Integrated Care for Serious Mental Illness, Physical Health Needs, and Social Services.

Abstract

As health care transitions from fee-for-service (FFS) to value-based care (VBC), models that effectively integrate mental and physical health are essential, particularly considering the unsustainable rise of health care expenditures and less-than-desired outcomes of FFS. Mental health represents a significant and growing component of health care. Mental Health Cooperative (MHC), a Tennessee-based integrated health care system, has implemented a patient-centric integrated care model that addresses both behavioral and physical health needs for patients with behavioral health severe mental illness (BHSMI). Services span outpatient psychiatric care, emergency crisis intervention, primary care, pharmacy, law enforcement co-response, and social services targeting homelessness, family support, and community engagement. The model is designed to meet patients where they are, with a strong emphasis on care coordination and addressing social determinants of health. MHC's infrastructure allows for real-time communication and response to patient needs, ensuring continuity of care. Since the program's launch in 2017 through 2024, the MHC model has been associated with 19% improvement in the total number of compliant events closed across several Healthcare Effectiveness Data and Information Set (HEDIS) quality measures - from 8,935 of 16,136 (55.4%) in 2018 to 11,930 of 18,112 (65.9%) in 2024, as well as a 33% reduction in emergency department visits - from 131 per 1000 members in 2017 to 87.9 per 1000 by the end of 2024, and a 26% reduction in inpatient admissions, from 11.2 to 8.3 per 1000 members during that same period. As a result, MHC estimates that, had other providers serving the patients through the Tennessee Health Link Medicaid program had similar attributed patient panels and had adopted the MHC VBC model, that could have generated approximately US$40.9 million in annual cost savings in 2024 for the Tennessee health care system. Such savings potential, along with MHC's financial sustainability, illustrate the viability of the model. Notably, 44.3% of MHC's margin of 6.1% in fiscal year 2025 (ending June 30, 2025) was attributed to the Tennessee Health Link incentive payment. MHC's model demonstrates improved outcomes and cost efficiencies that warrant an investment in scalability. This approach offers a blueprint for systems seeking to enhance mental health care while managing population health and long-term cost under VBC paradigms.