There is no dearth of conferences on health care reform these days. Representatives from the insurance, employee benefits and medical provider sectors are quick to describe how the new federal health care reform law (or ACA) will soon impact our lives. Considering the broad scope and reach of the ACA, their point seems well-taken.
However, these mainstream health care conferences often offer little commentary on the role that behavioral health services and expertise could have in a health-care-reformed world. There is occasional mention of the prevalence of depression among employees and chronically ill patients. There also may be some acknowledgment of the increasing influence of mental illness and chemical dependency on the rising cost of health care. However, there frequently is a general lack of recognition of the important part that behavioral health providers can play in addressing the many challenges posed by a transformed health care system in the U.S.
The reasons for this lack of recognition are not because the facts aren’t compelling enough. One of four Americans suffers from some form of mental illness every year. Depressive disorder is the leading cause of disability among Americans aged 14 to 44. Many conditions widely considered to be purely physical in nature (e.g. heart disease, diabetes, digestive disorders, some cancers, etc.) actually have a large psychological component. Finally, approximately 70 percent of all conditions having a significant behavioral health component are treated by primary care practitioners, rather than by behavioral health specialists.
Government officials in Washington state have become attuned to these issues. The state has submitted a proposal to the Centers for Medicare and Medicaid Services (CMS) as part of a planning grant it received to design an innovative care model for individuals eligible for both Medicare and Medicaid. Of course, the state’s interest is partly due to the recent realization that the cost of care for this dual eligible population accounts for 50 percent of health care expenditures, while they only constitute 5 percent of the population.
Washington state’s proposal follows ACA’s philosophy, which espouses the health home as the basis upon which the client’s total health care plan is constructed. Perhaps the most essential elements of that model are care management and care coordination. These two services hold great promise in promoting positive health outcomes for enrollees, and in assuring that funding is spent cost effectively.
Care management and care coordination are very similar to one of the most basic services offered by community behavioral health centers (CBHCs) nation-wide over the past twenty-five years: case management. With the Reagan administration’s shift in funding for these organizations from the federal government to states in the early 1980s, CBHCs were required to focus more attention upon persons with severe and chronic mental illness. Since such individuals need a variety of health and human services, the case management model was created as a mechanism to coordinate those services in a cost-effective manner.
With this in mind, let’s connect the dots. We know that psychological factors play a major role in the health—and illness—of a great many Americans. We also know that most individuals who seek help for behavioral health-related conditions receive it (only) in the form of medication from general medical practitioners. Those who struggle with the more debilitating forms of such conditions (e.g. mental illness, addiction, etc.) require a variety of health and social services to survive outside of institutions. Countless studies, including a 2007 report by the American Journal of Managed Care, found that care management/care coordination improves health outcomes and lowers costs for clients and payers. Community behavioral health organizations, as mentioned earlier, have developed decades of experience in providing such services in a cost- effective manner, when compared with unmanaged services or those occurring in institutional settings.
In view of these facts, it appears that a valuable community resource is being overlooked by many members of the insurance, employee benefits and general health care fields. That resource is the community behavioral health center. Not only do such organizations have more clinical expertise to serve those with mental illness and addiction issues, but they also are likely to provide the case management functions that can assure the client successfully receives other valuable services s/he may need for a healthy physical and psychological recovery.
David Stone, Ph.D. is CEO at Sound Mental Health, one of Washington state’s most comprehensive behavioral health service and substance abuse providers. The nonprofit (found at www.smh.org) serves more than 18,000 people annually through 80 diverse programs.