A view from the Summit

March 31, 2011
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In mid-March, I attended the 2011 summit meeting of ACMHA: The College for Behavioral Health Leadership, joining about 150 professionals in examining the issues that stand between where the behavioral health field is today and where we will want to be tomorrow.

For those who haven't been introduced to ACMHA, its charter is to identify and address questions of concern to American public policy, principally through wide-ranging, collegial discussions at its annual summit. And, while this summit is known for bringing together outstanding and influential leaders, ACMHA is also working hard to foster new leadership, so many younger professionals, interns, peers, and others were also in attendance.

This year's summit topic, “disruptive innovation” in behavioral healthcare, was aptly chosen, given the passage of the Affordable Care Act just one year ago. While the future under ACA-driven reforms bodes well for the behavioral health of Americans, summit goers predicted that few in our field will get there without making major changes. Those unable to change won't get there at all.

As some argue for a broader role for behavioral healthcare in a reformed healthcare system, our future is clouded by some very basic issues, especially when observed from the “outside in,” noted Paul Keckley from Deloitte, the summit's keynote speaker. While what we do every day is obvious to us, behavioral health:

  • Remains a mystery to virtually all in the medical establishment-notably primary care practitioners-our presumed future partners.

  • Resists quality measurement using many traditional measures of outcome-the gold standard established for medicine and payment.

  • Demands a more complex set of tools than traditional medicine, a combination of medical and social interventions whose impact and value are poorly understood outside of the field.

  • Is rarely appreciated by individuals unless their lives, or the lives of others close to them, are adversely affected by a behavioral health problem that leads to loss of job, education, social relationships, or other aspects of what we consider to be a meaningful life.

So, we've got some work to do to explain ourselves and our vision for the future of behavioral healthcare. Among the key questions we face are these:

  1. What's our identity? Are we a “specialty” field-like podiatry or dentistry? Or, are we-and our province of preventing or treating disorders of the brain or mind-so central to the practice of healthcare that we are integrated as an inseparable health partner?

  2. Whom do we serve? Behavioral healthcare isn't something that most people experience, because we act like a specialty that treats acutely and chronically ill people. But defining ourselves so narrowly is dangerous, because it separates us, as well as those we serve, from the mainstream of medicine and community.

    If we want to be perceived at the center of an integrated healthcare system and a healthy community, we must make the argument that behavioral health serves all. Serving all means that we must place a greater emphasis on how we serve the healthy through screening, prevention, and promotion; how we support acutely ill individuals through early diagnosis, supportive treatment, and wellness interventions; how we support community institutions-schools, hospitals, law enforcement-with cost effective supports that preserve their limited and more costly resources; and yes, how we meet the needs of those with long-term, serious mental illness.

  3. Why are we integral to healthcare? If the major health providing organizations in your community don't already know your organization and its capabilities, get out and visit them-after you've thought through and documented why your organization is integral to their success. The healthcare system has problems:
     

    • Effectively treating those with behavioral disorders and comorbid conditions.

    • Coping with high ER costs from frequent users, many of whom have behavioral or substance use problems.

    • Making referrals to effective treatment. In fact, they'd rather refer many “crisis cases” to the behavioral health system to start with.

Think about it: your organization can, and does, save the local healthcare system a lot of time and money. If local healthcare leaders aren't aware of the impact that your services make, let them know.

  1. What is our value to the community? If you can already document your skills, contributions, and value to the community based on outcomes, you're probably ahead of the field. Many behavioral health leaders, according to ACHMA participants, are struggling just to create their introductory or “elevator” speech, identify their contributions to the community, and develop data to document their outcomes and performance.

    And, although the concept of “recovery” is an important contribution that our field can offer to healthcare reform, it is not well understood in medicine or by the general public, in part because it's so difficult to measure. But there are practical measures of the worth of your prevention and treatment services: children and teens who are able to attend and persevere in school; young people who navigate difficult challenges to complete their education or land their first job; non-violent offenders who get cost-effective help for treatable problems instead of a costly prison sentence; adults who get the help they need to keep working, keep their homes, and keep their families together.

  2. What is our model for the future? The rise of health homes and accountable care organizations (ACOs) means that your organization will probably change a great deal in the next five years. You're likely to partner with, join, or create larger organizations with the scope of services, market access, capital, and vision to meet the needs of your community.

At the close of the ACMHA summit, participants were asked to pose as venture capitalists and fund innovations they felt would best meet future needs. From this discussion came a conceptual model for a peer-led health home or ACO within a larger wellness community. The model would employ peer supports and tools to sustain the resilience, recovery, and wellness of members, while enabling them to establish the relationships needed to fully participate in their local community.

If this developing model gains support from peers, family members, and providers, it could hold great promise for the future.

Dennis G. Grantham, Editor-in-Chief

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