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April 1, 2010
by Dennis G. Grantham, Senior Editor
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A confluence of four streams of change hits behavioral health as it rejoins the healthcare mainstream

Whitewater rafting is, for many, the adventure of a lifetime, the thrill of navigating visible and invisible obstacles amid fast changing, turbulent waters.

With passage of national healthcare reform legislation, the raft of our profession floats quietly, just upstream of the most powerful confluence of change it has ever faced. While some of our readers have navigated some of these streams, none of us have faced their combined force. The demands that this unique confluence brings and the skill, daring, and adaptability it demands of all of us make it comparable to a Class 4 or Class 5 rapid-a full-immersion, high-stakes adventure as behavioral healthcare moves into the mainstream of the healthcare system. Among the converging streams are:

Parity. More than a decade in the making, implementation of the Wellstone-Domenici parity law provided comprehensive behavioral health and treatment options, but with benefits that flowed to just one-third of all Americans. Parity's advocates told us that parity's full promise would be unrealized until the passage of healthcare reform. Now, it's here.

Funding. The nation's governors are shaking their heads in disbelief at an historic flood of red ink. But healthcare reform may now enable them to rapidly reduce the flow of state grants, including some on which your services may depend. Their logic makes sense, provided you're ready to steer into a surging revenue stream of expanded private and public healthcare insurance.

Competition. With the surge of funding comes the likelihood of new rafts entering the water. Larger healthcare players with standing relationships in the insurance industry and experience in providing flexible, responsive customer service may move into waters you've had largely to yourself. Before you can leverage the advantage of your experience in behavioral health or addiction treatment, you'll need to navigate a new world of technology, enable consumer-focused service access, and reliably process insurance claims.

Technology. Streams of effort outlined in the ARRA HITECH Act are rapidly gaining force and speed: 1) EHRs are readily available and regulations defining meaningful use will be completed soon. 2) Legislation awaiting introduction on Capitol Hill would, upon passage, specifically fix the HITECH Act to open EHR meaningful use incentives beyond individual providers to psychiatric hospitals, CMHCs, and addiction treatment centers for the first time. 3) Interoperability between behavioral health EHRs has now been demonstrated, while definition of a Continuity of Care Document (CCD) optimized for behavioral healthcare is advancing rapidly. 4) Legal and IT experts in the government and private sectors are homing in on confidentiality law changes that will provide robust protection of consumer information, support interchangeable EHRs, and accelerate development of regional or national health information exchanges.

As you enter this historic confluence, know that the same experienced and talented people that continue to shape its its many streams of change-in government, advocacy and industry groups, academia, information technology, consulting and provider organizations, legal and professional organizations, and many more-will be there to help guide you along the way. You'll see them on our pages this month and for many, many more.

Dennis G. Grantham, Senior Editor Behavioral Healthcare 2010 April;30(4):6