Mental health program hailed as way to reduce Medicaid costs

0 | Medicaid-CHIP, Mental Health


Tony Waller, left, places groceries into a cart last week as his case worker, Lance Sharples, pays the checkout clerk. Waller is transitioning to apartment living through a program that helps people with mental illness so they don’t rely so heavily on hospital emergency rooms for care.

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After navigating the brightly illuminated aisles of the Raytown Wal-Mart, Lance Sharples wheeled a grocery cart to the checkout line one night last week.

The clerk made quick work of the items that included bananas, hotdogs, frozen pizza, and white bread.

“You push, man,” Sharples told his companion as they headed for the door. “It’s your food.”

That’s not something Tony Waller, 39, has heard a lot in a lifetime spent largely on the streets.

He grew up around 66th St. and Prospect Ave. in Kansas City, Mo. When he was a teenager, a drunk driver hit him while he was walking to catch a bus. He never regained his ability to read and write, compounding his struggles with cerebral palsy.

Waller now lives in an apartment not far from the Wal-Mart, placed through a program launched four years ago by ReDiscover, a community mental health center in Lee’s Summit. Financial backing has come largely through the Health Care Foundation of Greater Kansas City.

One of the program goals is to stop the revolving door at hospital emergency rooms among persons with mental health and substance abuse problems. Medical experts generally consider it more cost-effective to manage chronic or preventable conditions before patients seek care in emergency rooms.

Last month, a Missouri Senate committee hailed the ReDiscover program as an example of how to reduce Medicaid costs.

A program official told the committee that ReDiscover had saved approximately $13.7 million in medical costs during its first year and a half. The center has spent about $800,000 on the program, officials said.

According to ReDiscover officials, the Missouri Department of Mental Health has allocated $7.5 million this year to implement the program around the state.

The bottom line is this, said Laura Shrader, ReDiscover’s hospital diversion director: “If you think people can change, they can change.”

The model

Caseworkers like Sharples are the central to the diversion program.

Through referrals from hospital emergency rooms and inpatient psychiatric units, the caseworkers provide assistance beyond typical case management. Small caseloads of fewer than 10 clients allow them to spend extra time with each person.

Armed with credit cards, the case workers don’t have to clear bureaucratic hurdles before they can provide simple assistance that can stabilize a patient’s life, Shrader said.

That might be finding clothes for someone who has nothing but a hospital gown, she said, or help paying a license bureau fee so a client can apply for benefits with a state-issued identification card.

In one case, Shrader said, ReDiscover paid a $600 community college debt for a young schizophrenic who had dropped out when his disease emerged.

Hospital staff referred the man to ReDiscover after he came to an emergency room 17 times in nine days. Now that he has the medication he needs, Shrader said, he has re-enrolled and is doing well so far.

Hospitals in and around the central and eastern part of the city, including Truman, Saint Luke’s and Centerpoint refer patients to the program. Referrals have also come from north of the Missouri River, including from hospitals in North Kansas City and Liberty, program officials said.

The program started with three community mental health centers. The program has double that amount now, including one that serves rural communities east of Kansas City.

With continued funding from the health care foundation and additional support from the Missouri Department of Mental Health, the number of caseworkers has grown from three to 14.

Some of the case managers work nights and weekends at hospitals.

‘Huge success’

At Truman Behavioral Health, Robin Morrison cited one example where a program participant had moved on to a job.

“Getting a job is a huge success for some of the people who have struggled and been homeless and who have had some pretty severe mental health issues or substance abuse issues,” said Morrison, director of crisis services.

Helping patients get those conditions under control, Morrison said, frees space for other patients in the emergency room and maximizes the effectiveness of the limited supply of inpatient psychiatric beds.

She said the program has also encouraged coordination among organizations.

That cooperation largely comes into play as case managers from the hospitals and community mental health centers work together to manage participants, Morrison said, which means that a case worker from Truman might step in to help with a ReDiscover client.

People such as Waller, the man in Raytown, often show up in emergency rooms when they are hungry or need a place to stay.

Or sometimes they need medical care they could not have, if they weren’t homeless.

Waller said he once suffered a broken jaw and a busted nose in an assault while he slept in a bus shelter. On the streets, he said, people might even rough you up to take your shoes.

Waller said he felt safer sleeping during the day, which is why he is still restless at night in his apartment.

He still struggles with old habits. Just the other day, he traded his vacuum cleaner for a six-pack of beer.

He smiled sheepishly when Sharples told that story.

“I need to stop doing that,” he said.

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