Three research studies of programs and services offered by Mercy Maricopa Integrated Care (Mercy Maricopa), a Medicaid managed care plan, to address social determinants of health found some components of the programs can reduce cost and improve quality of care for people with serious mental illness in Maricopa County, Arizona.
Mercy Maricopa and one of its sponsors, Mercy Care Plan, are fully administered by Aetna Medicaid, which assumes the operational and management oversight of the health plans, including the hiring of all health plan staff and the provision of financial, clinical and operational services and systems. Mercy Care Plan and Mercy Maricopa are not-for-profit 501(c)(3) organizations. Mercy Maricopa is sponsored by Mercy Care Plan, Dignity Health, Ascension Health, and Maricopa Integrated Health System. Mercy Care Plan is sponsored by Dignity Health and Ascension Health.
The studies, published on Jan. 10, 2018, were commissioned by Aetna, but conducted by the independent research institution, NORC at the University of Chicago.
The NORC studies looked at the experience of members enrolled in supportive housing, supported employment, and Assertive Community Treatment services, as well as the applicable program’s effect on the cost and quality of care and the utilization of services by adults with serious mental illness. The services in Maricopa County are combined at single community provider locations to make sure members have access to supportive services, as well as physical and behavioral health care.
The research findings suggest shifting services from more intensive inpatient and residential stays to outpatient and routine behavioral health care focused on chronic illness can affect cost and quality of care.
“Working collaboratively with providers, local stakeholders, the City of Phoenix, Valley of the Sun United Way, and the state of Arizona, we have shown that fully integrated care addressing social factors is the right way to meet the needs of Medicaid members with complex conditions,” said Mark Fisher, CEO of Mercy Care Plan.
“These studies validate the critical importance of addressing basic social needs to improve members’ physical and mental health,” said Laurie Brubaker, head of Aetna Medicaid. “Working with our community partners, Aetna Medicaid continues to invest in innovative tools and programs that can significantly improve the lives of our members, and the members we manage, right in their own communities.”
Addressing social determinants of health leads to positive health outcomes
The research found that members enrolled in the supportive housing intervention experienced decreases in total cost of care of 24 percent after enrolling in the program, while members in the Assertive Community Treatment intervention experienced significant reductions in certain costs, including a 6 percent relative decrease in per member per quarter costs in behavioral health professional services, an 11 percent relative decrease in health facility costs, and an 8 percent reduction in emergency department visits.These reductions were per member per quarter and represent the approximate difference in total cost before and after the receipt of supportive housing services and are not necessarily directly attributable to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. For housing, this analysis found that there was a reduction in total cost of care of $5,002 per member per quarter relative to a comparison group.
Members enrolled in the Scattered Site housing program had an average health care cost of about $20,000 per member per quarter in at least one quarter before starting in the supportive housing program.2 After enrolling in the supportive housing program, members experienced a $4,623 reduction per member per quarter in total cost of care. These members also had fewer psychiatric hospitalizations than they had before enrolling in the program.
While supported employment led to an increase in overall costs for enrolled members, likely because of the cost of the supported employment services and increases in other services, members who received supported employment services experienced varying degrees in reduction in both inpatient medical and psychiatric hospital stays, including a 35 percent decrease in inpatient medical hospitalizations.These reductions were per 1,000 members per quarter and represent the difference in total cost of cost before and after the receipt of services and may not be directly attributed to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. Members in the Assertive Community Treatment program, averaged 187 fewer outpatient emergency department visits per 1,000 members per quarter relative to those who did not receive the services, which was a significant decrease in utilization.
Continuing support for better community health
Mercy Maricopa and its partners showed a commitment to prioritizing member needs and a dedication to working with community stakeholders to ensure those needs were identified and addressed. Qualitative findings from this research suggests, that the increase in social support led to increased focus by members to obtain and regularly use sources of care – decreasing the need for emergency or inpatient services.
Integrated care streamlines the process of accessing care for members with serious mental illness. Having services within the clinics, for example, allows clinical teams to send a direct referral to a supported employment provider – enabling members to access these services immediately and reducing the interruption that occurs when members need to seek care somewhere else.
Continued education among clinicians and staff is also important to ensure they’re familiar with changes, additions, or new programs to help them provide better care to members. Mercy Maricopa created educational toolkits, known as Placemats or decision trees, to inform its staff of the discharge referral process. This way, members are provided with support and resources to help them remain healthy.