NYAPRS Note: Some of the brightest leaders in behavioral health policy, program, and innovation weigh in from across the country to share their thoughts on opportunities and challenges in 2015. This may read like a road-map of the year to come. Where do you fit in to the process of overcoming the hurdles and seizing opportunities?
Readers Open Up About Challenges They Expect to Face in 2015
We asked our readers to send us their thoughts on the challenges and opportunities awaiting the field in
2015. Here are some of their comments we received.
Ron Manderscheid, Ph.D., executive director, National As- sociation of County Behavioral Health & Developmental Disability Directors (NACBHDD)/National Association for Rural Mental Health (NARMH),Washington, D.C.
We do expect 2015 to be a year of great challenges, as well as wonderful opportunities. On the challenge side, we hope that we will influence the Supreme Court to decide that the Affordable Care Act permits federal tax subsidies when a state insurance exchange is operated by HHS (U.S. Department of Health and Human Services). We hope that we will move beyond Rep. Tim Murphy (R-Penn.) and his contentious proposed legislation (Helping Families in Mental Health Crisis Act) to a much better bill that reflects all key voices in our field. Finally, we hope that we will make significant progress in developing and implementing medical homes and health homes.
On the opportunity side, we will address the tragedy of the incarceration of persons with mental health and substance use conditions in county and city jails. We will make progress to incorporate dis- ease prevention and health promotion interventions into our work, and we will reach out to public health colleagues to help us address community issues. Finally, we will continue to expand peer support and integrated peer support very quickly. Clearly, we want the opportunities in 2015 to outweigh the challenges, and we want to continue our quest toward person-centered and whole health care at the rapid pace both deserve.
Patrick Gauthier, director, AHP (Advocates for Human Potential Inc.) Healthcare Solutions, Sudbury, Mass.
With health care reform now in full force, the behavioral health field faces ongoing challenges around the enforcement of the parity law (particularly around coverage of residential treatment services) and in relation to integration of behavioral health and medical health care — not least because the trend toward behavioral health carve-outs continues. Also, providers struggle to maintain revenue cycles and cash flow under the collective pressures of ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) implementation later in the year, the cost of technology implementations, and increasing competition.
Even more concerning for a truly integrated care approach is the delayed recognition of the importance of social determinants of health. The need is growing for inclusion of social and community- based services into integration efforts. On the other hand, the awareness and traction of population health management (PHM) concepts as a framework for integration offers tremendous potential for optimizing health. By focusing on specific populations’ needs, PHM engages clinicians, activates patients and families, and measures quality and outcomes based on significant population factors. Opportunities abound for behavioral health providers to apply PHM principles to such efforts as care coordination where chronic comorbid conditions exist. Another significant opportunity for business growth is the formation of provider networks, such as management service organizations (MSOs) and independent practice associations (IPAs), to maximize cost savings and new, profitable revenue streams.
Steven Ronik, Ph.D., CEO, Henderson Behavioral Health, Fort Lauderdale, Fla.
I think 2015 will see increased pressure on behavioral health systems to further integrate primary health care and behavioral health care. The evidence is now overwhelming relative to the very real overall health and financial outcome improvements that result from a true and deep integration. The “triple aim” of health care — improved health outcomes, decreased cost and improved patient experience — will be the mantra. And don’t be surprised to see “the patient experience” getting much of the attention. As competition increases and pay- for-outcomes becomes the norm, providers and payors will continue to spend enormous resources and focus on the “triple aim.” Finally, workforce and talent challenges will continue, and the best and most innovative organizations will direct increased capital on employee training, engagement and wellness. As always, leadership will mean everything and the most intentional organizations will thrive.
Clarke Ross, D.P.A., public policy director, American Association on Health and Disability, Rockville, Md.
