Organizers hope to streamline services, ease access to Medicare, Medicaid

MARQUETTE – A pending statewide pilot program with an Upper Peninsula presence is aimed at streamlining health services for patients using both Medicare and Medicaid.

The Michigan Department of Community Health is developing an integrated care proposal to strengthen service and support for individuals who are dually eligible for the two programs.

“Really, the goal is for a one-stop shop. People can make one phone call and access behavioral health and primary care needs,” said John Basse, the CEO of NorthCare Network. “The overall goal is that we don’t lose people in the system.”

The U.P.-based NorthCare – an affiliation of five community mental health services – will oversee the U.P. region of the MDCH’s pilot program. Three downstate regions will also take part in the three-year program.

The integrated care project seeks to improve quality and access to care by more effectively aligning Medicare and Medicaid services and bridging the divide between the physical health, long-term care and behavioral health systems.

Rather than making phone calls and appointments for each separate issue, Basse said, patients should be referred among professionals, who will be communicating more effectively.

“This is improving overall health, not just primary care,” Basse said. “As a person, they can receive better care.”

For instance, he said, if a patient visits a behavioral health specialist for treatment of bipolar disorder, the doctor will know what types of primary care the patient is receiving and will be able to more effectively order treatment.

The demonstration will promote the use of a person-centered approach in all aspects of the new care system. Additionally, the pilot will focus on increasing access to home and community-based services, ensuring continuity of care during the transition to the new system, and supporting self-determination and choice for individuals.

Basse said the MDCH will review the data at the end of the three-year pilot and will determine if patient outcomes have improved.

“This is a couple of years to see if this truly does provide better care and hopefully things work out for our region,” he said. “It really is streamlining things. It should save money.”

Basse said the pilot program has been in the works for more than a year and he expects that, within 18 months of the program kicking off, he will have a good idea of how successful it is.

While NorthCare deals primarily in behavioral health services, Basse said the organization will be working hand-in-hand with other primary care groups.

The main patient group for the program, he said, is not very large and is tough to target directly – people in any age group, he said, can be on medicare for disability reasons.

MDCH is currently negotiating a memorandum of understanding with the Centers for Medicare and Medicaid Services to outline state and federal responsibilities for the demonstration. Pending approval from CMS, MDCH is planning to implement the program in January 2014 with outreach, education, and enrollment starting in October 2013.

“While the project is still in negotiations with CMS, this is a significant step in the process,” MDCH Director James Haveman said in a written statement. “Our overall goal with the integrated care project is to improve quality and access to care for the populations in Michigan currently having to use two very different systems to receive the care they need.”

Kyle Whitney can be reached at 906-228-2500, ext. 250.