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Moving our agenda forward

July 1, 2010
by Ron Manderscheid, PhD
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Coalition unites 110 mental health and substance use care groups to support health reform principles

On June 9, the major associations representing the mental health and substance use fields assembled in a historic gathering to affirm that they will speak with one voice in implementing national health reform. Those gathered unanimously agreed to combine the efforts of the Whole Health Campaign and the Coalition for Whole Health into a single entity-represnting 110 organizations-with the latter name, all in support of implementing the provisions of the Patient Protection and Affordable Care Act of 2010.

This action is remarkable, given a past in which the mental health and substance use care and prevention fields have often been at odds over issues ranging from resource allocation to clinical control. Points of fissure have also formed around differences including public vs. private, treatment vs. prevention, state vs. county/local, managed care vs. provider, and more. Both the Campaign and the Coalition have worked to bridge these differences so that the fields can speak with a united voice.

Effective consensus was reached more than two years ago around three principles developed by the Whole Health Campaign: good health insurance coverage for persons with mental health and substance use conditions; good, integrated care that spans mental health, substance use, and primary care; and good prevention services for mental health and substance use conditions. On these principles, the Campaign produced eight policy papers, and the Coalition advocated for the major mental health and substance use provisions in the new reform legislation.

Several years of vital work lie ahead. This work will involve close collaboration with the Secretary of HHS; participation on boards, commissions, and taskforces; review of draft regulations; and communication with the field so its views are reflected accurately and it is informed of current developments.

The reform legislation represents a once-in-a-lifetime opportunity to make the mental health and substance use fields fully equal participants in healthcare, where we can and must succeed.

What are the reform-related issues that will be addressed?

Insurance reform. More than 32 million adult Americans will receive health insurance coverage through these provisions. This will occur through expansion of the Medicaid program for all who are at 133 percent of the Federal poverty level or less and the creation of State Health Insurance Exchanges. Both of these provisions will go into effect in 2014. About 10.5 million of these newly insured persons will have a mental health or substance use condition. My personal estimate is that the newly insured will bring $68 billion per year in new resources to our fields.

Coverage reform. Coverage reform has many features: elimination of pre-existing condition provisions in current plans; extension of parental coverage for adult children to age 26; elimination of annual and lifetime limits on coverage; and elimination of co-pays for prevention and promotion interventions. Each of these provisions will serve to expand access to mental health and substance use care. We need to begin to prepare now for these new coverage features.

Quality reform. The Secretary of HHS has been directed to address quality reform. This will involve development of demonstrations of patient-centered medical homes, including behavioral health medical homes; development of approaches and demonstrations for accountable care organizations that reintegrate care for the whole person; implementation of evidence-based practices; and implementation of quality measures. Because there cannot be good health without good mental and addictive health, we must work hard to influence the quality agenda.

Payment reform. This reform will be designed to improve the efficiency of our payment systems. Most state Medicaid systems use a costly, inefficient, encounter-based payment system. The Secretary of HHS will be designing episode and case-rate systems that adjust for performance, improve efficiency, and promote improved quality. We must pay particular attention here, since episode and case rates are likely to include mental health, substance use, and primary care.

Information technology reform. Financial incentives for adoption of electronic health records and personal health records encourages use of these tools to support better reporting and quality improvement.

Today, more than ever, the mental health and substance use fields must speak and act with unity as we participate in the implementation of health reform. I invite you to engage fully in the effort, every step of the way.
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 July-August;30(7):9