Mental health disorders were the most common reason Lancaster County’s most costly and vulnerable patients were admitted to hospitals last year, according to a first-of-its-kind study released this week.
The news didn’t surprise local health care providers, who have been working for several years to strengthen the mental health care system here.
“Chronic medical problems, coupled with behavioral health issues, serve to drive a disproportionate amount of care,” said Dr. John Wood, medical director of Lancaster General Health’s Care Connections program. “The intersection of these health problems is what we are trying to navigate and break through.”
The study by Pennsylvania Health Care Cost Containment Council focused on superutilizers: The 3 percent of patients responsible for many emergency room visits and 14 percent of all Pennsylvania hospital stays last year.
Superutilizers are a focus of health care reform because they have complex conditions and lives that the standard American health care system does not serve well. They also cost Medicare and Medicaid — and therefore taxpayers — a lot of money.
Advocates say properly managing those patients and their conditions could make unnecessary much of the costly care they currently receive. That would relieve pressure on the health care system, improve lives and save money.
Care Connections, which started in 2011, and WellSpan Health’s Bridges to Health, which started in 2012, are two local attempts to do just that.
Both were included in a separate Aligning Forces for Quality study released last fall. It found superutilizer programs in Pennsylvania saved about $717 per patient per month. It also found that 89 percent of patients had behavioral health disorders and that, in Lancaster County, 3 percent of Medicaid patients account for 51 percent of all Medicaid spending.
The programs work by focusing on the underlying reasons why patients have poor health, then marshaling an intensive, coordinated effort to address them.
Patients receive home visits; extra reminders about appointments and taking medications; help in finding safe housing and reliable transportation; and, in many cases, assistance with mental health concerns such as depression and anxiety, which exacerbate their physical conditions.
“Sometimes the depression or the anxiety can be the reason that a person with a chronic medical problem will go to the hospital in the first place,” said Allen R. Miller, a WellSpan psychologist.
Integration for everyone
The integration of medical and mental health care that superutilizers get in programs like Care Connections and Bridges to Health is something advocates would like to see for everyone.
Alice Yoder, director of community health and wellness for Lancaster General Health, is leading the Lancaster County Mental Well-being Collaborative, which formed last year. Primary care doctors have been thinking about integrating mental health care for a long time, she said, but doing that effectively requires careful planning.
“How do we redesign the system so it's seamless?” she asked. “How do we address the stigma issue?”
The group is starting by taking a survey of local mental health assets, looking at everything from where they are located to whom they serve, how affordable they are, and how long patients typically wait for service.
“This is an area of major gap in our community,” Yoder said. “It has been heartwarming in terms of all the providers that have come around the table.”