Mark Ishaug, MA
In 2011, Mark Ishaug joined Thresholds as CEO, driven to take on the position because of the opportunities emerging in Illinois at that particular time. The doors were just starting to open to allow for collaboration with managed care and for the ability to move more individuals from institutional to community-based care.
Ishaug saw the potential of the two trends, believing there was opportunity to improve not just points of care for individuals with behavioral conditions but the system itself.
“I’ve spent the vast majority of my working life building partnerships, using evidence-based practices, trying to create value and outcomes programs, and engaging in advocacy at the highest level,” Ishaug says.
Cenpatico, the behavioral health arm of the state Medicaid managed care organization, created a pilot program with Thresholds to improve outcomes for 50 of its high-risk, high-cost patients. Thresholds was paid a flat case rate to manage patient care and to deliver “relentless engagement” for those who were homeless, difficult to locate in their neighborhoods and too often not engaged in any type of care.
“We call our services ‘in vivo,’” he says. “We’re not a traditional community mental health center or federally qualified health center where the people come to us. We engage people where they are because that is what the evidence says works.”
In the year-long Cenpatico pilot ending in February 2014, results showed a 50 percent overall reduction in behavioral health admissions, a 55 percent reduction in 30-day readmissions, and a 58 percent reduction in 90-day readmissions. The overall cost for psychiatric inpatient care fell by 63 percent as well.
“This pilot project has grown into a full-fledged case-rate arrangement,” Ishaug says. “It’s a new way of doing business and partnering with managed care organizations to collectively achieve the outcomes we want.”
He also says new payment arrangements such as case rate models provide some latitude to deliver comprehensive services, unlike the fee-for-service model that limits what is reimbursed to specific medical interventions. For example, a community team seeking to engage a homeless member who has repeatedly visited the emergency room might not be able to bill a payer under a fee-for-service model, but their engagement services could be funded in a case rate model.
Thresholds manages care for about 400 Cenpatico enrollees right now, representing about 10 percent of Thresholds’ total membership population. In another managed care initiative, the organization has plans to begin a project with the local Blue Cross Blue Shield insurer to coordinate care and services for 1,000 of its enrollees.
Housing is healthcare
In the future, Ishaug envisions managed care companies investing beyond the health services and looking into housing for their enrollees because a person’s housing situation has a direct and dramatic effect on overall health. He says some discussion has begun over the last year about the right mechanism to fund managed care investment in housing, but it’s still at a conceptual level.
“All evidence suggests that homeless folks with mental health and substance use disorders are often frequent users of healthcare and are costing the system a fortune,” he says. “Getting people into affordable housing, while it may cost $700 or so a month, it’s a fraction of the cost for the ER or hospitalization, or worse, incarceration.”
Ishaug says Thresholds is one of Illinois’ largest providers of supportive housing for those with mental health conditions and substance use disorders with more than 1,500 people in properties the organization owns or rents. Clinical support is available at varying levels, depending on the individual’s needs and choice.
- Supervised group homes;
- Supportive housing in a single-room occupancy setting; and
- Independent apartment settings.
“Housing is healthcare,” he says. “The fact that we separate them is like separating the mind from the body or mental health from physical health.”
Thresholds is looking for ways to increase the inventory of available supportive housing in the future, whether through Section 8 or unique organizational partnerships. Creating more housing options is core to the organization’s mission, he says.