Medicaid Authorities, Health Plans, and Healthcare Delivery Systems are quickly approaching the tipping point in understanding that we cannot improve quality and bend the cost curve without addressing the healthcare needs of persons with a serious mental illness and the mental health and substance use needs of all Americans - Dale Jarvis
Behavioral Health is now on the Health Policy Community’s “Radar Screen” due to: 1) The 25 year mortality disparity identified in the Morbidity and Mortality Report; 2) Reports about the high prevalence of behavioral health disorders; and 3) The high healthcare costs of these individuals. A recent unpublished analysis by a Medicaid health plan showed that among the chronically ill population, the addition of one behavioral health condition doubles medical expenditure for physical health and also doubles emergency room visit rates and hospital admission rates. An October 2009 report from the Center for Health Care Strategies verified that nationally, 49% of Medicaid beneficiaries with disabilities have a psychiatric illness AND psychiatric illness is represented in 3 of the top 5 most prevalent pairs of disease among the highest cost beneficiaries. Based on these data, it becomes extremely difficult to bend the national healthcare expenditure cost curve without addressing the healthcare needs of persons with serious mental illness and the behavioral healthcare needs of all Americans.
As we move towards passage of a healthcare reform bill, two questions to consider are: How much will this bill really change healthcare in the next 2, 5, and 10 years? And, what impact will these changes have on the public behavioral healthcare system? The short answer to the first question is, there are provisions in the forthcoming bill that, when implemented by the Obama administration, will result in dramatic changes in how healthcare is delivered and financed in the United States. As for the public behavioral healthcare system, the combination of impending federal healthcare reform legislation and the Wellstone Domenici Parity Act will fundamentally alter how mental health and substance use services are organized and delivered in the United States.
Specialists: High performing Retire Decide to become PCPs Less opportunities available as med students think about their specialties PCPs More NPs & PAs Specialist conversions More med students going into primary care
Group Health Cooperative 2002-2006: Move towards Medical Home Email PCP Online Medical Records Same Day/Next Day Appointment (Increased patient access but also saw provider burn-out and decline in HEDIS scores) 2007: More robust Healthcare Home Pilot / Added more staff (15% more docs; 44% more mid-levels; 17% more RNs; 18% more MAs/LPNs; 72% more pharmacists) // Shifted to 30 minute PCP slots // (Reduced burnout, increased HEDIS scores, no difference in overall costs)
Payment mechanisms will be tied to these measures in a variety of ways. Bundled payments that only pay for part of potentially avoidable complications (PACs) will penalize providers that have higher error rates. CBHOs that don’t have structures and staffing to provide effective prevention and early intervention services and manage chronic health conditions will not be eligible for case rates and capacity-based payments to fund that work. CBHOs that don’t hit performance measure targets will not earn their bonuses. A related issue from above is whether existing carve-out plans that have worked closely with CBHOs to develop innovative payment mechanisms such as sub-capitation, case rates, risk corridors with bonuses, etc. will still be in business in the near future. Should CBHO groups and existing behavioral health carve-outs look to align/merge with health plans such as members of the Association for Community Affiliated Plans? What other strategies could be used to ensure their survival?
Payment mechanisms will be tied to these measures in a variety of ways. Bundled payments that only pay for part of potentially avoidable complications (PACs) will penalize providers that have higher error rates. CBHOs that don’t have structures and staffing to provide effective prevention and early intervention services and manage chronic health conditions will not be eligible for case rates and capacity-based payments to fund that work. CBHOs that don’t hit performance measure targets will not earn their bonuses. A related issue from above is whether existing carve-out plans that have worked closely with CBHOs to develop innovative payment mechanisms such as sub-capitation, case rates, risk corridors with bonuses, etc. will still be in business in the near future. Should CBHO groups and existing behavioral health carve-outs look to align/merge with health plans such as members of the Association for Community Affiliated Plans? What other strategies could be used to ensure their survival?
Payment mechanisms will be tied to these measures in a variety of ways. Bundled payments that only pay for part of potentially avoidable complications (PACs) will penalize providers that have higher error rates. CBHOs that don’t have structures and staffing to provide effective prevention and early intervention services and manage chronic health conditions will not be eligible for case rates and capacity-based payments to fund that work. CBHOs that don’t hit performance measure targets will not earn their bonuses. A related issue from above is whether existing carve-out plans that have worked closely with CBHOs to develop innovative payment mechanisms such as sub-capitation, case rates, risk corridors with bonuses, etc. will still be in business in the near future. Should CBHO groups and existing behavioral health carve-outs look to align/merge with health plans such as members of the Association for Community Affiliated Plans? What other strategies could be used to ensure their survival?
In April the National Council released a report, Behavioral Health /Primary Care Integration and The Person-Centered Healthcare Home , which addresses the gap between current Medical Home designs and the needs of persons with serious mental health and substance use disorders. This report presents a three-option blueprint for how CBHOs can come into alignment with health care reforms under consideration. Each quadrant considers the behavioral health and physical health risk and complexity of the population and suggests the health care home model that may be more appropriate.
![National Council Public Policy Committee Tuesday, June 29,2010 Dale Jarvis, CPA MCPP Healthcare Consulting, Inc. [email_address] ,[object Object]](https://image.slidesharecdn.com/howarewegoingtogetpaidtomorrowpublicpolicy2010a-100630091028-phpapp02/85/Implementing-Behavioral-Healthcare-Reform-1-320.jpg)
![Tipping Point... ,[object Object],[object Object],[object Object],$2.3 - $5.2 Trillion](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)