Healthcare Politics in the US


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medicaid, medicare, mental health, healthcare

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Healthcare Politics in the US

  1. 1. Reforming The Nations Mental Health System As healthcare reform is becoming a reality, there is much to celebrate within the mental healthcommunity. This includes passage of a healthcare reform package that includes parity for mentalhealth and addiction services, expansion of Medicaid to 133 % of Federal Poverty Level, inclusionof behavioral health organizations and individuals with mental illnesses in the new Medicaidmedical home state option, and authorization and increased funding for grants co-locating mentalhealth treatment and primary care. These and a host of other provisions expand the opportunitiesfor individuals with mental illnesses and addictions to obtain and maintain insurance coverage andaccess needed services.But this is not the end of the mental healthcare battle. Simply put, mental health advocates mustbe ready to play in a new game, in a world where increasing numbers of individuals - by virtue ofMedicaid expansion, the emerging Health Insurance Exchanges, and parity regulations - will haveaccess to behavioral health services. We expect to see an additional 15 million individuals - anincrease of 43 % - eligible for Medicaid alone, with more than 30 million individuals overall whowill, in the not too distant future, have insurance coverage.But this is far more than a matter of numbers - its about working smarter. Advocates of mentalhealthcare anticipate that healthcare reform-driven service delivery redesign and payment reformwill unfold at a rapid pace. In order to bend the cost curve, payment reform and service deliveryredesign will change how health, mental health, and substance use services are integrated,funded, and managed. Providers must learn to practice healthcare the way healthcare will bedone.As mental healthcare providers and advocates, we must become savvy about positioningourselves to take advantage of new markets and new opportunities to help control the design anddelivery of healthcare services. We must begin to build relationships within and across the entirehealthcare sector. As we revisit the concept of "managing care" for individuals and wholepopulations, we have to be certain that our focus on person-centered, recovery-focused treatmentand services is not subsumed by the drive to "bend the curve" in healthcare costs. We must beable to demonstrate our value not only to our customers, but also as key players in these newhealthcare consortia.We must become accountable for efficient and effective services that show results across allhealth 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 % and more. Werisk being left on the sidelines if we dont move with deliberate speed to ensure continuity andtimely access to care; comply with third-party payer requirements; coordinate care with a full rangeof health providers; and if necessary take on payers that refuse to honor the spirit and letter of theparity regulations.
  2. 2. We must become increasingly customer-focused, from the way we greet individuals who comethrough our door to the way we market our services. We should expect that with more moneyavailable in healthcare - particularly for mental health and addiction treatment - that new and wellcapitalized players will find behavioral health, traditionally a financially unattractive healthcaresector, far more appealing.People will be insured and will have an increasing range of options available to them. Whatdifferentiates our mental healthcare services? Why should an individual choose to receivetreatment and support from us? Are we offering services that will help them meet a full range ofhealthcare needs? Are our services culturally appropriate for the communities we serve? Can wehelp them understand and make appropriate use of their insurance coverage? We must retool ourorganizations with the knowledge that all individuals will now become true "consumers" ofhealthcare services.At the same time, we must also be aware that our work is far from over at the state and federallevel. Forty eight of 50 states are experiencing severe budget shortfalls. The threat is very real andthe mental healthcare advocates are fighting hard to hold on to current funding as legislatures seean opportunity to continue to withdraw needed funds. This is surely a bad idea - even the mostgenerous healthcare benefits will likely not cover the full range of wraparound supports that peoplewith mental illnesses and addictions need to fully recover.Due to greater understanding of how many Americans live with mental illnesses and addictiondisorders and how expensive the total healthcare expenditures are for this group, we havereached a critical tipping point when it comes to healthcare reform. We understand the importanceof treating the healthcare needs of individuals with serious mental illnesses and responding to thebehavioral healthcare needs of all Americans. This is creating a series of exciting opportunities forthe behavioral health community and a series of unprecedented challenges mental-healthorganizations across the U.S. are determined to provide expertise and leadership that supportsmember organizations, federal agencies, states, health plans, and consumer groups in ensuringthat the key issues facing persons with mental-health and substance use disorders are properlyaddressed and integrated into healthcare reform.In anticipation of parity and mental healthcare reform legislation, the many national and communitymental health organizations have been thinking, meeting and writing for well over a year. Theirwork continues and their outputs guide those organizations lobbying for government healthcarereform.MENTAL HEALTH SERVICE DELIVERY1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and
  3. 3. substance use treatment organizations, group practices, and individual clinicians will need toimprove 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 mentalhealth and substance use clinicians into primary care practices and primary care providers intomental health and substance use treatment organizations, using emerging and best practiceclinical 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 workforceand service array, underscoring the critical role these efforts play in supporting the recovery andwellness of persons with mental health and substance use disorders.4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental healthand substance use clinical guidelines and clinical tools will increase with support from the newPatient-Centered Outcomes Research Institute and other research and implementation efforts. Ofcourse, part of this initiative includes helping mental illness patients find a mental health clinicnearby.MENTAL HEALTH SYSTEM MANAGEMENT5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake maorchange processes to improve the quality and value of mental health and substance use servicesat parity as they redesign their Medicaid systems to prepare for expansion and design HealthInsurance Exchanges. Provider organizations will need to be able to work with new Medicaiddesigns and contract with and bill services through the Exchanges.6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need toredefine how to use behavioral health services to address absenteeism and presenteeism anddevelop a more resilient and productive workforce. Provider organizations will need to tailor theirservice offerings to meet employer needs and work with their contracting and billing systems.7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in somecases mandate the development of new management structures that support healthcare reformincluding Accountable Care Organizations and health plan redesign, providing guidance on howmental health and substance use should be included to improve quality and better manage totalhealthcare expenditures. Provider organizations should take part in and become owners of ACOsthat develop in their communities.MENTAL HEALTHCARE INFRASTRUCTURE
  4. 4. 8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forumwill 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 managecosts. Provider organizations will need to develop the infrastructure to operate within thisframework.9. Health Information Technology: Federal and state HIT initiatives need to reflect the importanceof mental-health and substance use services and include mental-health and substance useproviders and data requirements in funding, design work, and infrastructure development. Providerorganizations will need to be able to implement electronic health records and patient registries andconnect these systems to community health information networks and health informationexchanges.10. Healthcare Payment Reform: Payers and health plans will need to design and implement newpayment mechanisms including case rates and capitation that contain value-based purchasingand value-based insurance design strategies that are appropriate to provide the best drug rehabfor persons with mental health and substance use disorders. Visit this website to get in touch withNon 12 step drug rehab programs in your area. Providers will need to adapt their practicemanagement and billing systems and work processes in order to work with these newmechanisms.11. Workforce Development: Major efforts including work of the new Workforce AdvisoryCommittee will be needed to develop a national workforce strategy to meet the needs of personswith mental health and substance use disorder including expansion of peer counselors. Providerorganizations will need to participate in these efforts and be ready to ramp up their workforce tomeet unfolding demand.