Heather Rae, CEO, Common Ground: “The module is about providing peculiarity alternatives to psychiatric quadriplegic hospitalization, not about preventing indispensable admission.”
A partnership between Molina Healthcare of Michigan and mental health provider Common Ground in Bloomfield Hills is rebellious arguably a many costly and chronically ill patients in a health caring system: those who are dually enrolled in a Medicare and Medicaid programs.
Nationally, 9 million dual-eligible patients, including 200,000 in Michigan, comment for 40 percent of all Medicaid spending and 27 percent of all Medicare spending. Care costs sum about $350 billion a year, or 9 percent of a nation’s $4 billion annual health caring tab.
The Molina-Common Ground agreement is one instance of providers operative together to cut into those high costs.
It works like this: Under a contract, participating hospitals in Genesee County hit Common Ground when a Molina member comes into a puncture dialect with an strident mental health problem.
Within 30 minutes, a member of Common Ground’s predicament involvement and liberation group arrives during a sanatorium to consider a Molina member, pronounced Heather Rae, CEO of Common Ground.
Upon conference with a sanatorium puncture doctor, a studious is possibly certified to a sanatorium or diverted to Common Ground, where a studious receives a smallest of 30 days of outpatient care, Rae said.
If hospitalized, a particular is followed by Common Ground by face-to-face encounters and by write for 30 days.
Participating hospitals in Genesee County embody McLaren Flint and Hurley Medical Center in Flint.
During a initial year of a project, that began in early 2014, 19 of 39 patients, or 49 percent, who went to a sanatorium ER in Genesee County were successfully diverted to redeem during home and were not admitted.
Molina netted assets of $75,825 after profitable Common Ground for a services, that led to a lapse on investment of 4.15 to 1.
“The assets are significant,” pronounced Jim Forshee, M.D., Molina’s medical director. “We wish to enhance this program. Some of these patients don’t need to be hospitalized. Outpatient caring is a improved alternative.”
Patients with mental health issues finish adult during a sanatorium ER for a accumulation of reasons.
“They have a self-murder threat, they aren’t sleeping well, maybe they are violent with family members or have a remedy problem since their meds have changed,” Rae said. “Usually it is after 5 p.m., and they have no place to go.”
Forshee pronounced many patients who go to ERs with behavioral problems are in a predicament situation.
“They have domestic problems, romantic outbursts and are sick,” Forshee said. “Some are conference voices and saying spiders.”
Rae pronounced too many people with mental health issues are certified to hospitals for regard and diagnosis since ER staff are some-more lerned to conduct medical emergencies and not understanding with mental illness.
“The module is about providing peculiarity alternatives to psychiatric quadriplegic hospitalization, not about preventing people from a indispensable acknowledgment to a hospital,” pronounced Rae.
Rae pronounced a ER involvement judgment was a brainchild of former CEO Tony Rothschild, who late from Common Ground in October.
“Molina was really interested,” Rae said. “These programs have improved outcomes during a revoke cost to taxpayers.”
Common Ground is paid dual apart fees — initial comment and 30 days of outpatient services. “This is not a income center,” Rae said. “We don’t make a lot of income on it since it isn’t a purpose.”
Last March, a sovereign proof module began in Michigan and 9 other states to revoke costs of thousands of dual-eligible patients and to urge their caring coordination.
Under a agreement with a Michigan Department of Health and Human Services, Troy-based Molina is holding caring of several thousand dually authorised Medicare and Medicaid patients in a sovereign proof module in Macomb and Wayne counties.
Molina is one of 7 other HMOs and 4 mental health agencies participating in a Centers for Medicare and Medicaid Services‘ proof in Michigan. The idea is to cut 7 percent of costs over a subsequent 3 years.
Because a dual-eligible race is growing, Molina expects to enhance a ER diversion module with Common Ground and other mental health providers. He pronounced a tip reason for a dual-eligible studious acknowledgment to a sanatorium is behavioral health issues.
“Half of a visits of dual-eligible patients with mental health issues are now admitted,” pronounced Forshee, observant that before a module began, roughly all ER visits with mental health problems resulted in admission.
Greg Matzelle, Molina’s behavioral health manager, pronounced usually one studious so distant has been readmitted to a sanatorium in a same week after being assessed. “We try to commission a studious to go behind to their medical home and primary caring physician,” he said.
Rae pronounced Common Ground and Molina are articulate about fluctuating a corner module into Oakland County, where Molina estimates about 200 Molina patients could use a use in 2016.
Forshee pronounced cost assets in Oakland County could be aloft since there are some-more dual-eligible patients and since Common Ground has some-more resources.
For example, Rae pronounced that final year Common Ground combined dual new services to a Oakland County program: a 23-hour medically supervised regard module and a predicament residential section during Common Ground’s Resource and Crisis Center during a Oakland County bureaucratic formidable for county workers and other patients.
Over a past 10 years, Common Ground has helped Oakland County save income by shortening a series of employees certified to hospitals for behavioral health issues.
Rae pronounced Common Ground would like to enhance a module to other health skeleton in Genesee, Oakland, Wayne and Macomb counties. It also is articulate with another HMO in western Michigan, she said.
Another advantage to a ER diversion module is that it has helped assuage a necessity of psychiatric beds in hospitals.
“Nurses infrequently have to hunt around for an accessible bed, infrequently in a opposite unit,” he said.
“We’ve had patients send from Genesee County to Macomb County for a bed.”
Jay Greene: (313) 446-0325. Twitter: @jaybgreene
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