Mind-Body Connections: HOW FOUR COUNTIES IN PENNSYLVANIA ARE IMPROVING THE LIVES OF PATIENTS SUFFERING FROM BOTH SERIOUS MENTAL ILLNESS AND CHRONIC HEALTH CONDITIONS.

• Author: Crute, Sheree

As the GOP-controlled Congress continues its efforts to "repeal and replace" the Affordable Care Act (ACA), the most dramatic potential impacts of repeal are what draw the most attention: the numbers of people who could be left uninsured, and the dollars that could be lost from Medicaid.

A less attention-getting--but just as important--consequence of repeal would be the loss of inventive, and often pioneering, improvements in the care given to many Medicaid patients living with the combination of serious mental illness (SMI) and chronic health conditions. These innovations, ushered in before and expanded through the ACA, have quietly rescued millions of patients from a downward spiral of declining health, and, in some cases, homelessness and premature death.

Part of a group known as the "5/50"--the 5 percent of patients who are responsible for about 50 percent of the nation's medical costs--people with SMI face extreme health risks. They are likely to die, on average, twenty-five years earlier than the general population. For them, managing a chronic condition while living with mental issues such as severe depression, schizophrenia, or bipolar disorder can be nearly impossible. Patients like these may lack even the capacity to keep their daily lives on track, let alone handle a chronic health problem, like diabetes, that requires multiple trips to multiple doctors with multiple medications and treatments. All too often, they end up in the nation's emergency rooms, after a chronic condition has become so severe that it may cause serious disability or even death. The resulting rise in health care costs is enormous. Ineffective care for these patients accounts for as much as $120 billion in annual health care costs. Reducing these financial and human costs and improving the lives of people battling chronic physical and mental health problems have long been priorities for public health experts, and addressing the issue became a central part of the ACA.

Pennsylvania was among the first states to test the effectiveness of coordinating care for SMI patients, so that all of a patient's providers--physicians, nurses, psychiatrists, social workers, and others--consistently share information about the patient and, in some cases, develop a closer relationship with them. The result has been better health, as well as more compassionate, more effective--and more cost-effective--care.

For a patient who has not only a primary care doctor but also various other providers--a heart specialist, a kidney doctor, an ophthalmologist, a nutritionist, a physical therapist, a nurse practitioner, and others--in addition to mental health specialists, having someone to manage the moving parts can be lifesaving. Without the right coordination, for example, medications prescribed by one doctor for one problem could cause a reaction to other medications prescribed by someone else, putting that patient in the hospital and worse off than before.

Among the early examples of how coordinated care can improve the lives of patients with SMI and chronic health problems are two programs launched in Pennsylvania's Allegheny, Bucks, Montgomery, and Delaware Counties in 2009. In the years following the 2007-08 financial crisis and the ensuing recession, Pennsylvania public health officials became increasingly concerned about the mounting health problems of people with coexisting mental and physical health challenges. More than one million Pennsylvanians live with mental illness, according to the University of Southern California, while the Kaiser Family Foundation found that more than 30 percent of residents report...