A partnership between insurer Molina Healthcare of Michigan and mental health provider Common Ground in Bloomfield Hills, Mich., is tackling arguably the most expensive and chronically ill patients in the health care system: those who are dually enrolled in the Medicare and Medicaid programs.
Nationally, 9 million dual-eligible patients, including 200,000 in Michigan, account for 40% of all Medicaid spending and 27% of all Medicare spending. Care costs total about $350 billion a year, or 9% of the nation's $4 billion annual healthcare tab.
The Molina-Common Ground contract is one example of providers working together to cut into those high costs.
It works like this: Under the contract, participating hospitals in Genesee County contact Common Ground when a Molina member comes into the emergency department with an acute mental health problem.
Within 30 minutes, a member of Common Ground's crisis intervention and recovery team arrives at the hospital to assess the Molina member, said Heather Rae, CEO of Common Ground.
Upon consultation with the hospital emergency doctor, the patient is either admitted to the hospital or diverted to Common Ground, where the patient receives a minimum of 30 days of outpatient care, Rae said.
If hospitalized, the individual is followed by Common Ground through face-to-face encounters and by telephone for 30 days.
Participating hospitals in Genesee County include McLaren Flint and Hurley Medical Center in Flint.
During the first year of the project, which began in early 2014, 19 of 39 patients, or 49%, who went to a hospital ER in Genesee County were successfully diverted to recover at home and were not admitted.
Molina netted savings of $75,825 after paying Common Ground for its services, which led to a return on investment of 4.15 to 1.
"The savings are significant," said Jim Forshee, M.D., Molina's medical director. "We want to expand this program. Some of these patients don't need to be hospitalized. Outpatient care is a better alternative."
Patients with mental health issues end up at a hospital ER for a variety of reasons.
"They have a suicide threat, they aren't sleeping well, maybe they are abusive with family members or have a medication problem because their meds have changed," Rae said. "Usually it is after 5 p.m., and they have no place to go."
Forshee said most patients who go to ERs with behavioral problems are in a crisis situation.
"They have domestic problems, emotional outbursts and are sick," Forshee said. "Some are hearing voices and seeing spiders."
Rae said too many people with mental health issues are admitted to hospitals for observation and treatment because ER staff are more trained to manage medical emergencies and not deal with mental illness.
"The program is about providing quality alternatives to psychiatric inpatient hospitalization, not about preventing people from a needed admission to the hospital," said Rae.
Rae said the ER intervention concept was the brainchild of former CEO Tony Rothschild, who retired from Common Ground in October.
"Molina was very interested," Rae said. "These programs have better outcomes at a lower cost to taxpayers."
Common Ground is paid two separate fees — initial assessment and 30 days of outpatient services. "This is not a revenue center," Rae said. "We don't make a lot of money on it because it isn't our purpose."