Behavioral health has an invitation to sit at “the adult table” of healthcare delivery, but providers must be prepared to bring something worthwhile to the table with them.
According to Patrick Gauthier, director of healthcare solutions for Advocates for Human Potential, who spoke at the Behavioral Healthcare Executive Summit today in St. Louis, the key to integrating with the larger system is to place mental health and substance abuse disorders within the context of population health. That is the consideration most likely to resonate with hospitals and insurers.
“There is a danger if we only talk about our clients,” Gauthier said. “We’re going to lose the other stakeholders in the conversation because they will not make the connection that mental health or substance abuse is a co-occurring condition with other medical conditions. If you think in terms of ‘multiple chronic conditions,’ then you cover a lot more ground in your conversations.”
He recommends that providers learn to speak the language of other stakeholders and play a role in population health initiatives.
What is population health?
According to Gauthier, population health is the systematic effort to improve the health of a subpopulation. For example, pregnant women with Medicaid coverage in one neighborhood in St. Louis would be considered a subpopulation, and to improve their total health, care coordination and safe housing would be imperative.
The reason why population health is increasingly becoming a touchpoint for medical providers is because the Affordable Care Act, the accountable care movement and other policies are driving them toward it—not just for quality reasons but for payment reasons as well. And clearly, behavioral health is part of that outlook.
Where behavioral health fits
Behavioral providers must reconcile their own strategic vision and begin integrating with other stakeholders. It’s inevitable, Gauthier said. Otherwise, the medical provider organizations will quickly develop their own expertise—possibly recruiting your own staff away from you—and become a competitor with far more capital and much better resources. An accountable care organization (ACO) with a superior in-house behavioral health unit would be hard to compete against.
“Eighty-six percent of ACOs are doing their own behavioral healthcare right now,” Gauthier said.
The better option is to become a partner at the table, promoting the obvious value of behavioral health in today’s population-focused system. He recommended groups of existing providers band together and consider becoming a management services organization (MSO)—a collection of providers that are independent businesses but that share resources for administrative, operational and/or infrastructure needs that are outside of clinical care. Gauthier said solo primary care practices did the same thing 20 years ago, and now they are playing at the table with large hospitals and ACOs.
“I believe it will be 10 to 20 years before we can make the culture change and feel like we are sitting together as behavioral healthcare providers with our medical counterparts and we all belong, once and for all, to the same culture,” he said.