GREENVILLE — While the government and those seeking healthcare through the recently enacted Affordable Care Act (ACA) continue to fiddle around with the problematic healthcare marketplace website, health officials in Montcalm and Gratiot counties are taking their own initiative in trying to lower costs and improve quality of services.
Since the enactment of the ACA, Mid-Michigan District Health Department Officer Marcus Cheatham said the opportunity to lower costs for providers and reduce patient return visits has never been more prevalent. The primary reason for that, Cheatham added, is a lesser-known portion of ACA that gives higher cost refunds to care providers who successfully treat patients.
The current problem in the healthcare field, according to local officials, is far too many patients are what are considered “high utilizers,” those who frequently return to emergency rooms (often more than 10 times) to seek medical care for the same issue. Officials believe that is because they are being treated medically for what could be a mental illness. The hard part is medical professionals have little experience diagnosing mental illnesses and instead treat what is believed to be a medical problem.
“They treated trouble sleeping with a sedative, but the real problem is the person can’t sleep because they struggle with the fact they were abused as a kid,” said Mike Hetzman, clinical director for Gratiot County Community Mental Health. “It’s the mental health patients that get sidelined with very little validation for their illness.
“Mental health care and medical health care have been in different camps. The system created the beasts it now despises.”
And with 15 percent of Americans being uninsured — 8 percent of high utilizers are uninsured — hospitals often have to eat the costs of their visits to the emergency room, which average around $2,000 per visit, Cheatham said. And costs are multiplied for those with a serious medical issue paired with a mental disorder.
“When you have any chronic condition and a mental health condition, your costs skyrocket beyond what any other combination would,” Hetzman said. And it is often these people that continuously seek treatment, in part because communication between health providers is subpar at best, he added.
If the health care system is able to better treat these patients, and limit their visits to emergency rooms by properly connecting them with services they truly need, care providers will also benefit with eliminating costs related to a high volume of unpaid visits.
“When a person with a mental illness comes to the (emergency room), the hospital is unable to truly help them,” Cheatham said.
It’s for that reason health officials in the two counties have formed a coalition of sorts to brainstorm ideas of how to take advantage of opportunities ACA could provide in bettering services.
One of the ideas on the table during the team’s discussions has been what’s called a “community hub,” a protocol that would develop a process for identifying mental health issues and directing patients to services.
The idea, officials said, is to be able to better connect patients with mental health providers and form a collaboration between health and mental health fields.
Far from implementation and still in its infancy stage, the idea could mean a mental health official present in emergency rooms to help identify mental health indicators. Other potential resources could be a communication protocol in place to determine high utilizers and determine how the system has failed.
“There are successful models that have been developed out there already,” said Andrea Tabor, health services administrator for the Mid-Michigan District Health Department.
Tabor has studied a similar program in Milwaukee and said there are models that can guide local officials if a hub is pursued further.
“It’s an ambitious undertaking,” Hetzman said. “If we address the high utilizers for mental health issues, we’ll be trailblazers.”