Tag: mental health services

Integrating Behavioral Health into the Healthcare Home

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One of the many provisions included in the Patient Protection and Affordable Care Act (health care reform law) was the creation of pilot programs to integrate all health care services into a Health Home. The development of the ‘medical home‘ concept will be most important among those with complicated health concerns and in vulnerable populations. Those with significant health issues in addition to behavioral health disorders will be in special focus.

This attempt to integrate care will likely have major impacts on how behavioral health care services are provided to the seriously mentally ill and chemically dependent populations. The National Council has been actively involved in this movement and has received funds to found the Center for Integrated Health Solutions.

The National Council for Community Behavioral Healthcare has won a competitive cooperative agreement from the U.S. Department of Health and Human Services (HHS) to establish the Center for Integrated Health Solutions. The Center will address the comprehensive health needs of clients with mental illnesses and/or substance use disorders by improving the coordination of healthcare services in publicly funded community settings. The Center is funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources Services Administration (HRSA).

In that role, on January 19, 2011, the National Council participated in an extremely informative webinar on current integration projects initiated by community behavioral health organizations. Each of the organizations that participated came to their ‘Health Home’ program in a different way and developed programs using different models. The presentation made clear that there are likely to be as many ways to accomplish the purpose of integrating health care for the most vulnerable populations as there are organizations that will provide that care. Even so, there are significant issues to be considered, challenges to be met, and goals to be accomplished for the establishment of a successful program.

A recording of this webinar is to be posted at http://coce.samhsa.gov/ at an indefinite date. Information about Co-Occurring Disorders Integration & Innovation can be obtained at contact@codimail.org. 

The hope that these programs can provide more effective health care at a lower cost is high. I am sure we will all be watching carefully to see how these and other initiatives progress.

I invite those  of you who have interest and experience with integrated care to share your perspectives. Your input will be valuable to your colleagues.

Primary and Behavioral Healthcare Integration

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On Monday the National Council announced that they have won a competitive grant to provide training and technical assistance to move forward the process of integrating primary and behavioral health care services. They will provide support services and assistance to organizations that have received grants to develop integrated care within their organizations, as well as to other organizations seeking to move in this direction.

 One of the pushes in the ARRA stimulus funding and in the health care reform law (Patient Protection and Affordable Care Act) was more efficient and cost effective provision of health services. One possible way to accomplish this for those who experience mental health and addiction problems is to integrate the care they receive for all illnesses, physical and behavioral. The National Council has been at the forefront of this movement. Their snagging of this grant demonstrates their commitment to the cause of integrating primary and behavioral health care for vulnerable populations. The press release indicates the following:

The Center will provide training and technical assistance to 56 organizations that have collectively been awarded more than $26.2 million in grants as well as to community health centers and other primary care and behavioral health organizations. According to HHS Secretary Kathleen Sebelius, these grants are part of an unprecedented push by the Patient Protection and Affordable Care Act to help prevent and reduce chronic disease and promote wellness by treating behavioral health needs on an equal footing with other health conditions.

When I have mentioned this topic in previous blog articles, the response has been disbelief that such integration will occur any time soon. After all, behavioral health private practitioners of our generation are not likely to dramatically change the way in which they practice, and now they mostly practice independently of medical settings.

In fact, it is even the case that many of our community-based behavioral health  organizations have a hard time seeing themselves moving toward providing primary care services for their consumers. At least one of our customers tried establishing a primary care facility as part of their organization a couple of years ago. The service did not take hold and they closed it. Perhaps they were too far ahead of the curve to be successful.

According to the National Council, the motivation to integrate general and behavioral health care among the chronically and seriously mentally ill is the significantly shorter lifespan experienced by those with serious mental illnesses.

According to a 2006 national survey, persons with schizophrenia, bipolar disorder and major depression have lower than average life expectancy and die, on average, at the age of 53 — often from untreated and preventable chronic illnesses like hypertension, diabetes, obesity and cardiovascular disease. Lack of access to primary care and specialty medicine is a critical factor in these tragic outcomes. . . .

