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Doing national health reform

June 1, 2010
by Ron Manderscheid, PhD
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Providers must focus on developing the necessary tools and partnerships to prepare for reform

As spring waxes into summer, our personal enthusiasm for national health reform needs to evolve as quickly into a practical commitment to successful implementation. Our field work must begin quickly, so that behavioral healthcare is fully positioned to participate in each wave of reform as it mushrooms across the health landscape. We will need some important tools to accomplish this work, and we will want to make some new partners as we undertake this once-in-a-lifetime journey.

A tactical plan. First, we need a clear, tactical plan for implementing reform. This should be very practical, with operational steps and timelines. Reform has many working parts, including insurance, coverage, quality, payment, and IT-each of which we must address in order for reform to be successful. It is very similar to an orchestra that only produces a symphony when the instruments are played in unison from the same music.

We call on the U.S. Department of Health and Human Services to provide leadership and resources to undertake the development of this tactical plan. For us, HHS needs to coordinate the effort of SAMHSA, HRSA, CMS, AHRQ, and ONC, as well as the offices of the Assistant Secretary for Health and the Assistant Secretary for Planning and Evaluation. Resources will be available to undertake this work, since Secretary Sebelius was provided $1 billion in the legislation to implement reform.

To develop this plan, HHS should work with our national behavioral healthcare leadership organizations, such as ACMHA: The College for Behavioral Health Leadership and the Carter Center Mental Health Program; our national membership organizations, such as MHA, NAMI, FAVOR, NASMHPD, NASADAD, NACBHDD, and the National Council; and our national coalitions, such as the Whole Health Campaign and the National Coalition of Consumer-Survivor Organizations, to undertake this urgent planning effort. Transparency is critical, and timing is urgent. Our plan should be available by the end of the summer, at the latest.

Informational bulletins. Key groups in the field, such as consumers, family members, providers, and employers, have already expressed an urgent interest in the availability of informational bulletins that can interpret in simple language what reform actually means for them: Will their insurance change? Will their care change? Will their financial obligations change? The current information deficit is massive, and the need for accurate information is very urgent, particularly around reforms that will become effective in 2010.

We call on HHS and the Secretary to undertake this work as soon as possible. These informational bulletins can be produced by HHS staff directly, as well as through contract mechanisms that are already in place. Hopefully, the first bulletins will be available by the beginning of the summer. Priority should be given to bulletins for those persons who need and use services.

New partners. Perhaps most important for each of us, but also the most difficult to accomplish, will be the development of close working partnerships with organizations and groups with whom we have never worked in the past. These can range from a local federally qualified health center to a new accountable care organization that is being configured as we speak. (An accountable care organization is one that has a highly qualified staff, employs EBPs, monitors costs carefully, and assesses its success with each consumer; it is accountable for both outcomes and costs.) Our long-term, historical approach of “going it alone” will no longer be an effective adaptation in this new world. Our entire context and structure will be changed.

A beginning point can be a proactive assessment of available partners within our own spheres. For some, that will be other local entities and organizations; for others, national associations and organizations. Further, consideration should not be limited only to provider entities. For example, we must also include insurance carriers and IT vendors in our thinking. Being proactive will be exceptionally important.

In this very short commentary, I only have been able to provide the most rudimentary introduction to some key steps in implementing national health reform. I urge each of you to take these notions and provide the essential leadership to elaborate them further. We need a groundswell of interest in the steps to successful implementation of reform. I think that we will be judged harshly by history if we don't succeed.

Ron Manderscheid, PhD, worked for more than 30 years in the federal government on behavioral health research and policy. He is the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors as well as a member of Behavioral Healthcare's Editorial Board. Behavioral Healthcare 2010 June;30(6):40