News & Notes

Mental disorders most common diagnoses among nonelderly Medicaid “super-utilizers”: Medicaid “super-utilizers” accounted for half of all 30-day hospital readmissions for the Medicaid population in 2012, with a readmission rate nearly six times as high as the rate for other Medicaid patients, according to a new statistical brief from the Agency for Healthcare Research and Quality (AHRQ). The two most common reasons for hospitalization among these patients were mood disorders and schizophrenia and other psychotic disorders; alcohol disorders ranked sixth. Super-utilizers—patients with four or more hospital admissions annually—are a relatively small group of patients who account for a disproportionately large share of hospital services and costs. AHRQ’s analysis found that the 30-day all-cause readmission rate among super-utilizers was 52.4%, compared with 8.8% for other Medicaid patients. Medicaid super-utilizers had more hospital stays (5.9 versus 1.3 stays), longer stays (6.1 versus 4.5 days), and higher hospital costs per stay ($11,766 versus $9,032). Super-utilizers accounted for 14% of Medicaid hospital stays and 18% of Medicaid hospital costs. The statistical brief, Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012, is available on the AHRQ Web site at hcup-us.ahrq.gov/reports/statbriefs/sb184-Hospital-Stays-Medicaid-Super-Utilizers-2012.jsp.

CIHS guide to estimating costs of integration: Although the provision of integrated care is intended to reduce costs over the long term, implementing an integrated care program at a community mental health center (CMHC) means hiring new staff, setting up new services and operations, and acquiring supplies and equipment. The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has developed a guide to help CMHCs understand the process of estimating and analyzing the costs of providing primary care services to adults with serious mental illness so that administrators can budget for and evaluate the integrated care program. Data from cost analyses can be used for a variety of purposes, from internal accounting and planning to advocating for investment from partners, such as local hospitals, or major payers, such as the state Medicaid program. In addition to defining key terms, the guide details seven steps that CMHCs can follow to conduct a cost analysis and to make a strong presentation of findings to target audiences. Each step is informed by experiences of and strategies used by five CMHCs that received Primary and Behavioral Health Care Integration grants from SAMHSA in 2013 to implement integrated care programs. The 12-page guide, Analyzing the Costs of Integrated Care: A Brief Guide for Behavioral Health Care Clinics, is available on the CIHS site at www.integration.samhsa.gov/pbhci-learning-community/Cost_Analysis_Guide_FINAL.pdf.

Commonwealth Fund report on how ACOs approach integration: Organizations that attempt to integrate behavioral health and primary care may encounter barriers, especially if they use a traditional fee-for-service model. Accountable care organizations (ACOs) may be better positioned for integration because their more flexible reimbursement structures, which emphasize care coordination, can make an integrated model more financially viable. A new report from the Commonwealth Fund shows how participation in an ACO can support integration. It presents case studies of two ACOs: Crystal Run Healthcare ACO, a multispecialty medical group in New York with 16 clinics and 300 providers, and Essentia Health, an integrated delivery system in Wisconsin, Minnesota, North Dakota, and Idaho with 63 clinics, 1,500 providers, and 18 hospitals. The two ACOs sit at different points along the integration spectrum and demonstrate the diversity of ways in which ACOs might integrate primary and behavioral health care. The first uses a colocation plus collaboration model that facilitates connection between providers through proximity and improved information sharing. The second uses a model that adds behavioral health specialists to the primary care team to bolster physicians’ capacity to manage behavioral health conditions. The 17-page report, Creating Connections: An Early Look at the Integration of Behavioral Health and Primary Care in Accountable Care Organizations, is available at www.commonwealthfund.org/publications/fund-reports/2014/dec/creating-connections?omnicid=EALERT649075&[email protected].

NASHP brief examines role of nurse care coordinator in an ACO integrated care program: Hennepin Health, a Minnesota safety-net ACO launched in 2012, is authorized by the state legislature to care for uninsured populations with complex needs, such as homeless individuals, and for new Medicaid beneficiaries under the ACA expansion. More than one in four of Hennepin Health’s 8,500 patients have behavioral health needs, and a third have chronic conditions. Hennepin Health has begun to integrate primary care into Hennepin County Mental Health Center by using a behavioral health nurse care coordinator. A new issue brief from the National Academy for State Health Policy (NASHP) looks at the role of the care coordinator and lessons learned by Hennepin Health in the first year of integration. In addition to highlighting state policy implications, the brief illustrates how the nurse care coordinator has been able to drive improvements in care. Early data indicate that inpatient hospitalizations and the use of the emergency department among behavioral health patients have decreased. The brief is the third in a six-part series, supported by the AARP Public Policy Institute, that explores the evolving role of nurses in new delivery system models. Transforming the Workforce to Provide Better Chronic Care: The Role of a Behavioral Health Nurse Care Coordinator in Minnesota is available on the NASHP Web site at nashp.org/sites/default/files/AARP939_NursingCareinMN_Hennepin_Spotlight_Dec18.pdf.

