Wendy Long

For five years, TennCare enrollee James Smith was homeless, often sleeping in a tent by the Tennessee River.

Diagnosed as an alcoholic depressive, the 51-year-old Chattanooga resident found help for his mental health last year when he joined the AIM Center, a psychiatric rehab provider, and began getting treatments at Johnson Mental Health Center.

Now that he’s looking to get a primary care physician for the first time in years, Mr. Smith said upcoming changes to the TennCare Bureau’s payer structure will help make it easier for him coordinate health care for his physical and mental health needs.

Starting Jan. 1 in East Tennessee, TennCare managed care companies will handle both physical benefits as well as behavioral — or mental health — concerns. Previously, two separate payers — a managed care company and a behavioral heath company — worked independently to administer these benefits.

“I won’t have to sit and try to figure out which health plan is going to cover what. It’ll only be one health plan,” Mr. Smith said. “Anything that can simplify things in those terms I think is a better deal.”

Now, in East and West Tennessee, enrollees will access care through one insurance plan, either Volunteer State Health Plan, a wholly owned subsidiary of BlueCross BlueShield of Tennessee that administers TennCare benefits, or AmeriChoice, a division of United Healthcare.

“Ten or more years ago, the trend was to carve out behavioral health and treat it separately,” said Wendy Long, chief medical officer at TennCare. “But what we’re seeing now is a trend back the other way. Everybody now recognizes that many illnesses have both a physical and a mental health component. There’s not a nice bright line between (them).”

Managed care organizations still are negotiating contracts with providers in East Tennessee and offering training on how to improve communication between physical and mental health providers.

“We are working day and night to make sure that we transition the new members as smoothly as possible, with as little disruption as possible,” said Dr. Ron Wigley, manager of behavioral health programs with Volunteer State Health Plan in Chattanooga.

TennCare has staggered the implementation of the new setup by region, with the transition going into effect last year in Middle Tennessee and implemented just this past weekend in West Tennessee.

MORE NEED FOR COORDINATED CARE

The complex physical health needs of people with chronic mental illness underline the urgent need for coordination of care between doctors who take care of the mind and those who focus on the rest of the body, health care providers said.

People with severe mental illness lose 25 or more years of life expectancy compared to the general population, according to a study published last year in the Journal of the American Medical Association. The difference is largely due to the increased risk for cardiovascular disease, not suicide, the study reported.

“Very often people with mental illness have co-morbid conditions (such as) diabetes and coronary heart disease, obesity,” said Bonnie Currey, president of the AIM Center. “You really have to look at the whole body to treat the mental health piece.”

Despite some trepidation about the upcoming transitional period, mental health advocates are enthusiastic about the integration of services for TennCare enrollees.

The National Alliance on Mental Health in Tennessee “sees this as both having positive potential — and we have some worries,” said Sita Diehl, executive director of the alliance in Tennessee.

One concern is that some doctors might choose not to participate in TennCare again, she said.

“That’s our worry, that clinicians, if they feel like it’s too much of an administrative burden, they will bow out of TennCare,” she said.