Care Delivery Systems

Hospitals and Clinics

Use Complexity-Based Integrated Physical and Mental Condition Services to Enhance Care Delivery System Profitability in a Parity Environment

Independent hospitals or care delivery systems composed of hospitals and clinics will be forced to increase efficiency and lower costs as payment reform is implemented. One of the ways to accomplish this is by introducing “value-added” mental health services and care management in the medical setting (see Table below). More efficient integration of inpatient medical and mental condition services, such as through Complexity Intervention Units, delirium prevention programs, or proactive psychiatric consultation services can reduce total lengths of stay for comorbid patients and lessen the need for constant observation nursing staff in confused or agitated patients. These three simple inpatient programs can lead to substantial cost savings far in excess of the cost of personnel needed to staff them through shortened lengths of stay (greater profits associated with DRG reimbursement) and reduction in unreimbursed nursing costs (for one-on-one supervision).

Once inpatients with comorbid illness and/or health complexity have been stabilized through inpatient integrated clinical programs then outpatient integrated services help maintain improvement. Other chronically ill and/or complex patients are never hospitalized, however, require integrated outpatient services to stabilize health and reverse high health service utilization. Integrated outpatient programs do this reducing unnecessary and costly testing in those with unexplained somatic complaints and turning treatment resistance into health when coordinated physical and mental health care is a part of patient centered medical homes or multispecialty medical groups. For patients with high health complexity who present the greatest health challenge for clinicians, the addition of individualized care, such as through integrated care management, can improve outcomes for high need/high cost patients by helping them overcome clinical and non-clinical barriers to improvement.

If one or more of these describes your situation...

• Inpatient mental health services and personnel do not coordinate and rarely communicate with inpatient or outpatient physical health services or personnel
• Moving inpatients from medicine to psychiatry units and vice versa requires discharge and readmission, rather than transfer
• Reimbursement for inpatient mental condition services is consistently associated with greater loss in income than other medical units
• Administrative staff are unfamiliar with mechanisms through which financially sustainable general and mental condition services can be developed and the type of integrated programs that would add value
• A culture of mistrust exists between physical and mental health practitioners and services

...Ways that Cartesian Solutions, Inc.™ can help

• By educating general medical and mental health personnel about the interaction of physical and mental illness, addressing interdisciplinary conflicts, and creating a vision of collaboration and cooperation
• By lowering poorly reimbursed or unreimbursed care through the creation of financially sustainable integrated service environments within care delivery systems and independent hospitals for comorbid and complex patients
• By improving profitability for care delivery systems and independent hospitals through guidance of health professionals in the development of value-added and evidence-based mental condition services in medical inpatient and outpatient settings
• By creating an opportunity for improved reimbursement from health plans and government agencies that value integrated care delivery for complex patients
• By assisting in the development of customized integrated case management (care coordination) for patients with health complexity

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

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