New Study Shows Program for Patients With Severe Mental Health Conditions on Medicaid Led to 11.5% Decrease in Cost, Nearly 20% Decrease in Inpatient Utilization

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Nov 20, 2024, 09:40 ET

The paper, published today in NEJM Catalyst, analyzes Cityblock Health's Advanced Behavioral Health (ABH) Program for participants experiencing psychotic disorders or severe substance use disorders

BROOKLYN, N.Y., Nov. 20, 2024 /PRNewswire/ -- Cityblock Health, a value-based healthcare provider for Medicaid and dually eligible beneficiaries, today announced results from its Advanced Behavioral Health (ABH) Program as part of a study published today in NEJM Catalyst. Findings show that Medicaid members enrolled in Cityblock's ABH program had a statistically significant 11.5% decrease in total cost of care and a 19.7% decrease in inpatient utilization, compared to members not enrolled in the ABH program. In terms of health-related social needs, findings also show that 43% percent of members enrolled in the ABH program had an identified food need and 95% of food needs identified for members in the ABH program were addressed.

As of 2020, it's estimated that Medicaid enrollees have the highest overall prevalence of moderate to severe mental illness or substance use disorders with 39% of Medicaid enrollees having a mental illness and/or substance use disorder. Hospitalizations and readmissions for any condition are also more prevalent among patients with substance use disorders or schizophrenia than those without it, with high rates of treatment failure heavily impacting public and community health.

This study indicates that through a value-based care model that integrates community health workers with medical and psychiatric providers, Cityblock Health's Advanced Behavioral Health (ABH) Program can reduce rates of avoidable hospitalization and emergency department visits; increase access to treatments, such as long-acting injectables (LAIs) and social care referrals; and reduce the overall cost of care for members with psychotic disorders, particularly schizophrenia, and/or substance use disorders.

"Engaging those on Medicaid with mental and behavioral health conditions - especially more severe conditions like schizophrenia - is incredibly challenging," said Ruby Mehta, LCSW, MBA, lead author of the study and Head of Behavioral Health for Cityblock Health. "Treatment typically requires recurring visits to the doctor's office for LAIs which is not always possible as barriers to care like homelessness, distrust of physicians, lack of transportation and more, can drastically impact a patient's ability to seek treatment. This study intended to explore the effectiveness of our integrated value-based care model for advanced behavioral health which integrates specialized community health workers - or what I like to call "feet on the street"- with psychiatry, and is designed to increase access to such interventions and services to prevent costly hospitalizations and readmissions."

In traditional fee-for-service payment models, behavioral health, substance use disorder, social, and community-based care are inadequately reimbursed (or not reimbursed) by Medicaid, creating a significant care gap for high-need and high-cost populations. Value-based models where organizations like Cityblock receive a capitated payment from health plans that covers a member's total cost of care, allow for more flexibility in the services they're able to provide beyond medical and psychiatric care including in-home services, transitions of care, and community health workers to help address these social determinants of health, offering external referrals to housing resources and transportation support, among others, when necessary.

In this study, researchers from Cityblock's behavioral health team analyzed data from a pilot program in Washington, D.C. that took place in April 2022. The sample size in D.C. identified 215 members from a health plan partner that had a likelihood of avoidable behavioral health utilization. Of the 215 members identified, 123 individuals were engaged. On average, members were enrolled in the ABH program for about 10 months. During this time, enrolled members received an average of 2.3 connections with their care team staff per month and another two care planning activities per month. Care planning activities include coordinating with an external provider to set up appointments, or with the member's health plan benefit to order medical equipment, research food pantries, etc. Since the initial pilot, the ABH program has expanded to all seven of Cityblock's markets.

"Despite their prevalence, behavioral health conditions often remain under-addressed, leading to poorer outcomes and higher costs, especially for Medicaid members," said Kameron Matthews, MD, JD, FAAP, Chief Health Officer at Cityblock. "This study serves as further evidence of the efficacy of our Advanced Behavioral Health program, the importance of integration in a primary care model and the ability to address poor outcomes and deliver meaningful outcomes. I'm encouraged by the success of this program and the impact our integrated medical and behavioral health model can have for all our members who face behavioral health challenges."

This examination of Cityblock's ABH Program suggests that value-based care models—those that integrate medical, behavioral, substance use disorder and social care— that also utilize specialized community health workers who deeply understand members' lived experiences, can lead to increased access to evidence-based care, reduce inpatient hospitalizations, lower the total cost of care, and meet public health needs, for vulnerable populations on publicly funded health plans.

Other researchers participating in the study include David Dayan-Rosenman, MD, Daniel Sellinger, and Michael H. Tang, MD.

About Cityblock Health
Founded in 2017, Cityblock is a transformative, value-based primary care organization that serves over 100,000 Medicaid and Medicare-Medicaid dually eligible beneficiaries. Our medical practices deliver integrated clinical care, behavioral health services, and social care – virtually, in-home, and in community-based clinics. Modern technology is at the core of our care model, with custom-built tools to support every facet of care team operations and member interactions. Cityblock partners with 3 of the top 5 national Medicaid health plans, and currently operates in New York, Massachusetts, North Carolina, Ohio, Indiana, Illinois and Florida.

Cityblock has been named to Fast Company's World's 50 Most Innovative Companies list, CNBC's Disruptor 50 list, Forbes' America's Best Startup Employers list, and Fierce Healthcare's inaugural Fierce 15 list. To learn more about the company, visit www.cityblock.com.

All medical services are provided by licensed physicians and health care practitioners employed by Cityblock Medical Practice, P.A. Cityblock Health, Inc. provides management and administrative services to Cityblock Medical Practices.

SOURCE Cityblock Health