Financing is probably the most common perceived barrier in implementing integrated or collaborative mental health care. However, integrated health care is fundable in nearly every state right now! Even with the state by state difference in Medicaid programs, the complexity of Medicare billing, and uniqueness of healthcare coverage for those we serve, there are short term solutions that allow programming to proceed and services to be provided in integrated programs. In Medicaid fee-for-service and capitated states there are nearly a dozen ways to fund collaborative care and integrated mental health care initiatives.
The Community’s Money -
A consistent barrier in financing integrated healthcare services is that organizations think of the funding in a siloed way. It’s not uncommon to hear “this is my money” or “our money.” With this old approach to financing, the outcomes often need to benefit the organization and sometimes even the individuals within an organization. Success with financing integrated care requires a paradigm shift that involves putting the consumers’ and community’s best interest first. Agencies and organizations are stewards of the public money. It is a behavioral healthcare organization’s responsibility to make behavioral health resources available to the community as part of a package of services. This approach to financing integrated healthcare results in creative, effective service packages that meet everyone’s needs.
Generating the Will -
In these difficult financial times it seems natural to hunker down and wait for things to improve. Now, more than ever is the time to be creative and to stretch mental health resources to the maximum and assist consumers in their path to recovery. It may seem counter-intuitive but now may be when change is most possible and most effective. Now is the time to get the most creative financial minds together with the most conservative financial minds and hammer out exactly what is possible with the funding that is received. Partnering and collaboration are often keys to making money go further. This is particularly true in integrated healthcare where shared resources improve consumer outcomes while enhancing the bottom line of all the partners.
Advocating for State Level Medicaid Changes -
Medicaid regulations are made state by state in this country. This is both a blessing and a curse. A blessing in that there is often more ability to influence state policy rather than federal policy and a curse because the same work has to be done 50 times! A number of states already allow for billing two services on one day. It is possible to get a copy of that policy work in one state and work with another state to implement it.
Tips for Financing Mental Health Services Right Now -
Two series of codes are already approved for commercial, Medicare and Medicaid billing: SBIRT (Screening, Brief Intervention, Referral and Treatment) and the Health and Behavior Assessment/Intervention (96150-96155). The Health and Behavior Assessment/Intervention codes can be used to bill a behavioral health service ancillary to a primary care diagnosis. This would include providing services regarding chronic care management such as diabetes care, cardiac support, and consulting and assistance with COPD management. SBIRT can be billed in the primary care setting for screening for substance use/abuse.
In Wisconsin, case/care management services are billable for primary settings working with individuals with a serious mental illness. In Michigan the Primary Care Association has negotiated a memorandum of understanding that allows for FQHCs to bill two services in one day (www.mpca.net). In states where two services rendered on one day by one provider are not billable, programs have found innovative ways to collaborate that allow both partners to bill, using two provider numbers to provide the services. They key here is creative, collaborative thinking that maximizes the current financing options. Improving the health status of those we serve requires all of us to come to the table and work within existing financing structures to find solutions rather than use financing as way to delay discussions.
In states where capitation is used, it often provides the flexibility for local decision-making regarding services and funding. Don’t be afraid to expand thinking about creative ways to secure better outcomes by integrating staff into primary care setting to provide mental health services. Often, it requires no new approvals for mental health centers to provide community based services. In fee for service states, review the regulations and find any way you can to bill for services at a primary care site. You’ll generate better health outcomes and support your organization’s bottom line.
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Out of the many health problems associated with people, there is yet another kind of sickness. This is the mental sickness, which finds its cure in the mental health care. There can be a wide variety of reasons due to which people may undergo depression. A depressed State of mind is something that can have its impact on the physical health as well. The mental health care is directed towards making people realize that life is to be happy. They can feel the positive energy rising high within them. The mental health care is extended towards those people who find it hard to meet the difficulties of life. As A result of this, they start feeling the helplessness that they have been exposed to. This makes it very difficult for such people to carry on with life.
There can be different reasons behind a person getting into such misbalanced state of mind. It may happen due to an unsuccessful marital Relationship, loss of someone very close or failures in the field of career. Present day, even students Undergo this problem due to the excessive pressure put on them for competing with the demanding world. In case of the situations wherein
They fear to meet people who hold high expectations; they get into the depressed state of mind. However,it is not something that has no remedy. Just like any other problem, it can also be dealt with the mental health care. This includes taking good care about the happiness of people. Mental health care Includes boosting up the confidence of people suffering from this kind of problem. The people having depressed state of mind are exposed to wider persecutions of life.
