In mid-March, 200 leaders from the mental health and substance use care communities gathered in Santa Fe, New Mexico, for the Annual American College of Mental Health Administration (ACMHA) Summit. This year's theme, “Impacting Healthcare Reform '08: Moving the Mental Health and Substance Use Care Agenda,” was designed to reflect several major opportunities that coincide with the 2008 national elections. Participants sought information and strategies so that they can take action to influence the direction presidential candidates are moving national healthcare reform, to influence state universal health insurance coverage initiatives, and to evolve our agenda toward integration of mental health, substance use, and primary care services.
The bringing together of the twin issues of insurance reform and care reform is what set this ACMHA Summit apart from many other meetings. We know that both of these issues must be solved if transformation is to be successful. We also know that 2008 is a turning point for us because of the upcoming national elections. Clearly, the time for action on these twin issues is right now!
Summit participants heard from Tommy Thompson (a former HHS secretary, Wisconsin governor, and presidential candidate) on issues and strategies in national healthcare reform. Thompson pointed out the need for all of us to take a very proactive stance to influence the future national healthcare agenda in favor of improved mental health and substance use care. He indicated that chronic diseases must be addressed, since they now consume three out of every four healthcare dollars. Similarly, Medicare will begin going broke in 2013 unless reform efforts are urgently undertaken now.
Tom Coderre, national field director of Faces and Voices of Recovery, pointed to the critical importance of careful listening to consumers and family members in our national reform efforts around insurance reform, the first key issue. Linda Rosenberg, president and CEO of the National Council for Community Behavioral Healthcare, outlined impediments we will confront in these efforts, such as current Medicaid constraints, as well as opportunities likely to arise as a new president takes office.
Participants applauded the efforts of our fields to move the national healthcare reform agenda, particularly through the Whole Health Campaign (see my commentary in the April issue). Yet a major concern raised by participants was the difficulty of building consensus in Washington, with the implication that we need to work closely with both major parties. In this respect, our agenda is to influence their platform agendas going forward.
Marty Sellers, president and CEO of Sellers Feinberg and a leading national consultant on state universal coverage, reported that states are making some progress, principally through changes to Medicaid and the Children's Health Insurance Program. Barbara Leadholm, commissioner of the Massachusetts Department of Mental Health, reported on the design and implementation of universal health insurance in her state. The Massachusetts plan includes specific mental health and substance use care benefits, including those for the previously uninsured safety net population (those who are uninsured and not covered by Medicaid). Ruth Liu, associate secretary for health care policy at the California Health and Human Services Agency, reported on the development of a similar plan. Unfortunately, the California Senate did not approve the proposed plan, principally for political reasons. The panel concluded that, overall, progress is being made on state universal coverage. Frequently, a major factor in these efforts is an effective design for health insurance covering the safety net population.
For the first time, primary care physicians were invited to the Summit to discuss care reform, the second key issue. In their view, the medical home model holds considerable promise for future services integration (see my commentary in the October 2007 issue). Workgroups on children, adults with mental disorders, adults with addictive disorders, vets, and providers engaged in intense debates about next steps. One of the most promising actions to emerge from these discussions was the recommendation to foster dialogues between primary care and our communities in order to develop a common language and outlook so that subsequent steps can be taken to reform care and improve quality. Loud calls were heard to create a recovery-oriented system that is consumer- and family-directed.
On the closing day, political consultants Peter Fenn, from Fenn Communications Group, and Bob Keefe, from TKCI, were led by Johnny Allem, president and CEO of the Johnson Institute, in a spirited discussion on strategies for placing mental health and substance use care on the national agenda. They all agreed that it is important to work with politicians from both sides of the aisle, elicit the support of media personnel who have experienced these problems, and craft simple messages. Many participants made strong commitments to take personal action to move our twin agenda forward once they return home.
It is always very energizing to come to the ACMHA Summit to address the major emerging issues in our fields. It was particularly rewarding to engage the broader twin issues of insurance and care reform simultaneously. Both can be expected to have a profound effect upon our fields in the future. Hence, I call again for action now on both of these issues in this election year.
Background summaries of state universal coverage initiatives and the presidential candidates' plans for national healthcare reform can be found at http://www.acmha.org/summit/summit_2008.cfm. If you were not able to attend the 2008 Summit, I recommend strongly that you do so in 2009, ACMHA's 30th anniversary.
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