AbbeHealth increases focus on physical as well as mental health

Agency's integrated program helps 2,600

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CEDAR RAPIDS — The past several years have been transformative for Dan Smetzer.

Three years ago, the 55-year-old Cedar Rapids resident was admitted into Mercy Medical Center’s inpatient psychiatric ward and then found himself homeless.

But he’s worked to build back his life — he moved into a group home with Cedar Valley Community Support Services, found a job and now has a place of his own.

He’s also improving his health, mental and physical. He’s done it with the help of AbbeHealth and its Integrated Health Home program.

Integrated Health Homes — a state program for Medicaid recipients with a serious mental illness such as bipolar disorder or schizophrenia — work to provide whole-person, coordinated care. The agency now has an on-site clinic in addition to therapy services and has created care teams to help coordinate care with primary care doctors and the area’s major health systems.

The program is helping Smetzer quit smoking — he once smoked two and a half packs a day.

“I’m down to only two cigarettes a day,” he said.

And his care coordinator Devon Rickey helped him get a necessary back surgery.

The program has been so influential that Smetzer is training to become a peer counselor — an AbbeHealth employee who is member of the care coordination team.

“They’ve been on a journey with me the last three years,” he said. “They’ve been with me every step of the way. And all I’ve done is more up and up and up.”

This shift to treat mental and physical health together is relatively new, said Dan Strellner, president of AbbeHealth, a regional not-for-profit organization that provides mental health and aging services to more than 17,000 adults and children. Strellner, who spoke to The Gazette editorial board about the program on Jan. 12, said the system historically has been very siloed.

The idea is to combine both physical and mental health services to improve the health of those enrolled, in addition to improving bottom lines.

A large portion of individuals with a serious mental illness also have chronic health problems that often go untreated, Abbe officials said, due to lack of transportation, lack of a support system or other issues. Nationwide more than 60 percent of Medicaid members who suffer from a serious mental illness also have more than three other chronic health conditions. This can result in an average life span that is shortened by 25 years or more.

What’s more, Medicaid costs for individuals with both a chronic physical health condition and mental illness nationally are 75 percent higher than costs for Medicaid recipients without a mental illness, according to the AbbeHealth.

Building the program

Magellan Healthcare initially chose AbbeHealth to participate in a 2011 Integrated Health Home pilot program. The program was expanded statewide in 2013.

In the years since the expansion, AbbeHealth’s program has grown substantially from 250 participants to 2,600 in nine counties — or about 10 percent of those enrolled in an Integrated Health Home statewide, said Kathy Johnson, executive director of the Abbe Center for Community Mental Health.

The agency believes that by the end of the year it will have enrolled 300 more individuals into the program.

AbbeHealth also has added a good deal of staff to work with participants, Johnson said.

Some other program accomplishments:

l Completed health and wellness questionnaires on 99 percent of its enrollees

l Made certain enrollees had a preventive-care visit with a primary care physician

l Strengthened services to ensure 80 percent of those diagnosed with schizophrenia stayed on medications

l Developed care plans with a specific intervention strategy for individuals with a body mass index (BMI) of more than 35

l Calculated BMI testing with 90 percent of enrollees and conducted diabetic testing within six months for those with high BMI.

AbbeHealth also has increased staff to work with participants, Johnson said. When the program first began there were three employees, she said. Now there are 48.

The agency has put together teams of nurse care managers, care coordinators and peers — individuals with a mental illness at a point in their recovery to work with others — to coordinate physical and mental health services as well as provide educational services on efficient ways to use the health care system.

“For instance, you don’t need to go to the emergency room to get a pregnancy test,” she said.

Johnson said the team works to makes referrals, ensure participants show up at appointments, and receive necessary preventive care services, Johnson said. It also has added a “connection support” team — social workers who talk with outpatient offices.

This team was designed to decrease the no-show rate — which at one point was as high as 75 percent.

“We’re working with health care systems to keep them from being readmitted,” Johnson said. “We’re making sure they meet with their doctor for a follow up, that they’re picking up their medicine.”

Medicaid transition

The upcoming transition to Medicaid managed care will bring some changes ­on the payer side. Magellan, the company that provided managed care to the state’s Medicaid recipients receiving behavioral health services, stopped services at the end of 2015.

Meanwhile, the three managed-care companies that will take over care of the 560,000 Medicaid recipients on March 1 will inherit the Integrated Health Home program.

Magellan paid AbbeHealth a per-member/per-month fee for every participant enrolled. But part of that fee was not paid until AbbeHealth could prove it met certain benchmarks, such as creating a disease registry and testing clients for diabetes.

AbbeHealth intends to sign contracts with AmeriHealth Caritas Iowa, Amerigroup Iowa and UnitedHealthcare of the River Valley, but Johnson said originally the payment benchmarks differed.

The agency has had many meetings with the three companies to iron out the details, Johnson said, adding she feels more comfortable now than a month ago that the program will remain strong.

“We’re working with the (managed-care organizations) so that the benefit for the client remains,” Johnson said. “We’re working to build up those partnerships.”

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