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New Future for Behavioral Health Care—Where Are We Headed?

January 10, 2014 | By: Andy Carter, HAP President and CEO

New Future for Behavioral Health Care—Where Are We Headed?

The health care community has long-struggled to find the best way to effectively care for behavioral health patients. Early in my tenure, I spoke with hospital leaders who were providing extensive uncompensated care to patients with mental illness.

In some cases, these patients languished for months in an inpatient setting because they had nowhere to go. But without this safety net, where would these individuals receive any type of care?

Currently, about one in four adult Americans suffer from a mental illness each year. Many are negatively impacted by a fragmented system, insufficient funding for services, too few providers, restricted insurance coverage, and personal financial barriers.

According to the U.S. Department of Health and Human Services, in 2012, there were 5.4 million adults suffering from a mental illness who did not receive any mental health services. Several reasons were reported, including:

  • Inability to afford the cost of care (45.7%) 
  • Not knowing where to go for services (22.8%)

Now, more than ever, we have an opportunity to improve the quality of these lives through greater access to better coordinated care.

Beginning in 2014, mental health and substance abuse services are classified among the ten “Essential Health Benefits” under the Affordable Care Act. The new health insurance marketplaces cannot apply yearly or lifetime dollar limits on coverage of these benefits. Nor can insurers deny anyone coverage or charge more for pre-existing conditions.

The Affordable Care Act supports new health care delivery models that will better serve behavioral health patients by coordinating and managing all health care needs of an individual.

Payment incentives will encourage providers to better manage patients’ transitions among care settings.

There are new standards for the quality of behavioral health care.

Across the country, there is recognition that we cannot separate behavioral and medical health care. The “mind-body” linkage is critical. Behavioral health conditions exacerbate physical illnesses, and physical illnesses worsen behavioral disorders.

In 2013, Pennsylvania’s Department of Public Welfare’s Office of Mental Health and Substance Abuse Services (OMHSAS) held statewide forums on behavioral and physical health integration. There are plans for more in 2014.   

OHMSAS wants to assure that the system is person- and family-centered. HAP has been engaged in several related discussions, helping to provide guidance to the state on strategic planning.

The association is advocating for the use of advanced practice professionals to practice more fully in the behavioral health care setting to preserve access in high-utilization and under-served areas.

We are working with behavioral health navigators to assist hospitals with outreach and enrollment to get coverage for uninsured behavioral health constituents. And the Delaware Valley Healthcare Council of HAP serves on the new Community Behavioral Health Kitchen Cabinet to improve care delivery in the southeast.

As we work to improve access to care for patients with mental illness, we must add behavioral and physical health integration to the list. I look forward to being part of this important discussion.

Andy Carter
Written by Andy Carter

Andy Carter is the president and CEO of HAP. He is responsible for leading advocacy, policy planning, strategic direction, and communications for the hospital and health system members of one of the nation’s largest statewide health care advocacy organizations.




Comments

Comments posted are subject to HAP’s Community Guidelines under its Terms and Conditions.

By Paul Bacharach   |   Thursday, February 6, 2014 4:49 PM

What an astute observation from an acute care guy! I have seen first hand the separation of behavioral/substance abuse treatment from acute care and the failure to recognize the links with physical medicine (along with the socio-economic implications). They can't be addressed in isolation. I hope that we can forge closer links which integrates with the broader continuum going forward. Hope all is well. PB



By Susan Sargent   |   Friday, April 18, 2014 8:58 AM

I applaud Andy Carter's posting regarding the need for integration of medical and behavioral (BH) care. It is an area in which my colleague -- a dually boarded internist and psychiatrist -- and I have consulted over the past 15+ years. It has become more relevant and critical as many providers and hospitals within ACOs move toward population health and the risk-based contracts they entail. Specifically, they are learning that BH care needs to play a much larger and integrative role in improving the quality of care, the reduction of costs, and enhanced access for medical patients. Relevant to your posts are the following data gleaned from our research and engagements:
--80% of all BH services are provided in inpatient and outpatient medical settings.
--27-35% of adult medical inpatient admissions have documented comorbid BH conditions.
--35-43% of patients with chronic medical conditions have comorbid BH issues which increase the cost of their care.
--60-80% of complex (multiple chronic conditions) patients have BH comorbidities.
--14% of the Medicare, Medicaid and privately insured populations (291m lives) annually submit BH claims which account for 6.8% of all claims; yet this same 14% accounts for 27.5% of the total medical dollars.
--Mid-sized hospitals (~500 beds) annually spend an average of $1m on sitters/constant observation personnel for BH patients on medical units and in ERs.
--Medical patients with comorbid BH conditions have 30-day readmission rates averaging 35-70% higher than their non-comorbid counterparts.
I am pleased that you and HAP leadership are taking such a positive and much-needed position on integrated care. This advocacy coupled with effective implementation of value-added initiatives will truly improve your members' performance and their care of Pennsylvania residents.



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