After six years as CEO of the National Council, few would fault Linda Rosenberg for pausing long enough to look back on an already accomplished and eventful tenure. But that's not her style. Setting the tone for her staff and 1,800-strong organizational membership, Rosenberg prefers to look relentlessly and briskly forward, leading and speaking with an intensity and pace she traces to her hometown, New York City. It's a leadership approach that works, now more than ever, amid the swirling, fast-paced changes that are shaping the future of behavioral health.
In a recent, exclusive interview, Rosenberg highlighted key financial, operational, and legislative issues for behavioral health leaders as the National Council approaches its 41st Annual National Mental Health and Addictions Conference and Expo, May 2-4 in San Diego.
A new opportunity for managed care? “The thing that's on everybody's mind is, ‘What are the changes that we're going to see as a result of the Accountable Care Act and the budget deficits that remain in the states? ‘We've got new governors who are going to take a fresh look at spending. Will that mean a resurgence of managed care? And if so, what will it mean for providers? What would it look like?” she asks. “I think that right now, a lot of managed care companies are out there getting ready to bid on business, because they see an opportunity.
“The states are looking and saying ‘Hey, not only do we have budget deficits but in 2014, we're going to have more people on Medicaid-we're going to have these exchanges-and we need somebody to manage all of this for us.” Rosenberg explains. “You're seeing that situation in New York, for example, where they're looking at bringing everybody into managed care in some way.”
The meaning of health reform. With just over a year elapsed since passage of the Affordable Care Act, Rosenberg maintains that “everybody is still looking at, ‘What does this language in health care reform really mean? What is an accountable care organization? How many of them will there be? Will hospitals be the linchpins of those?
“And, oh, by the way, what about medical homes?” she continues, noting that explaining the details of the ACA already has been the subject of many papers, webinars, and presentation, with no end in sight. “We know that there's a state option in Medicaid, that states can create these medical homes. But, how many of them are going to do it? How do we position ourselves to be, or be part of, a medical home?”
No matter the answer, Rosenberg asserts, “We're looking into the future and trying to help providers position themselves for that new structure, because, whatever it is, provider organizations will be essential to it.” In the near term, the key concern, she says, is “how can they, along with the consumers and the families they serve, have a voice in shaping all of this as it unfolds?”
The fact that “nobody has the lowdown on this-nobody,” may well illustrate the vast scope of the changes ahead for a reformed health care system. “The ACA talks about various structures, but the regulations that go along with those structures and the way they play out will be very individualized, based on the communities being served.” She adds that “everybody is looking at the legislation and the rulemaking process, “trying to position themselves to shape and influence it.”
Rosenberg believes that behavioral healthcare's concerns will be well represented-and not only by the National Council. She credits SAMHSA Director Pamela Hyde with a strong start in Hyde's as-yet brief tenure, which began in January 2010. She notes that Hyde has won the trust of senior officials and has brought a strong and credible voice to the table on behalf of mental health and substance use treatment.
Parity-Still a long way to go. The issue of parity and its implementation-for consumers, families, and service organizations-is still playing out, says Rosenberg, even as the Mental Health Parity and Addiction Equity Act (MHPAEA) nears the third anniversary of its passage this fall. In the wake of a national survey that found that most Americans know little, if anything about the impact of recent mental health and addiction parity regulations, key questions remain: “Will people really have access that they didn't have before-and how will we make sure that they do?”, she asks.
“Will providers finally get some kind of decent rates for services based on parity and how will we make that happen?” On a range of parity related issues, she notes that “we know what's proposed, but how is it taking shape? Certainly, the National Council wants to have a voice in that and we think that our members need to have a voice in that, nationally and in their own communities.”
New faces in Congress. Already, results of last fall's elections make it clear to Rosenberg that “legislation on the House side is going to be very difficult.” She notes that new House roles suggest that new proposals must not only propose a policy, but explain how it saves money and suggest cutting another expenditure of an equal amount. Nevertheless, she asserts, “We're working on two pieces of legislation, trying to get them reintroduced in this session-the FQBHC (federally qualified behavioral health centers) bill and also our HIT (the Health Information Technology Extension for Behavioral Health) bill.” At present, she says that advocates are working with Senator Sheldon Whitehouse, Representative Tim Murphy, and the bill's previous Senate and House co-sponsors, to get the bills reintroduced.