In some cases, the meditation is also a part of the mental health care so as to get a focused approach to solve any kind of problem. In case, proper mental health care is not provided to the person, he may even attempt to commit suicide. The best approach is to let him speak out his heart. A person who takes the aid of mental health care May feel the need to come out of his sad state of mind. As a result of this, he will even make efforts at his end to come out of this depressed state. The Responsibility of mental health care is to tell him ways to heal himself. An integral part of the mental health care is to understand the feelings of this person. This will help him to get proper guidance. As a result of the unhappy mind, one generally tends to shirk all meals. This may effect his health. Mental health care also takes care to give him good nutrition.
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Li gets some extended privileges within Selkirk Mental health centre
The Criminal review board of Manitoba has ruled Vince Li will not be allowed passes to leave the Selkirk Mental Health Centre for at least the next year.
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Continuity of care between the inpatient and outpatient settings continues to be a challenge. Current hospital payments assume that hospitals are actively involved through discharge and the transition to outpatient settings and advocating for payments for outpatient providers to assist in this process is viewed as duplicative. This undermines mental health care providers’ ability to smoothly transition clients between service settings.
Meeting the credentialing requirements for program services and mental health professionals has posed new challenges. Community behavioral health organizations employ professionals that may not meet private insurers’ credentialing standards (for example, 3 years of post-licensure experience). Community providers have addressed this through contractual arrangements in which quality assurance and supervision requirements substitute for these credentialing standards. Services are billed under a supervisory protocol in which the supervising professional’s national provider identifier is used.
Additionally, some programs offer services that rely on a combination of funding sources such as county, state, and private insurers. In these situations, counties sometimes want to limit private insurance clients’ access to these programs because a portion of the overall program is covered by the county.
Impact of State Budget Cuts on Mental Health Care -
In a dramatic turnabout that may foreshadow dilemmas faced by other states, the governor of Minnesota vetoed funding for the state’s mental healthcare program. The legislature would have extended the program for several months, as a compromise was negotiated to retain elements of coverage for the state’s mental health population – a hospital uncompensated care fund, medication/pharmacy, and “coordinated care delivery systems.” In the system, an accountable hospital-centered program paid a fixed amount to cover about 40% of the state’s mental illness population who elected to participate. As there is no reimbursement for outpatient clinic and all non-hospital services, providers and consumers now are scrambling to seek disability determination or enroll in Medicare type coverage after the six month state mental illness coverage enrollment period ends.
While these cuts are only effective as of June 1, 2010, it is expected that they will result in increases to the uncompensated care burden on hospitals and community safety net providers.
How Do We Minimize The Impact of Budget Cuts on Mental Health Care?
Many not-for-profit membership organizations representing community mental health and other service provider agencies throughout Minnesota have been working in coalition with national mental health groups on advocacy related to the state’s mental health program changes. Initially, advocacy efforts were focused on encouraging the state legislature to vote in support of expanding the state Medicaid program early to receive additional federal funding (as provided for in the national healthcare reform bill). Unfortunately, this proved to be politically untenable in the immediate future; however, a measure was passed to allow the governor to use executive authority to expand Medicaid coverage for mental illness patients.
While being actively involved in this advocacy process is vitally important to the community behavioral health system, national mental health advocacy medicaid organizations and their members are also evaluating ways in which they can optimize their business practices to meet this changing budgetary reality. Among other strategies, community behavioral health providers are working to develop partnerships with community hospitals to reduce the number of avoidable emergency department admissions and ease the transition from the inpatient to outpatient settings, supporting clients through the disability determinations process so they may become eligible for Medicaid as quickly as possible, and raising funds that will help to cover the cost sharing requirements for state sponsored mental health care and the enrolled clients that are unable to pay.
Through this two-pronged approach that includes both advocacy and pragmatic business considerations, it is hoped that the community behavioral health system will be able to develop new cost-effective ways of delivering services that will be well-positioned to withstand funding changes while taking advantage of new opportunities made available through national and state health care reform initiatives.
