Pittsburgh Mercy, others in Pa. embark on new way to provide behavioral care

For nearly a year, Paula Roth has participated in group art therapy classes at Pittsburgh Mercy Health Systems to help her deal with depression that began two years ago after her husband died.

“It helps so much,” Ms. Roth, 47, of Brentwood, said while showing a reporter the wall mural she helped paint in an art therapy room at Pittsburgh Mercy’s South Side campus. “You just get your mind down into the art you’re working on and you don’t feel as bad.”

Mercy believes in the effectiveness of art therapy, which is why it provides it to clients.

There’s one big problem:

Medicaid, which covers many of the costs of more typical care at Mercy — like primary care, mental health and physical therapy — does not pay for services like art therapy, or other so-called “wrap-around” services like transportation or help in finding housing.

Mercy provides them at a financial loss to the organization but significant benefit to clients like Ms. Roth, said Craig Douglass, Mercy’s chief administrative officer.

But on Monday, Mercy and six other behavioral health centers around the state, kicked off a two-year pilot demonstration project that will expand Medicaid coverage to those additional services, which will be particularly helpful to patients with complex mental health issues, especially those with addiction.

The program creates a new payment model for behavioral health by paying a daily rate, rather than a rate for each “unit” of care clients get for traditional, approved services like primary care.

Mercy is the only center in southwestern Pennsylvania in this program.

Those with complex behavioral issues typically face financial challenges and mental health issues and/or are dealing with addiction.

“This is an opportunity to do what we think is best for our clients,” said Ray Wolfe, Mercy’s chief operating officer, “and to help people to live and get treatment in the community, and not in the jail or the emergency room.”

With the increased funding, Mercy expects to hire 30 to 40 employees over the next year, including 10 new case managers, as well as additional engagement specialists who work with clients to solve behavioral health issues. That could include, for example, making in-home visits to help clients with their diet or to figure out how to get to appointments regularly — basic issues that can result in large health improvements.

“I don’t want to make it sound like it is whatever goes; it is still patient-centered therapy,” said Ellen DiDominico, the Pennsylvania Departmenth of Human Services director of the bureau of policy and program development, which oversees the program here. “But they will be able to do some things a little differently, rather than just provide mental health services in a clinical setting.”

Mercy and the other behavior health centers believe that through this program, they will ultimately save money on the care of the clients because the clients will have better outcomes.

Mercy has long applied a version of such care to its clients — at its own cost — so “we have a lot of good theories behind it,” said Todd Wahrenberger, Mercy’s chief medical officer.

As part of the program, the various Mercy employees involved in a client’s case will meet regularly to talk about cases they have in common, to better share what is happening with a client, rather than just reading each other’s reports.

“Anything that encourages us to all talk together as a team and coordinate care, and understand better who needs more help in our programs, that’s got to have an impact on people’s lives,” Dr. Wahrenberger said.

One focus of the program will be to help clients suffering from addiction. Mercy anticipates serving up to about 130 clients with addiction who will get “assisted” therapy when they are prescribed Suboxone — a medication used to help treat heroin addiction.

When clients come in, Mr. Douglass said, they will not only get their Suboxone prescription, but they also will be assigned a case manager who will work with them to help with the other issues, as well as line up group therapy for them.

“We believe that with a combination of good case management and good group therapy, we think we can significantly impact the addiction crisis in our community,” Mr. Wolfe said.

“There are a lot of folks trying to coordinate effective therapies in heroic ways for people with addiction right now. But I don’t know of any model that tries to provide services at this level.”

The pilot project will seek to accomplish this by allowing significant flexibility to provide additional wraparound care for clients at each of the seven behavioral health centers in the state and health centers in seven other states.

To become part of the pilot project in those states, all the health centers, like Mercy, had to become Certified Community Behavioral Health Centers — or CCBHCs — approved by the federal government under the federal Protecting Access to Medicare Act, which was signed into law in 2014.

In Pennsylvania, the seven CCBHCs were identified after a lengthy and rigorous vetting process that started almost two years ago with an initial 80 centers being considered.

So what happens after the pilot program ends? Do health centers go back to providing the care at their own expense?

With all the metrics and data reporting including in the project, Ms. DiDominico said that “after two years we’ll have a good sense of what works and what doesn’t for our clinics, and what results in better outcomes for individuals.”