A pilot program designed to improve the health of people with severe and persistent mental illnesses will end July 1, but its backers say it hasn’t had enough time to show results.
In August 2014, Kansas began a “health home” program that put community mental health centers in charge of coordinating care for Medicaid patients with severe mental illnesses. In January, Budget Director Shawn Sullivan recommended that the state end the pilot program, which he says hadn’t produced significant results.
The federal government previously covered 90 percent of the costs related to health homes, but that percentage is set to drop to the usual Medicaid match, 56 percent. That would require the state to pay $13.4 million annually for the program starting in August.
Sara Belfry, a spokeswoman for the Kansas Department of Health and Environment, declined to release specific data about the health homes, but she says participants and a control group of people who had opted out of the program had similar results.
“For instance, we saw a similar decrease in (emergency room) utilization between these two groups and a similar increase in primary care physician visits,” she says.
KDHE will work with the health home programs and the three managed care organizations that administer Medicaid in Kansas — the privatized program called KanCare — to transition patients to other forms of care coordination, Belfry says.
“Many of these members will also be eligible for targeted case management,” she says.
‘Still in its infancy’
Bill Persinger, CEO of Valeo Behavioral Health Care in Topeka, says the center had seen some improvements in health home patients’ health, and it plans to meet with the state to discuss continuing the program. Health homes still could reduce costs by integrating care if the state gave the program more time, he says.
“It’s kind of still in its infancy,” he says. “The program hasn’t even been around two years.”
Valeo had nine employees working with the health home program to help patients set health goals and plan their care to reach those goals, Persinger says. The employees also would coordinate services and follow up to remind patients of their appointments, he says.
Tami Wichman, a registered nurse in charge of the health home program at Valeo, says the health home staff spent much of the program’s first year reaching eligible people and building trust. Some patients also needed to learn basic information like how to find a primary care doctor and arrange appointments, she says.
“We’ve laid down the foundation,” she says. “Now people are calling us saying, ‘How can I get in your health home?’”
But the health home employees do much more than arrange appointments, Wichman says. Staff help patients develop health action plans with their goals every 90 days, she says, and provide assistance to navigate the employment system, find dental care or take care of basic needs like food and shelter.
Costs are down for the group as a whole, Wichman says, but individual results vary because some patients need more help than others.
“Some of the people, it’s taken them almost a year to build up enough trust to make an appointment,” she says. “We’ve had people lower their A1C (blood sugar) to normal levels.”
Wichman says she is concerned the state doesn’t have enough data to know if the health homes were effective in improving health and lowering costs.
“I do think this is a long-term commitment, and it would be difficult to see large results on paper at this time,” she says.
No clear evaluation cutoff
Researchers who have evaluated health homes says there isn’t a clear cutoff point for knowing whether a program has been effective.
Mark Friedberg, a senior natural scientist with RAND Corporation, says health home programs and their results vary.
Reduced hospital use and costs are measures that states can examine to tell if a program is working, Friedberg says. Ideally, however, state officials also would consider whether patients are more likely to get recommended care and screenings and if patients and providers report they are satisfied, he says.
“The more you’re able to observe all of the outcomes you’re interested in, the less likely you are to miss something important,” he says.
Meredith Rosenthal, professor of health economics and policy at Harvard University’s School of Public Health, says it isn’t clear if two years is long enough to evaluate whether a health home was effective. She says she hasn’t heard of any studies on applying the health home model to patients with serious mental illnesses, whose needs are typically more complex than the general population.
In some cases, costs may even go up in the short term because people with serious mental illnesses may have other health needs that they haven’t been able to seek care for, Rosenthal says.
“Maybe in the long run this will improve health and possibly even save money, but only after needs are better met,” she says. “Stopping a pilot after less than two years, unless there was harm, seems premature.”
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC