Care Delivery Systems

Retain Profitability by Coupling Delivery Reform with Payment Reform

During the next seven years, payment for clinical care will change dramatically as a result of national health care legislation. Emphasis on and payment for specialist care and inpatient services will go down while patient-centered medical homes (PCMHs) are projected to assume a central position as the health industry moves to greater financial accountability for the way that it administers and delivers health services to populations of patients. In fact, PCMHs are at the heart of accountable care organizations (ACOs), new poorly defined entities tasked with retaining care quality while lowering total health care costs.

Regardless, hospitals and clinics and the physicians and physician groups that provide care in them will be called upon to proactively introduce changes in the way that care is delivered for health care quality at lower cost to be achieved. Perhaps more importantly, care delivery systems, such as

• Accountable care organizations,
• Hospital networks,
• Independent hospitals,
• Multispecialty physician groups, and
• Patient-centered medical homes

will not survive financially unless they align how they provide care with future payment models.

To date, little thought has been given to the cost impact of untreated or poorly treated mental conditions seen in the medical setting where the majority of mental condition patients are seen (see Figure below). This is especially important for patients with chronic medical conditions, chronic mental health and substance use disorders, or health complexity. These patients, seen primarily in medical settings, are the ones that use 50% to 70% of health services, yet for whom limited or no reimbursement is received. Cartesian Solutions, Inc.™ experts can assist care delivery system clients in the application of strategies that improve both physical and mental health outcomes in these patients. This in turn can lower unreimbursed or poorly reimbursed health care service use.

If one or more of these describes your situation

• A high percentage of those with no insurance or poor insurance coverage have chronic medical and mental health conditions or health complexity
• A small number of chronic, treatment resistant patients with no insurance or poor insurance coverage account for a proportionately high percentage of poorly reimbursed inpatient and outpatient services, emergency room use, and unreimbursed early readmissions
• Mental health specialists are unavailable or their services are substantially delayed in inpatient and outpatient medical settings
• Medical services for chronic mental health patients are difficult to access
• The few mental health services available in the medical setting are poorly organized and of limited value
• Mental health care, regardless of setting, is consistently associated with lost clinical delivery system revenue
• Hospital stays are twice as long for medical patients with mental condition comorbidity
• Unreimbursed constant observation for behavioral issues in the inpatient medical setting is escalating
• High service use and cost persist in the same chronic comorbid physical and mental condition patients year after year
• Accountable care organization planners have not considered the importance of integrated physical and mental condition care for enhancing quality, which reduces costs

Ways that Cartesian Solutions, Inc.™ can help

Cartesian Solutions, Inc.™ experts have an intimate understanding of the interaction of medical with mental conditions, clinical payment processes, payment reform legislation, and the effect each of these will have on future health outcomes and health care service utilization. In short, seventy percent of patients with mental conditions, primarily seen in the medical setting, do not receive any mental health treatment. These patients, especially the ones with chronic medical conditions or health complexity, remain ill, thus, continue to use large amounts of unreimbursed or poorly reimbursed primarily medical services if ineffectively treated (see Figure below). Unless the poor treatment, high service use, persistent illness cycle is interrupted, care delivery systems can expect a consistent and growing population of unprofitable patients.

Cartesian Solutions, Inc.™ experts help care delivery system leadership increase profitability in four ways:

1. By working with clinical leadership to develop customized, cost effective, and value-added models of physical and mental health service delivery using evidence-driven approaches, including in patient-centered medical homes;
2. By assisting with the creation of payment contracts with health plans and government agencies that foster integrated mental health service delivery and care management in medical settings;
3. By augmenting physical and mental condition outcomes in chronic and complex patients thus lowering unnecessary poorly reimbursed or unreimbursed service use; and
4. By enhancing profit sharing potential for ACOs as they reconfigure system-wide care delivery procedures to maximize quality at lower cost

For more information or to set up an appointment contact: Mary Kathol, Director of Project Implementation.

Click the links below if

• You represent or work for a hospital or a care delivery network composed of hospitals and clinics
• You are developing a patient-centered medical home or multispecialty group with aspirations to include evidence-based onsite mental condition services
• You are creating an accountable care organization and wish to capture care quality and savings by integrating physical and mental condition services as a part of your system
  

Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com