Tri-County Effort Assumes leadership to Address Comprehensive Care, Cost Savings

An initiative that began this fall at Tri-County Mental Health Services is targeting a new combination of cost savings and improved services.

Called Healthcare Home, the program is designed to ensure well-rounded care that addresses the frequent physical health issues facing mental health consumers. At the same time, the emphasis on preventative care, care coordination and eliminating unnecessary emergency care is expected to bring significant cost savings.

Straightforward Goals

Director Robbie-Joe Hughes, who is both an R.N. and Licensed Professional Counselor, noted that the initiative is a statewide effort that grew out of the Affordable Care Act of 2010. But while the fine print is complex, the overall plan and its goals are straightforward.

“The idea is to identify what needs to be done to treat our consumers comprehensively, to treat the 'whole person,'” Hughes explained. “We're bringing a lot of pieces together to make it work better for our clients and for taxpayers.”

Though not widely recognized, those with a mental illness frequently face serious physical health issues, from diabetes to heart and lung disease. These health issues not only add to what can be an overwhelming mental health challenge, they often aggravate the mental health issues. This is a significant reason why people with serious mental illness, on average, die 25 years sooner than the population at large.

“Sixty percent of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases,” Hughes said.

In some cases, mental illness itself makes consistent medical care difficult. Some psychiatric medications can add to the risk of diabetes or other metabolic issues. Substance abuse and lack of preventative or wellness efforts are also widespread.

Collaboration and Communication

Until now, the health system has not been successful in bridging that gap. “Services between and among mental health, primary care and chronic care specialists are often disconnected,” Hughes explained. “Healthcare Homes are designed to make sure that the health care needs are identified and coordinated in such a way that the whole person is receiving all the aspects of care they need and deserve.”

Hughes said the effort represents a significant step. “Missouri is the first state to implement Healthcare Homes in concert with community mental health centers,” she said. “The rest of the United States will be looking at us.”

The key to the Health Home strategy is collaboration. In many cases, the effort will not add services but simply ensure they are available if needed and that different providers are communicating. Although it sounds like common sense, health care so far has been typified by huge gaps that mean one provider may not know what another is doing. Patients may receive no treatment for serious issues or it comes in the form of ultra-expensive emergency room visits.

“The Healthcare Home is the bridge,” Hughes explained. “It won't provide all of the services but will shift from reactive health care delivery to proactive health promotion and chronic disease self-management, using education and health promotion to do that.”

The program will cover Tri-County's entire Clay, Platte and Ray County areas. Clients must have one of three conditions to meet the program's criteria, including serious mental illness or mental health and physical health issues, or a mental health condition and substance use disorder. The first efforts are focused on current Tri-County Medicaid clients, approximately 480 people.

Helping People, Reducing Costs

Avoiding or reducing their challenges makes both financial and humane sense. “With the rising cost of quality health care,” she said, “health education, wellness training and prevention measures are as significant as treatment and rehabilitation.”

Tri-County is also examining options for a primary care collaboration to meet the health care needs of the Healthcare Home participants. “The bottom line includes both improved care coordination and financial issues such as Medicaid costs,” Hughes said. “We're looking at alternative sources to provide the most efficient services while improving the overall health care of the people we serve.”

For more information on Tri-County and its services, visit www.tri-countymhs.org or call (816) 468-0400.

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