With healthcare reform the law of the land, we’ve had much to celebrate.
We’ve applauded President Obama and Congress for passage of a healthcare reform package that includes parity for mental health and addiction services, expansion of Medicaid to 133 percent of Federal Poverty Level, inclusion of behavioral health organizations and individuals with mental illnesses in the new Medicaid medical home state option, and authorization and increased funding for the SAMSHA grants co-locating mental health treatment and primary care.
These and a host of other provisions expand the opportunities for individuals with mental illnesses and addictions to obtain and maintain insurance coverage and access needed services. If you haven’t already done so, I urge you to thank your Senators and Representatives who voted for the most sweeping piece of healthcare legislation in more than 40 years. We very much appreciate their commitment to the behavioral health community and will continue to work with them — to be certain that reform is the good idea we believe it can be.
But we can’t do this alone. As the National Council’s lobbyist is fond of saying, government relations is a team sport. At so, we also celebrate you — your committed advocacy and passionate leadership encouraged the most pro-consumer parity rules in history and enabled key provisions of the Patient Protection and Affordable Care Act. And if this wasn’t enough, thanks to you, the push for creation of Federally Qualified Behavioral Health Centers is now a top agenda item. With your help, we are continuing to lobby to bring “parity” to public behavioral health and end the second-class status of community mental health and addiction providers in America’s safety net.
Due to greater understanding of how many Americans live with mental illnesses and addictions and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges — and the National Council is determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental health and substance use disorders are properly addressed and integrated into healthcare reform.
In anticipation of parity and reform legislation, the National Council’s public policy committee created a Healthcare Reform Workgroup that has been thinking, meeting and writing for well over a year. Their work continues and their outputs guide our activities in addressing eleven planning, design and implementation issues in three areas:
- service delivery
- system management
1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.
2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.
3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.
4. Clinical Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts.
5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.
6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.
7. Accountable Care Organizations and Health Plan Redesign: Payors will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.
8. Quality Improvement: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental health and substance use performance measures that will be used to improve delivery of mental health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.
9. Health Information Technology (HIT): Federal and state HIT initiatives need to reflect the importance of mental health and substance use services and include mental health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.
10. Payment Reform: Payors and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.
11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.
Simply put, we must be ready to play in a new game, in a world where increasing numbers of individuals — by virtue of Medicaid expansion, the emerging Health Insurance Exchanges, and parity regulations — will have access to behavioral health services. We expect to see an additional 15 million individuals — an increase of 43 percent — eligible for Medicaid alone, with more than 30 million individuals overall who will, in the not too distant future, have insurance coverage.
But this is far more than a matter of numbers — it’s about working smarter. We anticipate that healthcare reform-driven service delivery redesign and payment reform will unfold at a rapid pace. In order to bend the cost curve, payment reform and service delivery redesign will change how health, mental health and substance use services are integrated, funded, and managed.
We must learn to practice healthcare the way healthcare will be done.
We must become savvy about positioning ourselves to take advantage of new markets and new opportunities to help control the design and delivery of healthcare services. We must begin to build relationships within and across the entire healthcare sector. As we revisit the concept of “managing care” for individuals and whole populations, we have to be certain that our focus on person-centered, recovery-focused treatment and services is not subsumed by the drive to “bend the curve” in healthcare costs. We must be able to demonstrate our value not only to our customers, but also as key players in these new health care consortia.
We must become accountable for efficient and effective services that show results across all health domains. We believe fee-for-service reimbursement will slowly become a thing of the past. So, too, will be the ability to claim that caseloads are full with no-show rates of 50 percent and more. We risk being left on the sidelines if we don’t move with deliberate speed to ensure continuity and timely access to care; comply with third-party payer requirements; coordinate care with a full range of health providers; and if necessary take on payers that refuse to honor the spirit and letter of the parity regulations.
We must become increasingly customer-focused, from the way we greet individuals who come through our door to the way we market our services. We should expect that with more money available in healthcare – particularly for mental health and addiction treatment – that new and well capitalized players will find behavioral health, traditionally a financially unattractive healthcare sector, far more appealing.
People will be insured and will have an increasing range of options available to them. What differentiates our services? Why should an individual choose to receive treatment and support from us? Are we offering services that will help them meet a full range of healthcare needs? Are our services culturally appropriate for the communities we serve? Can we help them understand and make appropriate use of their insurance coverage? We must retool our organizations with the knowledge that all individuals will now become true “consumers” of healthcare services.
At the same time, we must also be aware that our work is far from over at the state and federal level. Forty-eight of 50 sates are experiencing severe budget shortfalls. The threat is very real and the National Council’s state and local partner associations and their stakeholder communities are fighting hard to hold on to current funding as legislatures see an opportunity to continue to withdraw needed funds. We know this is a bad idea — even the most generous healthcare benefits will likely not cover the full range of wraparound supports that people with mental illnesses and addictions need to recover.
At the federal level, we must work to ensure that SAMSHA funds are similarly maintained. In an environment where dollars and emphasis are focused on disease prevention, health promotion, and comparative effectiveness research, we must increase understanding of the contributions behavioral health has made to each of these areas.
Eleanor Roosevelt once said, “It takes as much energy to wish as it does to plan.” All of our planning, advocacy, and leadership to date have borne fruit, but we must not be content to wish it all works out well. We must fight for our future — and the future of the individuals we are privileged to serve — by acting as key players in the brave new world of healthcare. Remember to:
Participate in the National Council’s healthcare reform webinars.
Respond to the National Council’s Action Alerts you receive via e-mail.
Continue to lobby and educate your Senators and Representatives and their staff. There is still much work to be done!
The National Council is here to serve you. You can follow us on Twitter and become fans on Facebook; and you can reach me directly at LindaR@thenationalcouncil.org — I always welcome your feedback and suggestions.