Comments on: Health Care Reform and Behavioral Health

By: Kathy

Kathy — Fri, 23 Apr 2010 16:37:00 +0000

Thanks for your comment, Chris. I attended a webinar on Integrated Care hosted by CIMH yesterday. One of the speakers was from the National Council and the other from Kaiser Permanente. Most of what they focused on was the public behavioral health and substance use world rather than the arena of private healthcare. The models they discussed included some referral and consultation back and forth between the physical and BH realm (which would be supported by the NHIN), but seemed to me mostly focused on co-located services. I agree that it will be interesting to see what happens. I think payment models will control it. If the “Medical Home” pilots turn out to demonstrate major cost savings, I think that is the way care will go. If they do not, there will be more room for variety. In the public arena, I think we will have co-located services almost exclusively, and that we will have them within the next ten years. I will be curious to see if they fall mostly on the physical health side or on the CBHO side in terms of initiation of the integration. Time will tell…

By: Chris White

Chris White — Fri, 23 Apr 2010 16:13:57 +0000

It will be interesting to see if the efforts of integrating Primary care with Behavioral health from an infrastructure and software standpoint (NHIN connect, HIE’s, RHIOs, etc..) will encourage specialty providers to remain independent. In most of your examples, the path to remaining competitive relies on BH providers to merge with large hospital systems, BUT integrating technologies “should” allow for care coordination and data sharing across specialties. It will be a shame if all CBHOs are driven out of business by large hospitals. Thanks for a very thought-provoking article.

By: Dave Zachau

Dave Zachau — Fri, 02 Apr 2010 21:22:57 +0000

Thanks for the ideas to start considering as Health Care Reform prepares to ramp up. Yes, in Ohio we have community mental health boards,but each county has a “Mental Health Network” of community agencies made up of mental health agencies that are accredited by bodies like CARF. The agencies are business competition for the private practices in the community. Historically, the agencies have treated the indigent and the private practices have focused on insurance carrying clients. The only way for our private practice to work with the local mental board would be to become a community mental health agency. We have considered that, but the burden of obtaining CARF certification struck us as overwhelming. So, it would come down to the old saying, “if you can’t beat ‘em join ‘em.” Perhaps there is some way to work collaboratively, but the current environment is not set up that way for us. On the other hand, the hospital idea is an interesting one. Thanks again for the ideas.

By: Kathy

Kathy — Fri, 02 Apr 2010 18:45:00 +0000

Hi Dave,

First, it is useful to remember that most mental health services are provided in the public/community system rather than in private practices.

Second, as I understand what the National Council is saying, they believe that healthcare organizations with significant financial resources and who already provide general and specialty healthcare services will be in the best position to compete within the new system. Since Medicaid will ultimately be significantly expanded because of the changed thresholds for coverage, and since parity will make more insurance dollars available for mental health and addictions care, there will be more organizations/systems who will want to go after those dollars by providing behavioral health services along with the general health services they already provide.

An organization like Kaiser-Permanente is already perfectly positioned. Imagine more such systems springing up. A large hospital system buys the private practices of some of the docs on staff and starts to utilize only the family practitioners and specialists (including behavioral health) within their system, but in a much more integrated, coordinated care sort of way. Perhaps they would even use the same EMR and have access to the patient’s record for all providers who care for them.

In the public setting, they see public health organizations adding behavioral health and addiction treatment, at the same time that community behavioral health organizations are forming connections with public health organizations/clinics so they can provide integrated care.

I think those in private practice who want to participate need to start paying close attention to what is happening locally and become involved. What that means will vary from community to community. Ohio, for example, has county community mental health boards. That is where I would start to look for activity and changes. If Ohio law allows non-physician staff privileges at your local hospital, you might look into that. You might also consider attending some of the National Council webinars on healthcare reform to get an ongoing look at the bigger picture.

Hope this makes some sense. I would love to hear what others think might be useful moves.

By: Dave Zachau

Dave Zachau — Fri, 02 Apr 2010 18:05:36 +0000

As a private practice provider I am interested in being a competitor in the new system. What do you mean by “deep pockets and managing the whole range of health care services” as related to being better positioned to compete? Wanting to position ourselves optimally, what are some ways to better perform in an Integrated Care setting?