One in four people will suffer a mental, neurological, or substance use disorder at some point in their life; yet many cannot get access to basic medicines or basic mental health care. The mental health Gap Action Programme (mhGAP) asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy and prevented from suicide even where resources are scarce. For more information: www.who.int
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Quarter of students have mental health woes
In excess of one in four students in the Thames Valley school district suffers from mental health issues — most strongly linked to bullying — a study has found.[...]
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In 2007, the governor of Minnesota proposed a mental health initiative and the legislature passed it. One of the more important components of the initiative was legislation amending Minnesota’s two programs for the uninsured – General Assistance Medical Care and Minnesota Care – to add to the comprehensive mental health and addictions benefit.
Who Is Covered?
General Assistance Medical Care covers those with income at or below 75% of the federal poverty level who meet one or more of additional criteria known as General Assistance Medical Care qualifiers. Qualifiers include waiting or appealing disability determination by Social Security Administration or state medical review team; or being in a homeless or live in shelter, hotel, or other place of public accommodation.
Minnesota Care covers children and pregnant women, parents, and caretakers up to 275% of the federal poverty level, except that parents and caretakers gross income cannot exceed ,000. Single adults without children increased to 200% of federal poverty level by January 1, 2008 and will rise to 215% of federal poverty level by January 1, 2009.
What Services Are Covered?
For Minnesota Care, there are limits of ,000 on inpatient care for any condition (physical, mental health, or addictions) for parents over 175% of federal poverty level and childless adults. For General Assistance Medical Care, inpatient benefits are fully covered. Both programs cover chemical dependency outpatient services. An intensive array of outpatient and residential mental health services are available.
What Is The Cost?
In Minnesota, the Medicaid Temporary Assistance for Needy Families population, General Assistance Medical Care and Minnesota Care are enrolled in comprehensive nonprofit health plans that are responsible to deliver and are at risk for the entire health benefit, including behavioral health. Adding mental health rehabilitative services (including adult rehabilitative mental health services individual and group rehabilitation services, assertive community treatment, intensive residential treatment and mobile and residential crisis services) to Minnesota Care was projected to cost .40 per person per month. For General Assistance Medical Care, which includes a homeless population, the cost was .01 per person per month. The additional targeted case management service was projected to cost .22 per person per month for Minnesota Care and .66 for General Assistance Medical Care.
The legislature appropriated a total of million in additional state dollars in fiscal year 2008 and $ 3.5 million in fiscal year 2009 to add the adult rehabilitative services and case management in Minnesota Care. State funds previously targeted for case management were moved from the counties to the state in an amount of .4 million in fiscal year 2009.
What Led To Comprehensive Coverage?
The state collected data on the residents served by Minnesota Care, General Assistance Medical Care, and Medicaid managed care plans serving non-disabled populations, and discovered that an increasing number of individuals with serious mental illnesses were in these plans. Several insurance reforms – similar to those included in the national healthcare reform bill – modified the private market, including guaranteed issue in small and large group plans, broader rate bands, parity for mental health and chemical dependency services, medical loss ratios, high risk insurance pool, and others. A lawsuit by the attorney general called attention to health plan denials of payment for court-ordered treatment, for example for civil commitment or out of home placement for adolescents.
Health plans settled with an agreement that behavioral and mental health benefits would be covered by a health plan if the court based its decision on a diagnostic evaluation and plan of care developed by a qualified professional. In addition to the court-ordered services provision, the state contracts and capitation with prepaid health programs (Minnesota Care and General Assistance Medical Care) were amended to align risk and responsibility for services in institutions for mental illnesses, 180 days of nursing home or home health, and court-ordered treatment. There were also highly successful experiments reducing costs and improving outcomes for commercial and non-disabled Medicaid clients who were offered a more intensive community based mental health service that improved coordination with and linkages to behavioral healthcare, primary care, and other needed services.
These demonstrations produced a positive return on investment – .38/person/month – and gave the health plans tools to manage the increased risk that resulted from several insurance reforms, including parity, a statutory definition of medical necessity, and the court-ordered treatment provision.
