Missouri Medical Risk Management Program a Focus of National Effort To Foster Best Practices in Caring for Chronically Ill Medic

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.,

[phone]

Copyright