Patients are selected using a predictive model that identifies high-risk individuals. Currently there are 2,000 patients enrolled in the program1,000 adults and 1,000 youth. The clinical algorithms are specific to each age group and over 100 are run during the analysis. An Integrated Health Profile report is generated for each patient and is mailed to the primary psychiatrist, the primary-care physician, and the case manager every 60 days. The report is also posted online in collaboration with the Missouri HealthNet Disease Management Program. The reports contain patient-specific information about diagnoses, drug-drug interactions, medication adherence, and inpatient and emergency room utilization. A list of all prescriptions filled within the previous 90-day period is provided, and medications linked to prescribing that deviates from best practice guidelines are flagged. Health alerts identifying gaps in a patients medical care are provided. A physician feedback form is included.
The system is provided by a Medicaid vendor and funded through the MO HealthNet Technology Fund. The cost of the program is about $1 million annually. Implementing the HCO program requires an IT commitment from the state to provide a full historical data feed initially and regular updates thereafter. Missouri provides daily updates of all paid claims data to the vendor. Project management requires intermittent and small resource time from the Medicaid pharmacy director, the mental health medical director, and state level technology and management personnel. Local caregivers such as physicians and case managers must commit to reviewing the Integrated Health Profile for each enrollee and follow up on any clinical issues identified by the report.
Case Managers and physicians have reported the usefulness of the Integrated Health Profile. Early data analyses show that patients enrolled in the program have fewer inpatient admissions and improved medication adherence. An initial pilot of the program demonstrated that unnecessary emergency room and hospitalization visits decreased over the course of the program resulting in an estimated annualized savings of $6.15 million to MO Medicaid. In addition, a gap in medical or psychiatric home of 36% was decreased to 9% by the end of the pilot phase for these patients. Lets examine the case of a patient known as JS. When JS was first enrolled in the program he was living in a group home, had been seen by 18 providers in a three-month period, and was on 10 different medications. He had experienced multiple medication side effects, some requiring ER visits. Since his participation in the HCO program he has been assigned a case manager, has a primary-care physician and a primary psychiatrist, and his physical medical needs have been incorporated into his psychiatric care plan. At the time of reporting, JS was seeing eight providers and prescribed only one medication. He is transitioning into independent living.
The American Recovery and Reinvestment Act of 2009 has set aside $2 billion in funding for implementation grants, which can be used for health information technology (IT) architecture, training for healthcare professionals, development of best practices methodologies, interoperability between different providers systems, and telemedicine. It is the goal of mental health department to utilize stimulus law funds to create an interoperable transfer of clinical decision-support information in the current Integrated Health Profile to the current online health services record system for all SMI and MR/DD Medicaid recipients in 2010.
State chief information officer, Office of Administration, Missouri
Director, information technology services division, Department of Mental Health, Missouri