The state supported comprehensive coverage because it sought to provide mental health and addiction services in Minnesota as part of mainstream healthcare. Minnesota’s mental health agency and other stakeholders desired to move mental illness from its historical treatment as a social disease requiring social services to an illness like any other. They wanted to foster earlier interventions and avoid shifting enrollees among different programs in order to access specific services. Operationalizing this change required rethinking medical necessity determinations, provider credentialing, contracting, procedure codes and other processes common to private insurance plans.
How Did It Get Through The Political Process?
Three factors significantly contributed to the political viability of a benefit expansion in the Minnesota Care and General Assistance Medical Care programs:
>> The governor of Minnesota and the administration provided strong leadership. The provisions to expand the mental health benefits in these plans were part of the governor’s mental health initiative, set forth in advance of the 2007 legislative session.
>> An extremely strong coalition of stakeholders formed a mental health action group. This group is co-chaired by a representative from the department of human services and included representation from the private insurance industry and organized and knowledgeable advocacy and provider communities.
>> There was strong support in the legislature for the expansion of benefits in Minnesota Care and General Assistance Medical Care, including from a member of the finance committee in the house, who has a son with schizophrenia. The creation of a mental health division in the health and human services policy committee also helped move the policy discussion forward.
Why Does This Approach to Healthcare Reform Work?
A recent survey of community behavioral health organizations found that on average, 42% of reimbursement for services came from private insurers. While this represents the average, the survey found that there was quite a range in reimbursement sources. For community behavioral health organizations that specialize in services such as Assertive Community Treatment or case management, Medicaid is the predominant reimbursement source, either through fee-for-service or managed care.
Reimbursement from private insurance and Medicaid managed care is uniformly better than Medicaid fee-for-service. In addition to higher rates, the private insurers and Medicaid managed care organizations have been willing to offer special contracts for packages of services for crisis care and hospital discharge plus aftercare.
Mental health employment program set to close
A program that helps people with mental health disabilities land jobs has lost its federal funding and will have to close down by the end of March. The national BUILT Network program — administered by a St.[...]
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by xeeliz
The Four Quadrant Model is a proposed model for the clinical integration of mental health and behavioral health services. A focus on the prevalence of co-occurring disorders (i.e. depression and alcoholism) is paramount in this model. The Four Quadrant Model builds on the 1998 consensus document for mental health and substance abuse/addiction service integration. This model for a comprehensive, continuous and integrated system of care describes differing levels of mental health and substance abuse integration and clinician competencies based on the four-quadrant model, divided into severity for each disorder:
> Quadrant I: Low mental health – low substance abuse, served in primary care
> Quadrant II: High mental health – low substance abuse, served in the mental health system by staff who have substance abuse competency
> Quadrant III: Low mental health – high substance abuse, served in the substance abuse system by staff who have mental health competency
> Quadrant IV: High mental health – high substance abuse, served by a fully integrated mental health and substance abuse program
The Four Quadrant model is not intended to be prescriptive about what happens in each quadrant, but to serve as a conceptual framework for collaborative planning in each local system. Ideally it would be used as a part of collaborative planning for each new behavioral health and community mental healthcare site, with the local provider(s) of public behavioral health services using the framework to decide who will do what and how coordination for each person served will be assured.
The use of the Four Quadrant Model to consider subsets of the population, the major system elements and clinical roles would result in the following broad approaches:
QUADRANT I
Low behavioral health – low physical health complexity/risk, served in primary care with behavioral health care staff on site; very low/low individuals served by the principle care provider, with the behavioral health care staff serving those with slightly elevated health or behavioral health risk.
The principle care providers give primary care services and uses standard behavioral health screening tools and practice guidelines to serve most individuals in the primary care practice. Use of standardized behavioral health tools by the principle care providers and a tracking/registry system focuses referrals of a subset of the population to the behavioral health clinician. The role of the primary care based behavioral health clinician is to provide formal and informal consultation to the principle care providers as well as to provide behavioral health triage and assessment, brief treatment services to the patient, referral to community and educational resources, and health risk education. Behavioral health clinical and support services may include individual or group services, use of cognitive behavioral therapy, psycho-education, brief substance abuse intervention, and limited case management. The behavioral health clinician must be competent in both mental health and substance abuse assessment and service planning. The principle care provider prescribes psychotropic medications using treatment algorithms and has access to psychiatric consultation regarding medication management.