The average life expectancy of the population at large in the U.S. in 2006 reached an all time high of 78.1 years. This 25 year difference is unconscionable. It is believed by many in the public health and behavioral health communities that integrating health care services for the seriously mentally ill and chemically dependent populations will encourage treatment regimens that will benefit both physical and mental health.

Most of the organizations active in this integration movement are considered ‘safety net’ providers. Although part of an endangered system,  ‘safety net providers are providers that deliver a significant level of health care to uninsured, Medicaid, and other vulnerable patients.’ They are the health care safety net that is intended to keep vulnerable populations from falling through the cracks in our costly and difficult to navigate health care system.

Are any of our readers among the 56 organizations that have received grant funding to develop integrated physical and behavioral health services? Do you see this as a possible and worthwhile goal for private practitioners to move toward? What changes in training models and practice models would need to occur to integrate primary and behavioral health care?

Let us know your thoughts about these issues. Please enter your comments below.

Managed Care Organizations Oppose Parity

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An organization called the Coalition for Parity, Inc. comprised of managed behavioral health organizations (MBHOs) has filed suit to halt the implementation of the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act. This group has as some of its members Value Options, Magellan Health Services Inc., and Beacon Health Strategies Inc.

As reported by Open Minds and American Psychological Association Practice Organization, the lawsuit challenges the rulemaking process and has requested a temporary restraining order to stop the rulemaking process from moving forward. They argue that the Departments of Health and Human Services, Labor and Treasury overstepped their rulemaking authority in how they interpreted the statutory language and violated federal rulemaking procedure in publishing the rule as they did. While the judge denied the temporary restraining order because the law will not be enforced until July 1, 2010, the court will hear the case as presented by the parties to the action.

On May 9, 2010, the NY Times reported that insurance companies and employer groups are also objecting to the rules.

In a suit over the rules, Magellan and other companies said the concept of nonquantitative limits was “boundless and ill defined” and would reach virtually every policy and procedure used to manage mental health benefits.

As most mental health providers can readily attest, the procedures used by insurers and managed care organizations to limit costs and usage of behavioral health services have themselves been “boundless and ill defined”; after all, a treatment plan certainly could not be a valid treatment plan if it is printed on the wrong form. The MBHOs have been innovative in their development of “every policy and procedure used to manage mental health benefits.” Unfortunately, most of that management has consisted of denying or limiting the amount of service provided and placing onerous requirements on providers.

The NYTimes article states that:

One premise of the law is that mental illnesses often have a biological basis and can be treated as effectively as many physical ailments. But insurers say it is impossible to use the same techniques in managing the treatment of colon cancer and schizophrenia, or heart failure and major depression.

What do you think? Is it reasonable to assume that mental illness and addiction can be managed using the same techniques as are used to manage the treatment of cancer or heart disease?

Please share your comments below.

License to……

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Every two years around this time I am busy completing my Continuing Education Units (CEUs) so I can renew my license as a psychologist. I have done this every biennium since 1980, even though I retired from practice 17 years ago. In Florida, the license is both a practice and title act…to represent myself to the public as a psychologist, I need to be licensed. This was the first year I have even vaguely questioned why I continue to do so.

The decision to renew has usually been an easy one for me to make even though I do not practice and have no plan to return to work as a psychologist. I have a strong identification as a psychologist. I knew since early high school that I wanted a Ph.D. in clinical psychology; I always wanted to practice independently.

Even when we decided to relocate to central Florida and I took the opportunity to close my practice and work with SOS full time, I never considered dropping my license. After all, we have always told you that we provide software by psychologists for psychologists (and all other behavioral health providers). And anyway, who knows what time and politics will bring!

Usually my reading is a way to meet my CEU requirements and keep up with the clinical side of psychology. This year I was surprised; two of the articles I read this weekend were actually quite interesting to me; they were articles on personal or life coaching and Positive Psychology. Both of these areas have roots in the personal growth and Humanistic Psychology movements of the 1970’s, but are 21st century, mainstream ways of implementing growth-oriented interventions.

