Quantifying integrated physical and behavioral health care in Medi-Cal: a resource to measure care across systems for adult Medi-Cal enrollees
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Connolly, Katrina, author Finocchio, Len, author Newman, Matthew, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, July 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated Medicaid Mental Disorders -- therapy Mental Health Services Substance-Related Disorders -- therapy Aged Behavioral Medicine Information Dissemination Managed Care Programs Primary Health Care Quality Indicators, Health Care Humans California United States
- Genre(s):
- Technical Report
- Abstract:
- Many adult Medi-Cal enrollees require care from multiple systems. People receive physical health services and mental health services for low acuity ("mild-to-moderate") conditions from Medi-Cal managed care plans. County mental health plans provide specialty mental health services for serious mental illness, and county Drug Medi-Cal programs provide treatment for substance use disorders. People Who Need Both Physical and Behavioral Health Care. People with serious mental illness and substance use disorders are at greater risk of physical illnesses including obesity, diabetes, and cardiovascular disease. Despite this increased risk, they are less likely to receive routine primary care. Social instability, motivation challenges, fearfulness, and stigma may all make it more difficult for people with serious mental illness to seek out physical health care, and accessing care in siloed systems can be particularly challenging because many of these patients require intensive coordination, outreach, engagement, clinical information sharing, medication reconciliation, and patient and family engagement. Unfortunately, we understand very little about how well the Medi-Cal program meets the needs of patients requiring care across these multiple systems. Managed care plans and county systems do not regularly exchange information about the patients they share. Providers in the various systems frequently complain that they do not know what kind of care their patients are receiving from other systems, including that someone in their care has been hospitalized. Medi-Cal enrollees themselves may face health risks if their primary care provider is not aware of their psychiatric prescriptions, for example. At the county and statewide levels, there is no comprehensive effort to assess the health outcomes of people who receive Medi-Cal services from multiple systems and who stand to benefit from improved integration efforts. While several current Medi-Cal efforts, including the Whole Person Care pilots and Health Homes Program, are aimed at addressing these care integration challenges for specific populations of members, there is no comprehensive approach to measuring the impact of these integration efforts. It does not have to be this way. Available Measures. Even in the current siloed system, there are some avenues by which to measure care across systems. In consultation with stakeholders and experts, the Blue Sky Consulting Group has identified a set of valid and reliable measures that managed care plans, county mental health plans, and county substance use disorder programs can collect, track, and use. With these measures, programs can quantify and monitor health outcomes for people who access (or should access) care across multiple systems--outcomes likely to be affected by the integration of care across systems.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (9 pages)).
- NLM Unique ID:
- 101758657 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101758657