Missouri Medical Risk Management Program a Focus of National Effort To Foster Best Practices in Caring for Chronically Ill Medic
23 November 2005 - 2:00AM
PR Newswire (US)
Possible outcome of project: showing states options to better
manage their Medicaid budgets while giving patients the care they
need PENNINGTON, N.J., Nov. 22 /PRNewswire-FirstCall/ --
Comprehensive NeuroScience, Inc. (CNS) has been selected as one of
10 organizations to join a national collaborative to improve care
for Medicaid consumers with numerous health issues. The Center for
Health Care Strategies selected 10 organizations, which are being
asked to develop and test models of care delivery for Medicaid
consumers with multiple chronic conditions. The Medicaid Value
Program: Health Supports for Consumers with Chronic Conditions is
funded by Kaiser Permanente Community Benefit with additional
funding from The Robert Wood Johnson Foundation. Each organization
will receive a grant of $50,000 for its participation in the
collaborative. When the two-year project is complete, the Center
for Health Care Strategies will issue a toolkit, providing an
opportunity for states, health plans, consumer groups and providers
across the country to apply the tools to improve the quality of
care for other Medicaid beneficiaries with chronic needs. CNS' work
will focus on the Medical Risk Management Program (MRM) it operates
for the Missouri Department of Mental Health and the Division of
Medical Services. The program is funded by Eli Lilly and Company.
"We are thrilled to be a part of this prestigious project. We
believe that MRM is a perfect fit for the program. This is an
excellent opportunity to demonstrate that coordinating mental
health with physical health improves overall health outcomes," said
Dr. Richard Surles, senior vice president of CNS. Surles explained
that Missouri's MRM program focuses on Medicaid recipients who are
diagnosed with schizophrenia, a severe mental illness that affects
up to 3 percent of the Medicaid population. People diagnosed with
schizophrenia are twice as likely to have major medical illnesses
such as diabetes, hypertension, health failure, asthma, digestive
and lung disorders (Marder SR, et al. Physical health monitoring of
patients. Am J Psychiatry. 2004. Aug; 16 (8);1334-49.) The disease
can lead to disability and long-term dependence on government
payers, especially Medicaid. In Missouri alone, over 19,000
Medicaid recipients had a diagnosis of schizophrenia with the top
2,000 of them having a combined cost of about $100 million for
pharmacy, medical and psychiatric services. Pharmacy expenditures
comprised only about 20 percent of the overall costs while the
majority were related to numerous urgent care, emergency room and
inpatient visits, according to CNS. "We see the MRM program as a
way for states to use disease management principles to get
appropriate care for these patients while controlling the costs
associated with their treatment," Surles said. The researchers
created an algorithm to identify patients with a diagnosis of
schizophrenia who are at higher risk of adverse health outcomes and
higher service (medical, pharmacy and behavioral) costs. Three
thousand individuals were identified and, in phases, are being
enrolled in disease management programs and services to better
manage their health care. For example, the patient's health care
providers can work together for: -- Greater patient adherence to
medication plans -- Fewer unplanned urgent, emergent and inpatient
hospitalization events -- A healthier patient with a better quality
of life "By addressing the patient's health care needs, we hope to
be able to show lower health care costs per patient when compared
to costs of similar patients not involved in the MRM program,"
Surles said. The researchers already are having opportunities to
share details about this innovative project. The algorithm was the
topic of a recent poster presentation at American Psychiatric
Association's Institute on Psychiatric Services Meeting in San
Diego. "We were very pleased to see that the predictive algorithm
identified the Medicaid recipients who have high medical services
and pharmacy expenditures. The model also identified patients who
have both severe medical and psychiatric illnesses," said Joseph
Parks, M.D., medical director of the Department of Mental Health.
"The next steps are to implement programs designed for this
population and measure key health outcomes. We are very excited
about the possible outcomes that could point to ways for states to
better manage their health care budgets while continuing to provide
high quality care for these patients." DATASOURCE: Comprehensive
NeuroScience, Inc. CONTACT: Anne M. McCabe of Comprehensive
NeuroScience, Inc., +1-518-580-9527
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