Coordination of Care with Primary Care Physicians (PCP)

Third Thursday Provider Call

(February 19th, 2015)

Why Coordinate Care with PCP?

There are several reasons why coordination of care with those diagnosed with mental disorders is vital for quality care:

• High rate of co-morbidity of mental and physical conditions

• Increased morbidity and mortality

• Increased high risk behaviors

• Side effects of psychotropic medications

• Mental disorders such as depression and schizophrenia can influence the progression of serious chronic diseases such as arthritis, diabetes, stroke, heart disease & cancer.

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Mental Health and Medical Comorbidity

• 68% of adults with mental disorders in the US have medical conditions that require treatment Source: Druss, B.G., and Walker, E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: the Robert Wood Johnson Foundation.

Physical and Behavioral Health Co-occurring Conditions

58% of Adults have Medical Conditions

25% of Adults have Mental Health Conditions

29% of Adults with Medical Conditions Also Have Mental Health Conditions 68% of Adults with Mental Health Conditions Also Have Medical Conditions

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Increased Morbidity & Mortality

• According to SAMHSA, only 7.4% of these individuals with comorbidities receive treatment for both conditions

• Research indicates individuals with SMI die on average 25 years earlier than the general population.

• 3 out of every 5 persons with SMI serious die from preventable health conditions (www.thenationalcouncil.org/resourcecenter)

• The primary medical conditions that reduce the life spans of those with SMI are: Cardiovascular disease

Diabetes & kidney failure

Respiratory diseases

Infectious diseases (including HIV/AIDS)

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SMI Often Engage in High Risk Behaviors

• Smoking • Alcohol/drug use • Poor nutrition • Obesity/lack of exercise • Unsafe sexual behaviors • Risk taking behaviors that lead to injuries • Life in group residential facilities & homeless shelters expose people w/ SMI to more infectious diseases

There is clear need in this population for both mental

health and medical treatment.

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Risks Associated with Pharmacological Treatment

• Atypical antipsychotics have become the first line of treatment for many psychiatric diagnoses

• There are many potential adverse side effects with these medications that require frequent monitoring, including:

– Metabolic syndrome (↑weight, Diabetes Mellitus, ↑lipids)

– Irregular heart rate

– Extra-Pyramidal effects: Tardive Dyskinesia

– Agranulocytosis (severe lowered white blood count)

– Neuroleptic Malignant Syndrome

– Orthostatic hypotension (sudden drop in blood pressure)

– Anticholinergic side effects

– Akathisia (unpleasant sensation of restlessness)

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Antipsychotic Monitoring

• Fasting blood glucose is done at baseline and monitored

when commencing or changing antipsychotic medication and then every 3-6 months.

• A full blood count should be conducted every 3-6 months as best practice.

• Weight/Body Mass Index (BMI) should be checked at every visit or every three months.

• Only 20% of patients on atypical anti-psychotics receive needed glucose monitoring and only 10% receive lipid monitoring. (http://www.medpagetoday.com)

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PCP’s Can Play a Key Role in Mental Health

• IOM (2005): To achieve optimal health outcomes with SMI it is imperative to integrate primary care w/ mental health care

o PCP’s are vital in their roles in monitoring and treating medical conditions that result from and contribute to mental disorders, refilling & refilling meds, encouraging mental health visits & communicating with MHP’s

• Critical shortage of more than 20,000 psychiatrists nationwide

o 33% of adult psychiatric patients treated by PCPs. (www.ama-assn.org)

o 75% of children diagnosed with mental health disorders are now treated by PCP’s. (www.nihcm.org)

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Local Trends

Magellan worked with inpatient hospitals in 2013 to identify trends related to coordination of care:

• All Medicaid patients have an assigned PCP, but 68% of surveyed patients either didn’t know that or the name of their PCP.

Lessoned learned: PCP is identified on member’s Medicaid card. If

member does not have card at intake, it is important to follow up with member and/or family to get Medicaid card while member is being treated

• Most who don’t know they have a PCP would like a referral.

• Only 6% of patients refused to sign a release.

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Who is Responsible?

49%

32%

13%

4% 2%

Locations for Treatment for Behavioral Health Conditions

Rx Only

Outpatient and Rx

Outpatient Only

Combination of Inpatient, Outpatient, and/or Rx Inpatient Only, Rx

All providers are responsible for coordination of care: Most individuals seek treatment for behavioral health services on an outpatient basis.

Source: Kaiser Commission on Medicaid and the Uninsured. (April 2011). Mental Heath Financing in the United States: A Primer. Washington, DC.

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How can you help?

• Conduct a comprehensive assessment to identify physical health comorbidities at the initiation of treatment

• Educate members on the association between mental health and physical wellness

o Assess the patient’s degree of understanding

• Get member connected with PCP if medical comorbidities are identified.

• Check in with member to make sure that the are making scheduled PCP appointments.

• Assist member is scheduling lab visits.

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Finding a PCP

What can you do if the member does not know or have a PCP?

o Helpful Tip: The assigned PCP is identified on the back of the member’s Medicaid card

o If member does not have Medicaid card, contact relevant Bayou Health Plan to assist

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Walking the Walk - Magellan’s Role

Magellan makes coordination of care with PCP a priority:

• Magellan is actively working with Medicaid and the Bayou Health Plans to create a centralized database to improve identification of member PCP

• Magellan conducts clinical rounds with Bayou Health plans for member’s with severe medical and behavioral health comorbidities

• Magellan implemented a standardized referral process with Bayou Health plans

• Magellan Treatment Record Review audit tools emphasizing these items

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References

• www.integration.samhsa.gov

• www.ama-assn.org

• www.nihcm.org

• National Alliance on Mental Illness

• www.americanprogress.org

• www.americanprogress.org

• www.thenationalcouncil.org/resourcecenter

• Kaiser Commission on Medicaid and the Uninsured. (April 2011). Mental Heath Financing in the United States: A Primer. Washington, DC.

• Druss, B.G., and Walker, E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: the Robert Wood Johnson Foundation.

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Thanks

Confidentiality Statement for Educational Presentations

By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment. he information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.

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