Mental Health Reform

As healthcare reform is becoming a reality, there is much to celebrate within the mental health community. This includes passage of a healthcare reform package that includes parity for mental health and addiction services, expansion of Medicaid to 133% 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 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.

But this is not the end of the mental healthcare battle. Simply put, mental health advocates 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% – 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. Advocates of mental healthcare 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. Providers must learn to practice healthcare the way healthcare will be done.

As mental healthcare providers and advocates, 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 healthcare 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% 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 mental healthcare 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 states are experiencing severe budget shortfalls. The threat is very real and the mental healthcare advocates are fighting hard to hold on to current funding as legislatures see an opportunity to continue to withdraw needed funds. This is surely 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 fully recover.

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.