Missouri, compromised.

Author:Crute, Sheree

Patients with mental as well as physical illnesses are hard to treat. The show-me state has figured out a better, cheaper way, using funds from Obamacare. will Republicans in Washington kill it?

About a decade ago, Pat Powers's life began to spin "out of control," as she puts it. Powers, a soft-spoken Missouri native, was stressed out from working at Walmart and two other part-time jobs to make ends meet. She was also suffering from diabetes and severe anxiety and depression. She found her way to Crider Health Center, in St. Charles, Missouri, west of St. Louis, a federally funded community health facility that provides a host of physical and mental health services to Medicaid patients like Powers, all under one roof. There, a psychiatrist, realizing that Powers could not juggle multiple jobs and hope to get better, got her onto disability as he worked to stabilize her mental health issues. A physician also prescribed medication for her diabetes.

Yet despite the treatment, Powers still couldn't tame what she called her "nervous breakdowns"--emotional storms that left her seeking help in Missouri emergency rooms. While she fought to regain her emotional stability, her diabetes only got worse.

The problem was that the care Powers was receiving wasn't well coordinated, and she wasn't receiving the guidance and support she needed. Her psychiatrist and the doctor treating her diabetes weren't communicating sufficiently, and no one knew whether she was taking her prescribed medications (it turns out that she wasn't, at least not regularly).

The management at Crider, which is part of the Compass Health Network, was aware of the lack of coordination, and like thousands of health care professionals around the country, they were seeking ways to fix it. But like any facility trying to survive on Medicaid's penurious reimbursement rates, the funding wasn't available to do much more. Meanwhile, the lack of investment in coordination was, ironically, costing taxpayers a bundle. In 2011 alone, Powers racked up more than $10,000 in care, primarily in emergency rooms.

Powers is a member of a group with a dubious distinction: the "5/50" population, short for the 5 percent of patients who account for approximately 50 percent of the nation's health care costs. These are people who typically suffer from two or more chronic, complex health conditions. (See Anna Gorman, "Home Remedy," page 43.) Many are elderly. Some, like Powers, also have mental health issues that make treating their physical ailments especially...

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