The consumer of care, by seeking care in primary care, has selected a “clinical home.” Consistent with appropriate clinical practice, that should be honored. The primary care and specialty behavioral health system should develop protocols, however, that spell out how acute behavioral health episodes or high-risk consumers will be handled. This will also lead to clarity regarding the “clinical home” of consumers with serious persistent mental illness who are currently stable, which should be based upon consumer choice and the specifics of the community collaboration.
QUADRANT II
High behavioral health – low physical health complexity/risk, served in a specialty behavioral health system that coordinates with the principle care providers.
The principle care provider provides primary care services and collaborates with the specialty behavioral health providers to assure coordinated care for individuals. Psychiatric consultation for the principle care providers may be an element in these complex behavioral health situations, but it more likely that psychotropic medication management will be handled by the specialty behavioral health system. The role of the specialty behavioral health clinician is to provide behavioral health assessment, arrange for or deliver specialty behavioral health services, assure case management related to housing and other community supports, assure that the consumer has access to health care, and create a primary care communication approach (e.g., e-mail, v-mail, face to face) that assures coordinated service planning, especially in regard to medication management.
Specialty behavioral health clinical and support services will vary based upon state and county level planning and financing; some localities may encompass the full range of services offered by specialty behavioral health systems including:
Specialty Mental Health Services
> Crisis respite facilities
> 24/7 crisis telephone
> Crisis residential facilities
> Mobile crisis team
> Crisis observation 23 hour beds
> Urgent care walk in clinic
> Locked sub-acute residential
> Inpatient (voluntary and involuntary)
> Dual diagnosis inpatient
> Hospital discharge planning
> Partial hospitalization
> In-home stabilization
> Outreach to homeless shelters
> Outreach to jail/corrections
> Outreach to other special populations
> Individual/family treatment /counseling
> Group treatment/counseling
> Dual diagnosis treatment groups
> Multifamily groups
> Psychiatric evaluation/consultation
> Psychiatric prescribing/management
> Advice nurse (medication issues)
> Psychological testing
> Services for homebound frail or disabled
> Specialized services for older adults
> Brokerage case management
> 24/7 intensive home /community case management
> School-based assessment and treatment
> Supported classroom
> Stabilization classroom
> Day treatment (adult, adolescent, child)
> Supported employment /supported education
> Transitional services for young adults
> Individual skill building /coaching
> Intensive peer support
> After school structured services
> Summer daily structure and support
Specialty Substance Abuse Services
> Sobering sites
> Social detoxification/residential
> Outpatient medical detoxification
> Inpatient medical detoxification
> Pre-treatment groups
> Intensive outpatient treatment
> Outpatient treatment
> Day treatment
> Aftercare/12 step groups
> Narcotic replacement treatment
Residential Services
> Boarding homes
> Adult residential treatment
> Child/adolescent residential treatment
> Transitional housing
> Adult family homes
> Treatment foster care
> Low income housing (dedicated to behavioral health consumers)
Supports for Serious Persistent Mental Health Populations
> Representative payee/financial services
> Time limited transitional groups
> Parent support groups
> Youth support groups
> Dual diagnosis education/support groups
> Caregiver/family support groups
> Youth after school normalizing activities
> Youth tutors/mentors
The behavioral health clinician must be competent in both mental health and substance abuse assessment and service planning. A specific standard of practice should be adopted that defines the methods and frequency of communication with principle care providers. Note that this quadrant is where most public sector behavioral health consumers currently can be found.
QUADRANT III
Low behavioral health – high physical health complexity/risk, served in the primary care/medical specialty system with behavioral health staff on site in primary or medical specialty care, coordinating with all medical care providers including disease managers.
The principle care providers provides primary care services, works with medical specialty providers and disease managers (e.g. diabetes, asthma) to manage the physical health issues of the individual and uses standard behavioral health screening tools and practice guidelines to serve most individuals in the primary care practice. Use of standardized behavioral health tools by the principle care providers and a tracking/registry system focuses referrals of a subset of the population to the behavioral health clinician. The role of the primary care or medical specialty based behavioral health clinician is to provide behavioral health triage and assessment, consultation to the principle care providers or treatment services to the patient, referral to community and educational resources, and health risk education. Behavioral health clinical and support services may include individual or group services, use of cognitive behavioral therapy, psycho-education, brief substance abuse intervention, and limited case management. The behavioral health clinician must be competent in both mental health and substance abuse assessment and service planning. The principle care provider prescribes psychotropic medications using treatment algorithms and has access to psychiatric consultation regarding medication management.
