State officials and insurers can learn much about improving healthcare delivery from a series of programs that are already getting impressive results.
That’s the premise being pushed by of a new coalition of healthcare providers and policy experts – the Good Care Collaborative – that is promoting the benefits of integrating physical, behavioral and addiction treatments and services.
And it’s kicking off its effort this month with the first of a series of site visits to facilities employing healthcare programs that are showing positive results.
A common thread runs through many of these programs – they’re proving the effectiveness of offering a comprehensive and coordinated set of benefits, including both physical and behavioral healthcare.
Collaborative members want to encourage state officials and insurance companies to break down the barriers separating how physical, behavioral and addiction treatment are provided and funded in programs like Medicaid.
The collaborative is coordinated by the Camden Coalition of Healthcare Providers, the 12-year-old organization led by Dr. Jeffrey Brenner that has gained national attention for its work in “hot spotting,” or using data to target healthcare toward patients who can most benefit from it.
Mark Humowiecki, Camden Coalition legal counsel and director of governmental affairs, said the collaborative is “very interested in building a constituency for good Medicaid policy.”
He noted that many different organizations have traditionally cared about Medicaid, but they have taken a narrow view of how Medicaid affects their individual groups.
Medicaid is the primary government program for providing healthcare to low-income people and is also the primary funder of long-term care.
Its impact on the state is significant – in the fiscal year ending in June 2012, Medicaid spent $10.39 billion in New Jersey, according to federal data posted by the Kaiser Family Foundation.
Of that total, 53.9 percent was spent on acute care, covering visits to doctors’ offices and hospitals, as well as tests and prescription drugs; 34.1 percent went to long-term care, including nursing homes, mental health care and care for people with intellectual disabilities; and 12 percent was spent on reimbursing hospitals for serving uninsured and underinsured residents.
Humowiecki said the collaborative is aiming to “elevate the discussion” of what Medicaid-funded program should look like, by focusing on programs that provide high-quality, community-based services.
As an example, the collaborative has invited healthcare leaders – including state Medicaid and insurance company representatives – to visit the Program of Assertive Community Treatment (PACT), a comprehensive rehabilitation and treatment program for people with serious mental illnesses — on February 26 at Bridgeway Rehabilitation Services in the Fords section of Woodbridge.
“It is really a model for helping people who used to be in state mental institutions who are now coming out into the community, helping them to live and function in the community,” through an array of behavioral health and other services, Humowiecki said of PACT. He said the program, developed in Wisconsin in the 1960s, has a track record of positive results.
Linda J. Schwimmer, vice president of the New Jersey Health Care Quality Institute, said the collaborative will offer models that can be emulated in a modified form throughout the state. The lessons gained from those models will provide lessons for private insurers outside of the Medicaid program, Schwimmer said.
“The fact that we’ve bifurcated the way we pay for physical health and behavioral health has really set us back,” said Schwimmer, who previously worked as an executive with Horizon Healthcare Innovations, a division of Horizon Blue Cross Blue Shield of New Jersey that focuses on programs increasing care coordination.
Humowiecki emphasized that the Camden Coalition itself has learned that patients’ physical problems are often related to behavioral or mental health conditions.
“We know from our experience that folks with significant behavioral health issues — if unaddressed — wind up using emergency departments and they wind up in jail” and using other expensive social services, he said.
Other future site visits may include programs targeting care for pregnant women, senior citizens and people with AIDS.
The collaborative may also host webinars.
“There’s not always the opportunity to have the conversation, to spur the conversation across what we think are artificial divides,” Humowiecki said. “The trajectory of healthcare is really toward integration.”