CIHS assessment tools for organizations integrating primary and behavioral health care: The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has created a Web site that presents a range of tools designed to help organizations evaluate their readiness to embark on the road to integration. The tools are designed to help teams determine what components will be integrated, what staff and training are required, and what systems and resources will be needed. The results of assessment tools can promote dialogue about the value of integrated care and how best to support the development of systems of care. The assessments can provide a jumping off point to identify next steps in workforce development, explore the addition of specific clinical services, and adopt or expand health information technology capabilities. The tools are available on the CIHS site at www.integration.samhsa.gov/operations-administration/assessment-tools.

Report highlights permanent supportive housing achievements in Massachusetts: In December 2012, Massachusetts Governor Deval Patrick announced a goal of creating 1,000 new units of supportive housing across the state by December 2015. That goal was reached 18 months ahead of schedule in March 2014, according to a new report from the Massachusetts Office of Health and Human Services. The report describes a demonstration program, now in its third year, that was launched in Massachusetts in 2012, when 18 state agencies signed a memorandum of understanding in which they pledged to expand the state’s inventory of permanent supportive housing by partnering to improve existing processes; make recommendations for new, collaborative efforts; and develop a long-range action plan. The report describes how this Interagency Supportive Housing Working Group developed assessment tools and “vulnerability indices” to identify target populations, repurposed underutilized housing across the state, and consolidated funding streams. The report lists other policy challenges encountered by the working group, including incorporating stabilization services to ensure residents’ housing tenure, training case managers, expanding existing resources, and measuring outcomes. The 16-page report is available on the Web site of the Massachusetts Office of Housing and Urban Development at www.mass.gov/hed/docs/dhcd/news-updates/s-111-buildingonsuccess-stateactinplan.pdf.

NIAAA consumer guide on treatment options for alcohol problems: A new resource from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is designed to help individuals and families understand available treatment options for alcohol problems. The guide covers the latest evidence-based treatments and what to consider when choosing among them. “The popular concept of alcohol treatment is often limited to knowledge of 28-day inpatient rehab or 12-step programs,” said NIAAA Director George Koob, Ph.D. “In fact there are diverse treatment options of which people may be less aware, and many of which can be undertaken with minimal disruption to home and work life.” Approximately 17 million American adults have an alcohol use disorder, and one in ten children have a parent who has a drinking problem. The guide lists the signs of symptoms of alcohol problems; describes the types of professional involved in treating them; a range of treatments, including medications and behavioral treatments, and treatment settings; and offers advice for friends and family. The 15-page guide, Treatment for Alcohol Problems: Finding and Getting Help, is available on the NIAAA www.niaaa.nih.gov/news-events/news-releases/new-niaaa-resource-gives-guidance-treatment-options-alcohol-problems.

Ten-year state trends in cost of employer health insurance: Premiums and deductibles for employer-sponsored health insurance grew more slowly in 31 states and the District of Columbia between 2010 and 2013, after passage of the ACA, according to an analysis by the Commonwealth Fund that looked at 2003–2013 trends. However, the more modest rise in costs still exceeded growth in median income in most states over this period. In 37 states, average annual health plan premiums, including both the employer and the employee contributions, represented 20% or more of household income in 2013. In 2013, the annual total costs of employer-sponsored family coverage averaged just over $16,000, ranging from $13,477 to $14,382 in the five states with the lowest costs (Alabama, Arkansas, Idaho, Mississippi, and Hawaii) to $17,262 to $20,715 in the four highest-cost states (New Jersey, Massachusetts, New York, and Alaska) and the District of Columbia. To reduce their own cost of providing health insurance, employers have increased the amount that workers contribute to their premiums and also to their health care (through higher deductibles and copayments). In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms. High deductibles are becoming the norm, according to the report. In 2003, no state had an average deductible of $1,000 or more. By 2013, average per-person deductibles exceeded $1,000 in all but three states and the District of Columbia. The 22-page report, State Trends in the Cost of Employer Health Insurance Coverage, 2003–2013, is accompanied by an interactive U.S. map showing current average premiums and ten-year trends by state. Both are available on the Commonwealth Fund site at www.commonwealthfund.org/publications/issue-briefs/2015/jan/state-trends-in-employer-coverage?omnicid=EALERT670714&mid.