Ohio tests medical home model for patients with mental illness

With recent studies showing that use of the Patient-Centered Medical Home (PCMH) model may improve outcomes for patients with diabetes, the model is being put to the test on another chronic disease: mental illness.

The Ohio Department of Health is advocating for the PCMH model as a way to improve the physical health of patients with mental illness and reduce Medicaid spending.

“People with mental illness do get physical illness. We don’t want to keep them separated; instead we want to see if we can integrate mental health and physical health for every patient we take care of, whether that’s embedding a mental health worker in the traditional family practice office or having mental health embed primary care into their practices,” Theodore E. Wymyslo, MD, FAAFP, director of the department, tells Medical Economics exclusively.

If Ohio’s Community Behavioral Health Center Medicaid Health Homes program is approved by the Centers for Medicare and Medicaid Services, the concept could be implemented in some regions of the state by the end of the year. Medicaid health homes, which are modeled after PCMHs, are funded as a provision of the Patient Protection and Affordable Care Act.

The Case Western Reserve University School of Medicine in Cleveland hosted a seminar on the topic last week at Northcoast Behavioral Healthcare, one of the state’s six psychiatric hospitals. Of the 2.1 million Ohioans enrolled in Medicaid, 10% have severe mental illness. Those patients account for 26% of the state’s Medicaid spending, says Tracy Plouck, director of the Ohio Department of Mental Health.

Patients with severe mental illness have twice as many avoidable hospitalizations for diabetes, pulmonary disease, and asthma as those without mental illness, according to the Ohio Colleges of Medicine Government Resource Center.

Primary care physicians (PCPs), as the leaders of PCMH teams, can provide better mental health care by acting as “comprehensivists,” Wymyslo says. Most are already doing this in at least one way: depression screening.

Wymyslo advises PCPs to use a three-step process with patients between appointments:

follow up regularly;

anticipate needs; and

educate patients on how to be healthier in mind, body, and spirit. “By doing that, we get at those mental health issues-their emotional distresses they struggle with-and what we find is that their physical well-being improves also,” he says.

“I don’t expect all PCPs to become mental health workers at all. All I care is that they link [their patients] with someone who can deal with that. That can be someone in their office or using modern technology, let’s virtually link with clinicians in the community,” Wymyslo says. “Our natural tendencies are to say if I’m uncomfortable with emotional issues, I’m just going to deal with your high blood pressure, diabetes, and let’s take a look at that knee that’s been bothering you.”

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