As a longtime student and participant in the public health world, I know that our current bifurcated system of mental and physical health is based on decades of history.
It is no surprise to me that there exists a fundamental misunderstanding of how we should be addressing health overall given this dynamic. And data shows that the divided system is not conducive to the health of those in the system. The average person with a mental health issue in our state and around the nation has a far shorter life span than those without – and a lack of physical health treatments is the primary cause of that shorter life span.
We can and must do better, as science shows conclusively that these issues are very intertwined. Mental health problems often have their start in physical health issues such as opioid addiction being one easily seen today, and physical health issues can reinforce mental health challenges.
We know today that about 2/3 of the total Medicaid spend is on beneficiaries who have co-occurring conditions, (that is, chronic disease and behavioral condition). States all around us (red states and blue states) are melding their Medicaid program together to achieve integration and serve the “whole person”. That is simply what we hope we can do in Michigan.
Bottom line: Our current system does not work well for consumers and they all agree with that conclusion. The issue is how to fix it.
Health Plans in Michigan
Michigan’s HMO companies – a mix of non-profit and for-profit for example have a proven track record of working within a managed care environment to provide substantial health improvements in a cost-effective way.
The data is there. Compared to fee for service and other systems, our Medicaid Health Plans have provided more services, more physician encounters, more access to care and hundreds of millions of dollars in savings to taxpayers. A win-win recipe by any measure. The cost-effective is vital because, as we know, our state Legislature is not going to increase taxes in today’s environment, and the demands for health services among low income families continues to increase. That squeeze means we will do one of two things: We get smarter at providing services (mental and physical) or we ration care (not providing services to some, or reducing payments to providers, which effectively do the same thing). We must keep our eye on both “balls”, better care and the cost of care.
We have done that in the Medicaid program. I was present at the start of the experiment of managed physical health care in the late 1990s while employed at that time in the Medicaid program as we transitioned from the traditional fee for service model. The program has evolved, and today companies are carefully measured by the state on a host of indexes to ensure that those enrolled in the Medicaid system, both traditional and the expanded Healthy Michigan program, are getting better care every year in a measurable way. We are measured on whether our members are getting prenatal care, whether they are making appointments for regular checkups, getting diabetic care, taking their heart medicine, being given access to and are following up on smoking cessation…a host of specific measures. Year after year, Michigan’s Medicaid Health Plans are ranked among the best in the country by the National Committee on Quality Assurance, NCQA as published in Consumer Reports.
Our companies, for-profit and non-profit, compete to offer these services and consumers have choice regarding which plan to participate—characteristics not found in the behavioral system. Those who compete the best get a chance to provide services to more. Those who fall short get fewer opportunities. This is a smart, collaborative system. The data shows folks are getting better care, and the cost of delivering that better health care to a Medicaid patient has increased far, far slower than the cost of health care overall. It’s a win-win for the patient and the taxpayer.