As the healthcare arena changes over the course of the next few years, it is highly likely that some organizations will seek to provide pure healthcare services. Others will choose to diversify their services in a variety of ways…and even to provide their services in unique fashion. Open Minds recently discussed both telehealth delivery of services and the use of virtual reality interventions to treat certain problems.

What new kinds of therapy has your organization considered? Do you continue to provide the same services you have always performed, or are you on the lookout for ways to diversify? What criteria do you use to decide if a particular service or technique should be added to your bag of tricks?

Please share your comments. We would love to know how you expand the services your organization provides. Just enter your comment in the box below. If you do not see a box, click on the title of the article and scroll down to the comment box. Thanks for reading!

Health Care Reform and Behavioral Health

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On March 21, 2010, the U.S. House of Representatives passed the Patient Protection and Affordable Care Act. Subsequently, they passed the Reconciliation Act  (H.R. 4872) making changes in the original bill. After some maneuvering, all the necessary legislation was passed by both houses of congress and on Tuesday, March 30, 2010, President Obama signed the Healthcare and Education Affordability Reconciliation Act of 2010 into law.

In the past week or two I have seen many questions about what the effects of this legislation will be. Behavioral health provider organizations are especially concerned about what the effects will be on mental health and addiction service funding.

One of the most useful resources I have come across was forwarded to the Florida Psychological Association member listserv by Dr. Bob Porter. The Bazelon Center for Mental Health Law has done an excellent job of summarizing the law and its impact on coverage for mental health services. While it will take years for all of the provisions of the new law to be implemented, a Congressional document summarizes some of the immediate effects.

In the private insurance sector, generic requirements of the law have particular impact for those with mental illnesses. In the past, such diagnoses have routinely triggered pre-existing condition clauses in policies. Within the first 6 months, the new law prohibits this discrimination.

  1. No discrimination against children with pre-existing conditions.
  2. No rescissions based on developing an illness.
  3. No lifetime limits on coverage.
  4. Tightly regulated annual limits on coverage.

In addition, for those who are currently uninsured, the law mandates:

  1. Immediate help for those with pre-existing conditions (an interim high-risk pool).
  2. Extending coverage for young people up to their 26th birthday through parents’ insurance.

Since so many who have been diagnosed with mental illnesses or with substance abuse issues have been denied coverage or have had coverage revoked or have reached the limits of their benefits, we should see immediate increased access to behavioral health and addiction services. The ability for parents to keep young adults on their insurance plans until they are 26 years old will assist some of the young people who experience late adolescent onset of serious mental illness or substance abuse conditions. This will allow a period during which their parents will be more able to facilitate transition to some other form of insurance coverage.

The National Council for Community Behavioral Healthcare, the trade association of behavioral health community service providers, hosted a webinar on healthcare reform and its impacts, Healthcare Reform: What Happens Next? Additionally, their Public Policy Update for April 1 gives links to resources as well as information about moving forward from here.

I attended the Council’s webinar this week and was struck by a couple of things. Because the Council primarily represents organizations that provide services in the public sector, their information is generally focused in this direction. For me, there were three take-aways from this session, and they were not all for public sector providers:

  1. The Council believes Fee for Service will probably go away in the long run, to be replaced by Case Rates with a Bonus for improvement of the consumer.
  2. Behavioral health providers need to position themselves for the long term. Integrated care is likely to be the way of the future and it is best to start to get positioned for that now.
  3. Private practices can be competitors in the new system; however, those with deep pockets who can manage the whole range of healthcare services will be better positioned to compete.

Community Behavioral Health Organizations (CHBOs) have been working on these steps for the past couple of years and there will be pilot programs using CBHOs together with Federally Qualified Health Programs to start to provide integrated care. Unless private behavioral health practitioners also start to position themselves to play in the Integrated Care setting, they are likely to get left behind.

Even the American Psychological Association’s advocacy efforts focus on the assurance that mental health services will be part of integrated care. This sounds very much like an integration of mental health services into such settings to me.

What do you think about how the new health care reform law will affect behavioral health services? Do you foresee changes in how care is provided? What changes are you willing to make in your organization in order to assure participation in a reformed health care system? Please enter your comment below. If you don’t see the comment box, just click on the title of the article and then enter you comment at the bottom.