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In most states, individuals with serious mental illness and chronic medical conditions are among Medicaid’s highest-cost, highest-need populations. Only 5% of Medicaid beneficiaries account for more than 50% of total program spending in most states. To add to this, health care costs are as much as 75% higher for patients with chronic conditions who also have mental illness, compared to those patients without a mental illness.
With this in mind, Pennsylvania’s Department of Public Welfare set out to demonstrate the benefits of integrated care for Medicaid beneficiaries with serious mental illness and chronic medical conditions. The initiative, Serious Mental Illness (SMI) Innovations Project, part of the national Rethinking Care Program coordinated by the Center for Health Care Strategies (CHCS), began in 2009 and included two pilots in the southeastern and southwestern regions of the state.
The state partnered with managed care organizations, managed behavioral health organizations, and county behavioral health systems in both regional pilots. Some of the common features for both pilots included:
"States across the country are looking for better ways to control costs and improve quality for Medicaid's highest-need, highest-cost beneficiaries," said Allison Hamblin, CHCS vice president. "In Pennsylvania, improved integration of physical and behavioral health services was an effective means for achieving these goals. The pilot programs' experience offers concrete strategies to guide other states interested in developing similar approaches."