The general health care sector is moving to meaningfully integrate behavioral health into general health. The behavioral health field is meaningfully moving to bring general health into behavioral health settings. Trains are moving on separate tracks. However, interoperable, integrated and person-centered electronic health record systems generally do not include behavioral health. Also, while the general health care and community-based disability fields are implementing person-centered, whole health quality measurement, the behavioral health field is just now implementing medical-behavioral setting traditional treatment measurements. Can the behavioral health field catch up in integrated delivery, including electronic health records and meaningful nonclinical community support measurement? In 2015, will the behavioral health field move from hand carts to trains?
Debra L. Wentz, Ph.D., CEO, New Jersey Association of Mental Health and Addiction Agencies Inc., Trenton, N.J.
Hope is always on the horizon with the advent of a new year. What I find especially exciting is Congress’ focus on private-public partnerships to accelerate the discovery, development and delivery cycle in the United States to foster innovation and bring new treatments and cures to children and adults with mental health and substance use disorders. Under the leadership of New Jersey’s own Congressman Leonard Lance and the Energy and Commerce Committee, New Jersey’s and the nation’s pharmaceutical and bio- medical industry and private corporations are partnering to research the causes of schizophrenia and bi- polar disorder, as well as investing in personalized medicine, which also offers great potential for early intervention and for eliminating the trial-and-error approach by targeting subgroups for different treatments based on genetics.
While passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) was groundbreaking, there are limitations that behavioral health stakeholders find disappointing. The law does not mandate that insurance companies cover mental health and substance use treatment services. Rather, it only requires insurance plans that cover these services to do so with coverage limits and out-of-pocket expenses that are quantitatively and qualitatively equal as coverage for medical and surgical care. Despite this progress as well as that provided through the mandated parity coverage of mental health and substance use services of all those who fall under the Medicaid Expansion and the Healthcare Market- place, how comprehensively the MHPAEA is implemented remains a challenge as insurers interpret medical necessity more narrowly than the recovery-oriented and habilitative services necessary to keep those with mental health and substance use challenges well. In fact, in order to move closer to the day when mental illnesses and substance use disorders are treated just like physical ailments — not only clinically, but also in attitude, we still have mountains to climb … but at least, we already are in the foothills!
A positive sign is the greater focus on mental illnesses and substance use disorders — in New Jersey, from Governor Christie’s clear commitment to addiction prevention and treatment and the increased awareness of the illnesses, as well as suicide, following the death of actors Philip Seymour Hoffman and Robin Williams. The challenge will be to keep a sustained sense of urgency in providing adequate visibility for the issues, funding for treatment, and necessary services, including housing, employment, transportation and other supports, without a tragedy such as opioid overdoses, school shootings or more suicides to propel the field forward.
To call eliminating the barrier of stigma against individuals with mental and substance use disorders a mere challenge is to understate how much public and political will it will take to bring funding levels and mind-sets to the point that these illnesses are regarded simply as other diseases. Given the high prevalence rates of behavioral health disorders, we will build on progress and demand fair rates and adequate treatment for services, housing, employment and other supports to keep our providers fiscally healthy so
they can serve children and adults with emotional and behavioral disorders and mental illnesses and substance use disorders well and in recovery in 2015 and beyond.
Tom Doub, Ph.D., CEO, Centerstone Research Institute, Nashville, Tenn.
We are at the dawn of an exciting era in health care. Given the convergence of innovative mobile technologies with payment reforms in health care that reward better care and lower costs, we are likely to see more innovation in health care in the next five years than during any period in the last 50.
The Centerstone Research Institute recently hosted a forum on mental health and mobile technologies at the mHealth Summit in Washington, D.C. What is becoming apparent as we begin to use mobile technologies in health care is that the most important location in health care is no longer the doctor’s office, or even the hospital, but rather the home.
This is being made possible by an explosion of new mobile phone, app and sensor technologies that will enable you to connect to your health care providers just as easily as you might check in for a flight, order movie tickets, or even use secure banking online. While health care has long enjoyed sophisticated technology in hospitals and clinics, health care is finally about to enter the 21st century in terms of consumer technology. This is great news for all of us, and a great opportunity for health care organizations and entrepreneurs to help invent that future. •
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