Chronic care

Innovations

State Medicaid Program Pays Additional Capitated Fee to Integrated Primary Care and Mental Health Homes, Leading to Better Outcomes and Lower Costs 03/01/14

The Missouri Medicaid Health Home program provides capitated payments to primary care and mental health medical homes that adopt an integrated staffing model that allows patients to receive both medical and mental health care, leading to better health outcomes and lower utilization and costs.

Community Health Workers Offer Culturally Tailored Interactive Workshops and Counseling to Filipino Americans, Leading to Improvements in Medication Adherence and Cardiovascular Risk Factors 02/28/14

Community health workers provided culturally tailored workshops and one-on-one counseling and support to Filipino Americans at high risk of cardiovascular disease, leading to greater adherence to medication regimens, better attendance at scheduled appointments, improved blood pressure control, and lower body mass index.

State-Financed, Primary Care–Led, Accountable Care Collaborative Provides Comprehensive, Coordinated Care to Medicaid Beneficiaries, Reducing Admissions, Use of Imaging Services, and Costs 02/05/14

A State-led accountable care collaborative provides comprehensive, coordinated care to Medicaid beneficiaries through primary care medical homes, reducing use of inpatient, imaging, and emergency department services, and generating estimated savings of $6 million for the State.

Patient Notepad Improves Communication With Physicians, Including Likelihood of Having Questions Answered 01/28/14

Patients receive a notepad with sample questions and informational prompts intended to facilitate communication with physicians, leading to more notetaking by patients and a greater likelihood of having their questions answered by physicians.

Mobile Clinic Delivers Culturally Competent Services to Underserved Neighborhoods, Leading to Identification of Untreated Chronic Conditions, Better Blood Pressure Control, and Significant Return on Investment 01/22/14

A mobile clinic provides screening, education, coaching, and health navigation services to residents of four underserved communities, leading to the identification of many previously undetected chronic conditions, better blood pressure control, and a substantial return on investment.

Neurologists Enhance Access to Specialty Care Through Virtual, In-Home Visits for Patients With Parkinson's Disease, Generating High Levels of Satisfaction 01/17/14

Neurologists with expertise in movement disorders enhance access to specialty care by offering virtual house calls to patients with Parkinson's disease, generating very high levels of patient satisfaction.

State Medicaid Program Reimburses for Physical Health and Wellness Services Provided by Mental Health Peers, Leading to Anecdotal Reports of Improved Outcomes 01/16/14

The Georgia Medicaid program expanded the definition of reimbursable services provided by mental health peer specialists to include physical health and wellness services, resulting in the training and certification of 175 such specialists to provide these services and in anecdotal reports of improved physical health outcomes among clients who receive the services.

Data-Driven System Helps Emergency Medical Services Identify Frequent Callers and Connect Them to Community Services, Reducing Transports and Costs 12/30/13

An emergency medical services system uses a data-driven program to identify frequent 911 callers and facilitate access to community-based medical, social service, and other interventions to address their underlying needs, leading to significant reductions in emergency transports and associated costs.

Mental Health Center Provides Integrated Primary Care and Care Coordination to Medicaid Beneficiaries With Severe Mental Illness, Enhancing Access to Services and Improving Outcomes 12/20/13

With support from State funding, a community mental health center provides integrated mental health, primary care, care coordination, and wellness services to Medicaid beneficiaries with severe and persistent mental illness, leading to better chronic disease outcomes.

Peer Specialists in Federally Qualified Health Centers Enhance Access to Behavioral and Physical Health Support Services for Clients With Co-Occurring Medical and Mental Health Issues 12/13/13

Certified peer specialists provide emotional support, education, links to community services, and other support to individuals with co-occurring medical and mental health diagnoses at two Michigan federally qualified health centers, generating high levels of satisfaction and anecdotal reports of improvements in physical and mental health.

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