Integrated care has been a healthcare issue for years, but it became more relevant with the signing of the Affordable Care Act in 2010.
The idea that mental and physical health professionals should “talk to each other” about their common clientele has become an emotionally charged topic for people on Medicare and Medicaid, their families, their supporters, and disability advocates.
Policy makers have proposed a variety of solutions, including the development of a common electronic health record (Federal HI TECH Act). Staffing of primary care offices with psychiatric clinicians in colocation models; Collaboration through interdisciplinary nursing conferences and, in Michigan, drafting the current behavioral health carveout (which means that Medicaid funding for services to people with the most severe mental illnesses is for the public mental health system only) is no longer a delimitation between Medicaid health plans and the prepaid health insurance plans.
In 2016, when the boilerplate language known as Section 298 was introduced into the government at the time. Rick Snyder’s budget, the debate about integrated care and what it should “look like” began. The suggestion: mix the streams. Share the Medicaid on the health plans and have the community mental health service providers contract the health plans. Rearrange the administrative structures. For what?
Problem solved?
Hey wait a minute What is the problem? Aside from the fact that behavioral and physical health professionals don’t often do as well a job of communicating about their common clientele, another problem is that people with severe mental illnesses die about 25 years earlier than the rest of the population.
This was the conclusion of a study conducted by Craig W. Colton, Ph.D., and Ronald Manderscheid, Ph.D., published in 2006.
The proposed solution: improve these people’s access to health care and community resources, and their life expectancy may improve. The “how” has been around for over 40 years: case management services.
In the early 1960s, nearly 500,000 people with severe mental illness were placed in state mental hospitals in the United States. With the invention of chlorpromazine in 1952 – the first antipsychotic – it was believed that people with mental illness could leave the hospital and live successfully in the community. In order to achieve this ideal, outpatient services were required, which were offered through communal psychiatric centers.
Community Mental Health was born on October 31, 1963 when President John F. Kennedy signed the Community Mental Health Centers Act of 1963.
Case management services are one of the services developed through the community psychiatric centers. Case management is designed to help people with more severe mental illness find their way around the community by linking them to services such as housing and healthcare and assisting with applying for government programs such as grocery stamps, social security disability, and / or SSI and Medicaid.
Case managers are responsible for helping their clients solve problems and deal with crises that arise. Case managers are confidants, and good ones provide the ultimate in concierge service.
When John’s symptoms of schizophrenia affect his ability to stay in his subsidized home, the case manager’s job is to step in and stand up for John.
Case managers stand up for their customers. They help their customers by knowing where the local pantry is and by taking John to the pantry when his grocery tags are gone. Case managers are the way to tackle the “social determinants of health” which include poverty, homelessness and inadequate access to health care.
Case managers speak to doctors, nurses, family members, and apartment managers as needed. Case managers monitor their employees for symptoms, get them shopping, and call the Community Action Agency when John can’t pay his DTE Energy bill.
Case management is an integrated care and it is far more personal than an electronic health record that can communicate with another EHR.
The solution is simple and does not imply that an overly bureaucratic and difficult to navigate system is overly bureaucratic and difficult to navigate. Integration simply means communicating and collaborating with community resources.
True integration focuses on the person who needs assistance navigating complex community systems including physical health care. And case management is a service that is uniquely linked to the community mental health system as its core function has always been to keep individuals out of state and community mental hospitals and in the community.
If we are willing to take a “person-centered” approach to health care, shifts and blending of funding flows will become unnecessary and will ultimately be the way to save money in the long run.
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