Structuring the Integration of Care Management Services For Medicaid Enrollees Recipients With Chronic Illness, Substance Abuse Problems and Possible Psychiatric Disorders
Structuring the Integration of Care Management Services For Medicaid Enrollees Recipients With Chronic Illness, Substance Abuse Problems and Possible Psychiatric Disorders
The study seeks to measure the effect of increased coordination of care on medical costs,
 treatment utilization and selected clinical indicators among a Medicaid population with
 chronic medical conditions and substance abuse problems? We shall address this question by
 conducting a demonstration project consisting of the provision of integrated care management
 (somatic and behavioral) to Medicaid enrollees living on the Eastern Shore of Maryland and
 who have both chronic medical conditions and problems with substance abuse. A specific
 component of the study will be the participation of Maryland's Mental Health Administration
 (MHA) and MAPS, the administrator of psychiatric services for the Medicaid enrollees in
 Maryland. We shall compare the results of the integrated care management for the study sample
 on the Eastern Shore with a control group from the counties of western Maryland.
Problem in context. In an environment of increased competition for governmental funding,
 Medicaid programs in every state are bracing for decreased resources being available for the
 care of their enrollees. A possible result of less funding is reduced quality of healthcare.
 In response to this threat, The Center for Health Care Strategies, Inc, (CHCS) a non-profit
 organization dedicated to improving the quality of publicly financed health care, issued an
 RFP for participation in a multisite project to expand or enhance existing efforts to improve
 the way care for Medicaid enrollees with multiple chronic conditions is delivered,
 integrated, measured and financed.

 Present knowledge. While there is strong documentation of improved population health status
 with care management, the evidence for the immediate economic effects of care management
 initiatives is mixed for commercial and absent for Medicaid populations. CHCS is presently
 conducting a multisite study (in which we participate) of whether or not a business case
 (return on investment) can be made for quality improvement initiatives in a Medicaid
 population.

 Research question. What is the effect of increased coordination of care on medical costs,
 treatment utilization and selected clinical indicators among a Medicaid population with
 chronic medical conditions and substance abuse problems? We shall address this question by
 conducting a demonstration project consisting of the provision of integrated care management
 (somatic and behavioral) to Medicaid enrollees living on the Eastern Shore of Maryland and
 who have both chronic medical conditions and problems with substance abuse. A specific
 component of the study will be the participation of Maryland's Mental Health Administration
 (MHA) and MAPS, the administrator of psychiatric services for the Medicaid enrollees in
 Maryland. We shall compare the results of the integrated care management for the study sample
 on the Eastern Shore with a control group from the counties of western Maryland.

 The primary goal of the project will be to improve the coordination of medical, substance
 abuse and mental health services for a group of Medicaid beneficiaries with chronic medical
 conditions. We hypothesize that the recipients of integrated care management (on the Eastern
 Shore) will have lower total medical costs (pharmacy, inpatient and outpatient), higher
 utilization of mental health and substance abuse services and lower use of emergency
 department services than those who received customary care (in western Maryland).

 The secondary goal of this project will be to assist in the further development and piloting
 of information systems within MHA that will facilitate sharing of clinical information
 necessary for the coordination of behavioral (mental health and substance abuse) and medical
 care management between a Medicaid MCO (JHHC's PPMCO) and the mental health carve-out ASO,
 MAPS-MD. The outcome measurement for the secondary objective will be the extent to which an
 information system for coordination of care and population based queries has been established
 within MHA and is, with proper oversight by MHA, accessible to responsible entities.

 Significance. The project targets a vulnerable population within Medicaid enrollees that are
 challenged when accessing care and are responsible for high total medical costs. The results
 of the project should be helpful to other the MCOs in Maryland's Health Partners, as well as
 to states with similar Medicaid systems as they seek to provide integrated healthcare
 services to their populations.
Inclusion Criteria:

 1. 21 years of age or older;

 2. Resident of one of the following Maryland counties: Caroline, Cecil, Kent, Queen
 Anne's, Talbot, Dorchester, Somerset, Wicomico, Worcester, Allegheny, Frederick,
 Garrett, Washington, Calvert, Charles, or St. Mary's; or

 3. Chronic medical condition(s) identified by ACG Case Mix software (e.g. an ACG score =>
 0.10) as likely to incur high costs in the following year; and

 4. Substance use problem in the past 27 months as indicated by an ICD-9 code or CPT code
 on DHMH list for Special Needs Population.

 Exclusion Criterion.

 1) Enrolled in or eligible for enrollment in a Special Needs disease management program at
 JHHC: HIV/AIDS, Partners with Mom, Omega Life. It is necessary to exclude these programs
 because PPMCO members are already receiving intensive care management.