and Hudak estimates about 1,000 are Medicaid patients who would qualify to take part in its Health Home program.

In December, community mental health centers across Missouri will begin enrolling patients to participate in its Health Home, which will start Jan. 1.

During the first two years, Bax said, services provided using the Health Home model will be reimbursed by Medicaid at a rate of 90 percent federally funded and 10 percent state funded, instead of the normal 64/36 federal/state match rate. He said there was no estimate available on how much money the model would save Missouri because the amount depends on the number of people who participate.

Missouri's Health Home model was developed with the assistance of consultants funded by Missouri Foundation for Health.

"One of the barriers we see is that providers need assistance to transform their practices. It costs money, there's training involved and staff time involved," said Ryan Barker, director of health policy at the Missouri Foundation for Health.

The foundation recently announced it will fund 80 physicians' practices to become patient-centered medical homes. More information can be found at mffh.org.

mmiller@semissourian.com

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Pertinent address:

402 S. Silver Springs Road, Cape Girardeau, MO