OHP members with mental health issues more likely to visit ER

Oregon Health Plan members with mental illness use the emergency department for physical health reasons at a rate 2 1/2 times greater than members without mental illness, officials said Friday.

This rate has remained steady over time, indicating room for improvement in coordination of care for members with mental illness. A new report from OHA highlights this health disparity and encourages coordinated care organizations (CCOs) to take a “deeper dive” into their data to develop strategies specific to the needs of members with mental illness.

“We need to do more to make sure all OHP members, including those with complex needs, benefit from health system transformation,” said Lori Coyner, OHA Medicaid director. “We know individuals with serious mental illness face barriers to maintaining their physical health, including experiencing stigma in health care settings. One promising solution is to better integrate physical, oral and behavioral health services.”

Baseline data shows some CCOs have smaller disparities in this area than others. One of those is Jackson Care Connect, which has been using value-based payments as incentives to encourage integration of behavioral health care into primary care clinics. Value-based payments change the way health care is paid for and delivered by moving away from fee-for-service payments and paying providers based on value instead.

In October 2018 the Oregon Health Policy Board adopted a set of policies designed to improve the health of OHP members, address health disparities, control program costs and continue to transform health care delivery. These policy priorities will be written into the 2020-2024 CCO contracts and represent the next phase of health transformation in Oregon, known as “CCO 2.0.“

At the direction of Governor Kate Brown, one of the CCO 2.0 priority policy areas aims to improve the behavioral health system and address barriers to access to and integration of care. Over the next five years, OHA will work with CCOs to:

Use metrics to provide incentives for behavioral health integration and measure its outcomes. Expand programs that integrate primary care into behavioral health settings. Require providers to implement trauma-informed care practices. Ensure an adequate provider network. Provide access to behavioral health care that meets standards for timely access to care.

“With CCO 2.0, we have an opportunity to help break down silos to support members in getting the physical and behavioral health care they need — in the right place at the right time,” said Coyner. “We can also use incentives to spur innovation, learn from CCOs or programs that are doing well in this area, and spread best practices.”

Last year, 2018, was the sixth year of Oregon’s pay-for-performance program where OHA created a quality pool from a percentage of monthly CCO payments to reward performance. The quality pool model rewards CCOs for the quality of care provided to Oregon Health Plan members and has been a driver for innovation and performance improvement.

OHA has provided incentives for reducing emergency department use since the program took effect, and avoidable emergency department visits decreased by over 50 percent from 2011 to 2017. Emergency department use among members with mental illness is a new incentive measure. Results from the first year of this measure will be released with the 2018 CCO Metrics Report in June.

A copy of the report is available on the OHA website.