The University Record, July 3, 2000

Health Program links mental, physical health care

By Kara Gavin
Health System Public Relations

In a pioneering effort to bridge the chasm between mental health services and medical care for Medicaid recipients and indigent patients, the Health System and the Washtenaw County Board of Commissioners have launched the Washtenaw Community Health Organization.

The innovative $50 million program began July 1 and aims to streamline care for thousands of local residents by bringing together the Health System's medical and psychiatric services and the mental health, developmental disability and substance abuse services provided by Washtenaw Community Mental Health (CMH).

The new system will attempt to overcome the current disconnect between mental and physical health care providers. It will make it easier and more cost-effective for persons with a mental illness, an addiction or a developmental disability to receive primary and specialty care at U-M facilities for their medical problems. It also will help U-M patients who qualify for CMH services to get treatment for mental health problems.

"This initiative addresses an immediate, serious need for better, nearly seamless care for those who often fall in the cracks in the health care system," says Gilbert S. Omenn, executive vice president for medical affairs and CEO of the Health System. "At the same time, it satisfies the state's desire to constrain Medicaid costs and change the way publicly funded mental health services are provided."

Washtenaw CMH director Kathy Reynolds adds that the partnership "brings together public institutions to take responsibility together for the taxpayer's dollars that help some of our county's most vulnerable people. We hope to show that the health care system can see these consumers as 'whole people,' and care for them in a way that makes more sense for everyone."

And, says David Neal, head of the Social Work in Psychiatry division of the Department of Psychiatry, "if it can work in Washtenaw County, it can work anywhere where medical and behavioral health providers have the will to join hands."

By bridging the gap between physical and mental health for public consumers, the new initiative seeks to overcome a separation that has grown in the years since state-funded mental health services moved from inpatient institutions with their own physical health infrastructure, to community-based programs coordinated by county CMH organizations.

The project addresses the tendency of providers to "cost shift," or steer indigent consumers to other services rather than bearing the cost of care themselves. This practice has caused some people to avoid seeking treatment for fear of red tape, causing their problems to worsen. A lack of coordination among providers also has allowed conflicts to arise between care decisions.

The new system will tie together CMH and Health System services with a single path to information, appointments and referrals. It will try to win the trust and cooperation of those who need care by maintaining their relationships with their providers and improving service to them.

The project is made possible by legislation sponsored by state senators Beverly Hammerstrom (R-District 17) and Alma Wheeler Smith (D-District 18), and signed by Gov. John Engler. It enables the formation of the Washtenaw Community Health Organization, to be founded and funded by the Health System and Washtenaw CMH as a new governmental entity.

"I was very pleased to introduce Senate Bill 1006 to help facilitate this wonderful collaboration of resources for the citizens of Washtenaw County," says Hammerstrom. "I have no doubt mental health consumers will benefit from this arrangement and that the U-M/Washtenaw CMH partnership will become a model for other communities."

The new organization will contract with the two partners for the services of existing staff, including unionized employees. Members of the schools of Social Work, Nursing and Public Health and the Medical School also will participate. A 12-member board will oversee the organization, with six members appointed by the county and six by the U-M. All were selected for their qualifications and interest in improving care; several are direct or indirect recipients of mental health services.

The project's managed care structure fits well with the Michigan Department of Community Health's plan to fund mental health services in the same way it funds other medical care by 2003. The state already has begun to reimburse mental health providers for services according to a fixed fee structure, and will soon ask them to assume total risk for cost overruns even as they compete with both the public and private sectors to provide services.

"As our state proactively seeks to improve quality and access for public health consumers while containing costs, this innovative program will set an example for other community mental health boards throughout Michigan," says Michigan Department of Community Health Director James Haveman.

The U-M already covers about half of Washtenaw County's 11,000 Medicaid recipients through its non-profit M-CARE managed care plans, and another 126 under the MIChild program for uninsured children. The Michigan Center for Diagnosis and Referral (M-CDR), part of the Department of Psychiatry, coordinates the Health System's mental health care admissions and referrals for these and other consumers. In addition, the Health System cares for about 1,000 indigent uninsured people each year through its Washtenaw Health Plan.

Though the U-M already provides both mental and physical care to many Medicaid and indigent consumers, there has been no way to coordinate that care, nor to ensure that consumers follow up on referrals to other services within or outside the Health System. The new program will allow Health System staff to track patients' use of U-M and county services through the online CareWeb patient information system. This may help reduce costs by allowing physicians in different systems to know what tests, medications and other treatments already have been provided to a patient by others.

Washtenaw CMH--one of the state's 49 CMHsserves thousands of residents with mental illnesses, emotional disorders, developmental disabilities and substance abuse problems. Under the new program, physical health services may be made available at some of its community-based mental health service sites.

In addition to encouraging providers to communicate, improving patient access and care, and containing costs, the partnership will allow University researchers to study what works and what doesn't when it comes to caring for this population.

"This will make it easier to find the best ways to improve care while containing costs," says medical director Tom Carli, clinical associate professor of psychiatry and director of the M-CDR. "We'll be able to analyze the cost of medications, look at how well certain therapies work, examine connections between mental and physical conditions, and determine which diseases and disorders have the highest treatment costs and opportunities for better management."

Washtenaw Community Health Organization Board

The six UMHS appointees are: Sallie R. Churchill, professor emerita of social work; Michael F. Dabbs, president, Brain Injury Association of Michigan; Diane K. Davidson, vice president, Destination Group, Interactive Division, Thetford/Norcold Corp.; Jean Magnano Bollinger, artist and human services volunteer; Donna Roth, retired deputy county administrator, Washtenaw County; and David A. Share, medical director, The Corner Young Adults Health Center.

The six Washtenaw County appointees are: Leila Bauer, retired Washtenaw County deputy treasurer; Barbara Levin Bergman, Washtenaw County commissioner; Barbara Chesney, professor of sociology, University of Toledo, and Washtenaw County resident; Peter Holmes, retired professor of psychology, Eastern Michigan University; Linda King, Washtenaw Community College Adult Transition Services supervisor; and Lafayette Wallace, consumer representative.