As those in the treatment community are aware, recovery from addiction and mental illness is not over once the individual leaves the treatment program. In fact, the most important part is just beginning for that individual, according to former U.S. Congressman Patrick Kennedy.
“Community-based services are essential to keeping people and their families intact,” he said at the National Council for Behavioral Health conference on May 7. “A lot of [recovery] is not medical, per se. In fact, the stuff that makes the biggest difference in keeping us stable in our lives often isn’t medical.”
The problem, as he noted, is that the insurance companies have yet to acknowledge this and cover the aspects of recovery that include safe, affordable housing; peer support and community services; and vocational training and support.
If insurance companies are not willing to cover the elements of a recovery-oriented system of care, “they don’t want to cover the other stuff either,” Kennedy said.
He explained to the audience in Washington D.C. that he recently joined in a lawsuit against the health insurance company United Healthcare “because I’m sick and tired of them treating illnesses of the brain any differently than they treat any other chronic illnesses that they cover.”
Because the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) – of which Kennedy was an architect – states that analogous services must be provided between primary care, secondary care, and tertiary care, Kennedy said it is no longer acceptable to let someone die because of the “fail first” rule.
The current state of mental health and addiction treatment is much like if a person was a diabetic and had to wait until he had to have his legs amputated before the insurance company would cover his illness.
“We wait until you’re at death’s door,” Kennedy explained. “And then we don’t even cover it. We say we’ll cover a little bit but then you have to go out there and die because we haven’t given you any of the supportive services. That’s the situation today.”
The way to fix this issue is to measure and show outcomes. All of the various items that currently “can’t be measured” among this population – jail costs, ER visits, unemployment, enforcement and correctional costs – need to be measured. These results can be taken to the states and insurance companies who will then have the option of paying now or paying later.
Although there are disagreements and sides taken, both democrats and republicans can agree on at least one thing – they both want outcomes.
And in order to achieve outcomes, insurance companies have to pay for more than just medical care, Kennedy said. After these supportive services are paid for, the results will show a reduction in morbidity and mortality.
In order to show the true value of the treatment programs and recovery support services, other areas will need to be measured. He gave a few examples, including:
- How a diabetic doesn’t have as many complications as when he’s an alcoholic;
- How the cardiovascular disease patient doesn’t have as many heart attacks when he is treated for depression; and,
- How the cancer patient is more compliant and has less costs associated because of the treatment in his mental health.
He added, “Until we stop these carve-outs that segregate mental healthcare from overall healthcare, we’re never going to be able to prove to the rest of society and the rest of medicine, that what you have to offer is the biggest value added in healthcare reform.”