Depending on the setting, the behavioral health clinician may also serve as a health educator regarding lifestyle and chronic health conditions found in the general public (diabetes, asthma) or conditions found in at-risk populations (Hepatitis C, HIV). These population-based services, as articulated by Bob Dyer, would include: patient education, activity planning; prompting; skill assessment; skill building; and, mutual support. In addition to these disease management services, the behavioral health clinician might serve as a physician extender, supporting efficient use of physician time by problem solving with acute or chronic patients, as well as working with patients on medication compliance issues.
Specialty healthcare and disease management programs could also integrate depression screening into a wide array of self management and rehabilitation programs, building on current research findings regarding the frequency and impact of depression in cardiovascular or diabetes populations.
QUADRANT IV
High behavioral health – high physical health complexity/risk, served in both the specialty behavioral health and primary care/medical specialty systems; in addition to the behavioral health case manager, there may be a disease manager, in which case the two managers work at a high level of coordination with one another and other members of the team.
The principle care providers works with medical specialty providers and disease managers (e.g. diabetes, asthma) to manage the physical health issues of the individual, while collaborating with the behavioral health system in the planning and delivery of behavioral health clinical and support services, which include those listed in Quadrant II. Psychiatric consultation is a key element in these most complex situations. The role of the specialty behavioral health clinician is to provide behavioral health assessment, arrange for or deliver specialty behavioral health services, assure case management related to housing and other community supports, and collaborate at a high level with the healthcare system team. The behavioral health clinician must be competent in both mental health and substance abuse assessment and service planning.
In some settings, behavioral health services may be integrated with specialty provider teams (for example, Kaiser has behavioral health clinicians in OB/GYN working with substance abusing pregnant women). With the extension of disease management programs into Medicaid health plans, there is the likelihood of coordinating with disease managers in addition to healthcare providers. The behavioral health clinician and disease manager should assure they are not duplicating tasks, but working together to support the needs of the consumer. A specific standard of practice should be adopted that defines the methods and frequency of communication.
Mental Health At New Low For College Freshmen
A survey shows the mental health of college freshmen sank to an all-time low this academic year.
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Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. 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 Mental health organizations across the U.S. are 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 mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform. .
MENTAL HEALTH SERVICE DELIVERY
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. Mental Health Clinic 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. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.
MENTAL HEALTH SYSTEM MANAGEMENT
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: Payers 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.
MENTAL HEALTHCARE INFRASTRUCTURE
8. Quality Improvement for Mental Healthcare: 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: 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. Healthcare Payment Reform: Payers 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.
Mental Health Patient Relates To Loughner
The mass shooting in Tucson and the mental history of suspect Jared Loughner has sparked debate about whether the state’s mental health services are adequate.
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In August, Whole Foods CEO John Mackey argued in the pages of the Wall Street Journal that the solution to America’s health care crisis was to be found in “less government control and more individual empowerment.” His own company’s unique health care plan, Mackey wrote, covers 90 percent of employees, costs less than health insurance plans, aned provides a “very high degree of worker satisfaction.” But for the sin of not supporting a government take over of health care, labor unions and left-wing activists called for a boycott of Whole Foods, claiming that Mackey’s solutions were unworkable and his employees were unhappy. Reason.tv talked to protesters, Mackey, and employees about “the Whole Foods alternative to ObamaCare.” Produced by Michael C. Moynihan and Dan Hayes. Edited by Dan Hayes. Approximately 5 minutes. (Full disclosure: Mackey has contributed to Reason Foundation, the nonprofit that publishes this website.) Related video: John Mackey’s Conscious Capitalism: The Whole Foods CEO on health care, veganism, and free markets: www.youtube.com Go to reason.tv for downloadable versions of these and other videos.
Professor Anthony Hassan discusses mental health care in the military in the aftermath of the shooting at Fort Hood, the dynamics of mental health care professionals seeking treatment for themselves, and what students at USC are learning to help prepare them to work in a military context. Dr. Hassan is a retired Air Force officer and the current director of the Center for Research and Innovation on Veterans and Military Families at the USC School of Social Work.