PITTSBURGH, Dec. 7, 2012 /PRNewswire/ -- Connected Care – a program developed by Community Care Behavioral Health Organization and UPMC for You – has resulted in significant reductions in the use of behavioral and physical health services by their members and is influencing other community-based programs that provide Medicaid services for individuals with serious mental illness.
Connected Care, which Pittsburgh-based Community Care and UPMC for You started in 2009 as a two-year pilot program for the Pennsylvania Department of Public Welfare (DPW), is designed to integrate behavioral and physical health care Medicaid services for individuals with serious mental illness. The program also addressed a similar set of needs in dually-eligible Medicare recipients enrolled with the two organizations. Behavioral and physical health care systems often lack coordination, which can result in a negative impact on individuals, including those with schizophrenia, episodic mood disorders, or borderline personality disorders.
According to a report by Mathematica Policy Research, an independent research firm that has been assessing the effectiveness of policies and programs since 1968, "mental health hospitalizations and readmissions improved for all Connected Care members, most likely because of targeted member outreach and education and concurrent initiatives focused on similar goals."
"Positive changes in (emergency department) use among members … were likely due in part to improved processes and greater cross-staff familiarity," the report said.
Community Care and UPMC for You worked with other key stakeholders to create Connected Care in order to address the need for better coordinated care between behavioral health and physical health systems in Allegheny County, Pennsylvania. Connected Care employed a recovery-oriented model that was a partnership between Community Care, UPMC for You, the Center for Health Care Strategies, DPW, and the Allegheny County Department of Human Services. UPMC for You is the Medicaid program of UPMC Health Plan, and, like Community Care, it is part of the UPMC Insurance Services Division.
Through the use of Medicaid claims, enrollment data and utilization history for persons with serious mental illness, individualized integrated care plans were developed based on members' needs. A multi-disciplinary team consisting of staff from both Community Care and UPMC for You worked with providers and members to implement these plans, and a lead care manager coordinated care for each member.
"Community Care and UPMC for You are proud of the success of Connected Care," said James M. Schuster, MD, MBA, Chief Medical Officer of Community Care.
"We will continue to support multiple strategies to improve coordinated care for all of our members," said John Lovelace, President of UPMC for You.
The success of the Connected Care pilot program has also influenced other community-based programs. Community Care and UPMC for You provide support and facilitation of targeted programs to improve behavioral and physical health care coordination in many regions of Pennsylvania.
"As more health plans offer behavioral services, there is potential for other plans to adopt a similar model (to Connected Care)," the Mathematica Policy Research study concluded. The report also said that "information about key elements of integrated care," developed through the pilot program could be carried into "other regions and populations."
About Community Care
Community Care, a nonprofit, tax-exempt recovery-focused behavioral health managed care organization headquartered in Pittsburgh, Pennsylvania manages mental health and substance use disorder services for approximately 700,000 Medical Assistance recipients in Pennsylvania. Community Care also serves as the behavioral health organization for the Hudson River Region of New York State. Part of UPMC, Community Care was incorporated in 1996 with a mission to improve the health and well-being of the community through the delivery of effective and accessible behavioral health services.
About UPMC for You
UPMC for You is the Medicaid program of UPMC Health Plan and is part of the UPMC Insurance Services Division. UPMC for You is the largest Medicaid program in western Pennsylvania and has been ranked as the No. 1 Medicaid program in Pennsylvania for eight of the nine years that the National Council on Quality Assurance (NCQA) has ranked Medicaid plans. UPMC for You is owned by UPMC, an integrated global health enterprise. The integrated partner companies of the UPMC Insurance Services Division also include UPMC WorkPartners, LifeSolutions and Community Care Behavioral Health. The UPMC Insurance Services Division offers a full range of group health insurance, Medicare Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance and workers' compensation products and services to over 2 million members.
UPMC is a $9 billion global health enterprise with 54,000 employees headquartered in Pittsburgh, Pa., and is transforming health care by integrating 21 hospitals, 400 doctors' offices and outpatient sites, 3,000 employed physicians, international and commercial services and a health insurance division. The integrated partner companies of the UPMC Insurance Services Division – which includes UPMC Health Plan, UPMC WorkPartners, UPMC for You (Medical Assistance), and Community Care Behavioral Health – offer a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is redefining health care by using innovative science, technology and medicine to invent new models of accountable, cost-efficient and patient-centered care. For more information on how UPMC is taking medicine from where it is to where it needs to be, go to www.upmc.com.
SOURCE Community Care