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Panel: Behavioral health providers uncertain about impact of coming health reforms

May 16, 2013
by Laura Ashpole, J.D.
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Patient needs and service opportunities abound, but industry panelists question how much new revenue will follow promised reforms


At the National Council for Behavioral Health Conference in Las Vegas in early April, a panel of experts exhibited skepticism about what health reform may mean for the behavioral health field. The panel, moderated by Dale Jarvis, founder of Dale Jarvis and Associates, featured:

·         Ron Brand, Executive Director of the Minnesota Association of Community Mental Health Programs, Inc.,

·         Ann Christian, CEO of the Washington Community Mental Health Council,

·         George DelGrosso, Executive Director of the Colorado Behavioral Healthcare Council,

·         Chuck Ingoglia, Vice President of Public Policy at the National Council for Community Behavioral Healthcare,

·         Tim Swinfard, CEO of Pathways Community Behavioral Healthcare, and

·         Hugh Wirtz, CEO of Ohio Council of Behavioral Healthcare Providers.

Innovation and integration opportunities

The panel opened with a discussion of the notable health-reform challenges behavioral health organizations face.  One panelist urged the crowd to think of the many moving pieces of health reform as “innovation opportunities,” and specifically called out these opportunities:

·         integration to provide population-based care;

·         service delivery redesign;

·         value-based payment reform; and

·         implementation of health information technology beyond electronic health records. 

Regarding the options for primary and behavioral health care integration, most panelists agreed that integration ought to be bi-directional. They encouraged behavioral health providers to think not just about adding primary care to their service lines, but also to the requirements for bringing behavioral health to primary care sites. Panelists encouraged attendees to consider two key questions: What preventive and primary care services could they as behavioral health providers begin offering their clients? What specialized behavioral health services could they market and provide to primary care providers or locations in the area?

Building market presence

Because many organizations are seeking to expand market presence or service capabilities through acquisition, network formation, or partnerships, panelists urged providers to remember that options are broader than ever. In addition to integrating or partnering with other health care organizations, panelists recommended that providers look further, to possible partnerships with managed care organizations (“MCOs”) or health insurance companies as potential partners. 

Regardless of the potential partner, the panel advised provider organizations to begin marketing activities now to build market presence and influence. They suggested that providers form or join statewide or regional networks, detail out and “package” internal product lines and capabilities in ways that demonstrate their value and revenue potential to potential purchasers or partners, and that organization leadership develop the structure and capabilities to ensure the organization’s ability to provide same-day access to mental health and substance use disorder services.

Reaping reform’s rewards — or not?

Prior to the Supreme Court’s decision on the Affordable Care Act, it was widely expected that 2014 would see insurance coverage expand — via the Medicaid expansion and the insurance marketplaces — to 32 million Americans, including some 10.5 million with behavioral health disorders.

However, in the wake of the Court decision and subsequent state decisions to reject the federal government’s Medicaid expansion offer or pursue alternate expansion options, estimates of the number of newly insured have fallen, as have estimates of the service revenue likely to flow to behavioral healthcare. While Jarvis suggested that some four million newly insured would seek behavioral health services and generate $25 billion in new service revenues, panelists adopted more of a “wait and see” attitude, arguing that it is not yet clear where the additional revenue “will land” (in specialty behavioral health, primary care, or general medicine) and whether the behavioral health coverage provided will, given 50 different state essential health benefits options, “be enough” to provide high quality treatment.

Moreover, some panelists cautioned workshop attendees that more behavioral health revenue will likely mean more competition among more providers to deliver a share of the expanding market for care. Others pointed out that a surge in demand could only exacerbate the current shortage in the number of qualified behavioral health professionals and pit provider against provider in increasingly costly competition for a limited pool of qualified personnel.

What’s next? What should providers do?

To cope with the challenges of health reform, panelists suggested that providers take action: