Medicaid integration can be a health-care success story

mental health books

Across the country, efforts to integrate Medicaid behavioral health and physical health services to improve access and overall quality of care are under way. Regardless of what happens over the coming months, as Congress considers how to address the Affordable Care Act, these efforts will prevail because it just makes sense to treat and serve the “whole person.”

Rick Murdock

Rick Murdock recently retired as executive director of the Michigan Association of Health Plans.

The Michigan Association of Health Plans continues to believe that a transition to merge our government-financed mental health system with our current managed Medicaid system under a single accountable contract ultimately will do more to ensure individuals get all the care they need, when they need it, in a cost-effective manner, than any other proposal under consideration. 

Unfortunately, concerns were raised early last year with policymakers that a move to an integrated system would lead to lower quality service, or result in privatizing mental health care, even though privatization of the rest of Medicaid occurred years ago, and continues through the Healthy Michigan Program. Of course I’m biased, but the evidence seems pretty clear that integration can be achieved through the successful managed Medicaid program that we have in place today. Let me explain.

Members of the association I lead have used data-based, competition-driven, consumer-empowered managed health care solutions time and again to provide better care for low income families. Thanks to their smart management and the state’s outcome-driven regulations, we have seen improved outcomes for low-income beneficiaries in the Medicaid program while holding cost increases below the health care system as a whole. 

In addition to the traditional Medicaid population of pregnant women and children, Michigan’s managed Medicaid system today oversees health care for the disabled, children with special needs and foster-care children. All need and receive personal attention, care management and consumer-focused care. 

I am proud of my members who are annually ranked among the country’s best managed care organizations. This record bodes well for the future.

Our managed care system works so well, many people don’t even realize it has operated for 20 years, and today is responsible for effectively overseeing health care for nearly 2 million of Michigan’s 10 million residents. In 1996, the state opened to competitive bidding the opportunity for insurers, for-profit and non-profit alike, to manage services to the state’s Medicaid recipients.

The contracts are periodically rebid, most recently in 2015. Those eligible for Medicaid have the ability to choose from those companies who have won the bids in their regions. Each company develops lists of providers, and pays those providers for the services they deliver.  In fact, it was due to the existence of this delivery and management system that the Legislature was comfortable in adopting Medicaid expansion – the Healthy Michigan Program.

Through the bidding process, Medicaid health plans take all risk for providing all contracted services. Under this system, patients face no care rationing due to waiting lists or budget constraints. Companies have to perform, or the state will turn to another insurer to manage the caseload. That gives them an incentive to quickly identify those consumers needing complex and acute services and work with their own staff and health care providers to deliver early intervention. Properly delivered care coordination and disease management limits their exposure to higher costs; it’s far more cost effective to take extra steps to ensure a diabetic takes his or her medicine than to pay for an amputation and related after care. The same principle works as we move into integration.

How might this be applied to behavioral health? Throughout 2016, a number of groups have participated in state-convened meetings to consider whether and how to integrate mental and physical health care for low-income residents. Recommendations from this group address many of the issues raised by consumers but perhaps more importantly, the recommendations also validate that we have a system in need of reform.

We have the opportunity to move forward in Michigan. The so-called Section 298 report requested by the Legislature on how best to combine behavioral and physical health services is nearing completion. A final report is due in early 2017. Through careful and prudent decisions on pilot and demonstration models, Michigan has an opportunity to create a system that combines health management in a consumer-focused manner and incorporate the consumer designed recommendations coming out of the Section 298 report.

An integrated managed Medicaid system, merging behavioral and physical health care through contracted incentives and performance metrics for companies to meet all the needs of a patient can give patients better care than our current bifurcated system. 

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Nancy Kaplan
Sun, 01/08/2017 - 7:29am

I disagree! This would be a nightmare.

cHarley Mitchel...
Sun, 01/08/2017 - 9:07am

I agree with the views of the writer of this article. Michigan sorely needs fir Medicaid to include coverage for those who need Behavioral Health treatment, therapy, etc.

