Modern medicine often views the mind and body on separate tracks, both in terms of treatment and health insurance reimbursement. But patients with psychological disorders can have a hard time managing their physical health. So some Medicaid programs, which provide health coverage for people with low incomes, have tried to coordinate patients’ physical and mental health care. The goal is to save state and federal governments money while improving the health of patients.
Tennessee’s Medicaid program, known as TennCare, has more than 100,000 patients who have had a psychiatric inpatient or stabilization episode, along with an official mental health diagnosis — depression or bipolar disorder, maybe, or, as in Poynter’s case, alcohol addiction. Coordinating mental and physical health care presents business challenges because, typically, two different entities pay the bills, even within Medicaid programs. That’s why TennCare started offering incentives to reward teamwork.
TennCare’s interdisciplinary program, known as Tennessee Health Link, was launched in December 2016. The first year, the agency paid nearly $7 million in bonuses to mental health providers who guide patients in care related to their physical health. TennCare has a five-star metric to gauge a care coordinator’s performance, measuring each patient’s inpatient hospital and psychiatric admissions as well as visits to emergency rooms. Providers are eligible for up to 25% of what’s calculated as the savings to the Medicaid program.
Studies show this sort of coordination and teamwork could end up saving TennCare hundreds of dollars per year, per patient. And a 2018 study from consulting firm Milliman found most of the savings are on the medical side — not from trimming mental health treatment.
In experiments around the U.S. among varied patient populations, savings from care coordination at times have been elusive. A TennCare spokesperson said it’s too early to tell whether its program is either improving health or saving money. As a start, though, TennCare reports these dual-track patients are visiting the ER less often.