1. Medicaid Matters: Depression and other Psychiatric Illnesses
Jorge Cortina, MD DFAPA
West Virginia Medicaid Behavioral Health Medical Director for UniCare an Anthem Company

2. Cost of Chronic Mental Illnesses
Human suffering costs are incalculable
Those with serious mental illness die 25 years earlier
Suicide is 10th leading cause of death and 2 or 3rd in teens/young adults
Mood disorders are 3rd highest cause of hospitalization under age 44
$11,000-21,000 annual costs for those with schizophrenia
Medicaid members with BH or SUD Diagnosis 3X higher costs
Lost productivity and wages (193 billion annually-2008)
Uninsured & Mental illness is 19% in non expansion states vs. 13% in expansion states
Chapel. Prevalence and Medical Costs of Chronic Diseases Among Adult Medicaid Beneficiaries (2017)
retrieved 8/27/18
retrieved 8/27/18
retrieved 8/27/18

3. Mental Health of West Virginians
WV highest rates of Opioid Used Disorder and complications
(NAS, infections and overdose)
2nd highest rate of depression (nearly 1 in 4)
Most common in middle aged low income
2nd highest rates of smoking (25%)
11th highest rate of mental illness or substance abuse
retrieved 8/27/18
retrieved 8/27/19

4. Interaction between chronic physical and mental conditions and Social Determinants of Health
Physical illness and conditions such as diabetes, heart disease, COPD increase the risk of depression and depression hinders good self care
Those with Psychiatric and Substance Use Disorders
Higher prevalence of medical illnesses such as COPD, heart disease and diabetes
Less likely to get their conditions diagnosed and treated
More likely to be impoverished, malnourished, homeless, exposed to unhealthy environments
Alexandria, VA: Parks, J., et al. Morbidity and Mortality in People with Serious Mental Illness (2006)

5. Bill 48
Schizophrenia
Smokes (60% with his DX do)
Antipsychotics
Diabetes
Homeless
No transportation

6. Mary 56 Single Many adverse childhood experiences
Unskilled unsteady work
Smokes, has bronchitis
Anxious and depressed
Obese
Shops at the convenience store
Heats with wood stove

7. Two Major Challenges (and Opportunities)
Care delivered in silos, no coordination between medical and BH care
Providing expensive health for preventable conditions that could be prevented by addressing social determinants of health

8. Integrated Care for Physical and Behavioral Disorders
Levels of integration 1 2 3
Coordination
(different settings occasionally sharing information and plans)
Colocation
(greater opportunity for coordination and collaboration)
Integration
(merged, collaborative, single record, strong relationships, frequent contact and informal consultation)
retrieved 8/27/18

9. Healthy People 2020 Examples of Social Determinants of Health
Safe and affordable housing
Education
Public safety
Access to healthy foods
Local emergency/health services
Area free of life-threatening toxins

10. Successful Disease Management
Size matters
Simplicity
Patient centered
Ability to collect data easily and analyze results
Quality (HEDIS, Satisfaction)
Costs (utilization)
Incentives for provider, patient, and others
retrieved 8/27/18

11. Medicaid Initiatives to address SDOH and Promote Integrated Care
Partnering with Area Agencies for Aging to address SDOH
Paramedicine visiting frequent users of ER
Health Homes
Care management and coordination
Health promotion
Transitions
Referrals to community and social support
Home and Community Based Services
Health Home providers (teams)

12. Questions?