Purchasers of Health Care Products

Government Agencies

Maximizing Health Care Resource Use by Integrating Medical and Mental Condition Services for Enrollees with Health Complexity

Government agencies, whether federal, state, or local, supply public health insurance for those who are unable to afford or choose not to purchase private insurance, for the elderly, for those with serious pre-existing conditions (the uninsurable), and for those who can no longer afford their private insurance as a result of newly acquired illness or injury. As a result, enrollees in government programs typically have a higher illness burden and greater complexity. This creates a special challenge for government agencies that pay for the care delivered within a fixed budget. Thus, their enrollees have more difficulty accessing services due to benefit restrictions, due to poor-payment-based limited provider networks, or due to constricted services and/or service personnel in poorly reimbursed, fiscally strapped public delivery systems.

For government agencies, Cartesian Solutions, Inc.™ can bring significant value by helping them extend the health budget through the creation of clinical programs that reverse unnecessary high service use in enrollees with health complexity, many of whom have concurrent medical and mental conditions. Critical in this process is the expansion of programs that facilitate mental health service delivery in the general medical setting where high costs persist when mental conditions go untreated or poorly treated.

If one or more of these describes a government agency's situation...

• There is a disconnection between general medical and mental condition services, e.g., community health clinics that don’t communication with community mental health clinics about common patients
• There is high emergency room use and readmission rates for enrollees with chronic medical and/or mental conditions
• Social, special educational, and judicial system services are taxed by enrollees with chronic medical and/or mental conditions
• The provider network for enrollees is small and waiting lists are long because of non-competitive reimbursement rates for medical and mental condition services
• County or state-based care managers are over-extended for the population served, i.e., they lose effectiveness by trying to manage more enrollees than is possible given the level of complexity, and are discipline specific, i.e., segregated physical and mental condition management assistance and support

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

• Assist in the expansion of services delivered per dollar spent by insuring that health plans and management services target enrollees with high complexity and comorbid illness for integrated physical and mental condition care and integrated case management
• Assist in lowering medical service use while improving clinical outcomes by helping to build coordinated physical and mental condition service delivery in public programs, e.g., patient-centered medical homes, consolidated community medical and mental health clinics, accountable care organizations, complexity intervention units
• Auditing purchased care management vendor programs to insure that cost saving integrated interventions for complex enrollees are being used and that outcomes are measured and reported

Additional health-related expenses accrue for government agencies not because of poor employment productivity but as a result of increased social services use, e.g., housing, food stamps, unemployment; as a result of special education needs, e.g., poor academic performance or discipline problems in children who are a part of an unhealthy family unit; or as a result of criminal justice system involvement, e.g., crimes related to poorly treated substance use disorders or mental conditions. These can also improve as enrollee health improves.

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