General information

CMSP Behavioral Health Pilot Project

California’s County Medical Services Program (CMSP) operates in 34 rural counties throughout California, providing health care services for adults who are indigent but not eligible for Medi-Cal. More than a third of the total cost for the program was for beneficiaries who had behavioral health (mental health or substance abuse) conditions. The CMSP Governing Board contracted with The Lewin Group to evaluate a behavioral health pilot project to test the effectiveness of providing mental health and substance abuse counseling services integrated with primary care in improving health, utilization, and cost outcomes. Fourteen primary care sites reported serving a total of 2,339 participants during the pilot March 2008 through February 2011.

Key findings included:

  • Goal 1: Stabilize participants’ health.  Scores showed statistically significant improvement.
  • Goal 2: Provide coordinated primary care, behavioral health, and psychiatric services. The 14 pilot sites varied a great deal in their level of integration and coordination.
  • Goal 3: Increase appropriate use of primary and specialty care services.  The report described a dramatic redistribution of total costs for participants, indicating a shift from inpatient hospitalization toward increased use of primary care and outpatient behavioral health services and was effective in improving psychiatric medication adherence for participants.
  • Goal 4: Reduce late-stage hospitalizations due to untreated medical conditions. Results showed that both medical and psychiatric hospital admission rates and days decreased – a 56.6% reduction in the number of inpatient psychiatric days and medical admissions decreased 57.9%. Inpatient per member per month (PMPM) costs decreased by 37.1%.
  • Goal 5: Reduce unnecessary and/or inappropriate emergency room use. Emergency room visits decreased 12.3%.
  • Goal 6: Achieve financial savings through improved cost-effectiveness. Overall, the results indicate that the modest interventions implemented appeared to cause a dramatic redistribution of total costs for participants, with costs shifting from inpatient hospitalization toward primary care and outpatient behavioral health services.

The report provides considerable evidence of improvement in care coordination between primary care and behavioral health, increased use of appropriate services, decreased hospitalizations and emergency room utilization. It also suggests that strengthening coordination between physical and mental health care delivery systems can improve the health for the individual and produce significant redistribution of health care spending, with costs shifting away from inpatient hospitalization and emergency departments and towards primary care services (clinic, outpatient, and pharmacy).

The full report is attached.

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