John Saari
Sun, 01/08/2017 - 9:44am

Treat and serve the whole person from cradle to grave is what this civilized society is moving to. Spreading the responsibility to as many as posssible including our selves. Pay as you go. Ability to pay. Profit accountability. The governments Fed, State, County and Twp must join for the success of each community. Imagine drones flying the borders, with tranc guns. A bigger drone picks up the unconscience trespasser and brings them back to their territory about 5 miles.

Barry Visel
Sun, 01/08/2017 - 9:47am

I have a child with disability. He has Social Security disability, MediCare and Medicaid. He signed up for supplemental insurance through the only option available to him in our county (no options available). A few months later the insurance company told him he no longer qualified for their insurance because he wasn't eligible for either MediCare or Medicaid...but, they wouldn't tell him which one...nor would they tell him where, specifically, they got their information ("his name was one a list they received from the State"). Upon inquiry, neither MediCare nor Medicaid could identify any gap had ever occurred in his eligibility. Letters to the DHHS director and state representative have gone unanswered. One accountability. This isn't the system I would depend on for mental health care.

Tommy Brann
Sun, 01/08/2017 - 2:01pm

Can I help? Do not know if can but will try. Not trying to step on anyone's toes but will try. 517 373 2277 Rep Brann

Sun, 04/02/2017 - 4:19pm

Rep Brann may I ask who has more control over policy, dhs or the legislature? I'm curious about the Ssdi/Medicare people being exempted by the legislature for the Obamacare expansion. Instead of my spend down disappearing it effectively TRIPLED to save money. Was that done by dhs by community health or by you guys. That also wiped out my access to dental. I also have been trying for years to get home health. No go because we were exempted from that expansion. Today I read after asking over and over case worker after case worker how I might have more support I read today that there is a state program I appear to be eligible for that is cash assistance )which I asked about). Unfortunately I can't find the income threshold ANYWHERE on line. even if it's 200 dollars a month over 5 years is upwards of 10 thousand dollars. that is about 1 years worth of income for me. Then I'm reading the money levied on gas and on registrations went back in to the general with a third of it going to the aca costs. How do we get answers because just like in some of these stories dhs will say it's the legislators the legislators say they don't know how it hapoened and nothing changes. I am so tired of fighting these battles just trying to survive. It just would be nice to have a way to consistently get groceries picked up and my sheets washed.

Sun, 01/08/2017 - 11:55am

Sounds like the insurance company just doesn't want to cover your child. So much for letting the marketplace respond to our needs. No wonder those in power don't want to think of healthcare as a right rather than a mere need.

Nick Ciaramitaro
Sun, 01/08/2017 - 6:24pm

As someone who was directly involved in the creation of the Medicaid Managed Care system in the late 1990's, what Rick fails to tell you is that everyone agreed at the time that a carve out for mental health services was necessary for the success of the program. That's because mental health services must go far beyond the traditional medical model and includes a great deal of support for successful community living. The Health Care plans have little or no experience in delivering those support services while the Community Mental Health system specializes in it. The CMH system does leave a great deal to be desired in a number of ares but so does the HMO system. Rather than the false premise of choosing between the two we need to look to using the best of both. Too many people fall between the cracks and don't receive essential services in both systems.

John S.
Mon, 01/09/2017 - 7:05pm

Managed care works best for areas of medicine that are like manufacturing widgets--straightforward diagnosis and predictable, standardized treatments and costs. It doesn't work so well in other areas that are more complicated and unpredictable. Mental health patients present a variety of complicated behavioral, health, and social problems that may not have solutions, are difficult to diagnose, and even more difficult to treat. I'd be very surprised if HMOs and their contracted providers are up to the task. What might happen? Performance measures will be developed and used that gauge the amount and quality of service delivery and not outcomes (improvements in behavioral, health, and social outcomes for patients). All will be doing their jobs, and doing their jobs well, as indicated by performance measures, but for little long term patient benefit. How do you hold service providers accountable for things over which they have little or no control? The surest bet is that a system will be designed that benefits HMOs and service providers first and foremost.

Adam P.
Tue, 01/10/2017 - 11:25am

What happened to individual choice? Why can't I choose to have my Insurance company help manage my mental health? At what point will the State let ME decide?