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Unexplored opportunities in reform

March 1, 2010
by Ronald W. Manderscheid, PhD
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Providers should prepare to make qualitative changes post reform

In their analyses of national healthcare reform, pundits typically look only at potential winners and losers, gains or losses. In doing so, they assume that those involved with healthcare will simply do more or less of the same things, post reform, that they did before.

But such analysis misses the mark. With or without passage of the national healthcare legislation currently under consideration on Capitol Hill, we must recognize that healthcare reform is inevitable and that, when it comes, our activities and functions will qualitatively change. Here are just a few examples of those changes.

Outreach to the newly insured. We already know that one-third of uninsured adults have mental or substance use conditions. As current or future reform efforts offer these persons access to personal health insurance, we face the question: Who will provide outreach to them? How will they access and receive behavioral healthcare? Clearly, local behavioral healthcare entities will have a significant role in this outreach process.

New individual and population interventions. Any meaningful health reform will emphasize more disease prevention and health promotion activities. The essence of prevention and promotion is behavioral change-the appropriate purview of mental health and substance use providers. This clearly implies that mental health and substance use providers should play a major role. At the level of the person, this might mean that local behavioral healthcare providers offer health promotion interventions similar to those currently being developed by businesses. However, at the population level, such intervention could lead to a yet-to-be-developed field of behavioral health. We can lead the way in developing behavioral change interventions for entire populations by evolving the role of population health coaches to apply these interventions. Of course, consumer and family input will be essential to this pursuit.

Identifying social and physical determinants of health. New work suggests that developing local community collaboratives can be an effective means of promoting better social and physical determinants of health. Widespread development and utilization of such collaboratives can assure identification and adoption of better social and physical determinants of health, resulting in large-scale trends toward better health and less disease. The work already undertaken to create community collaboratives in Texas, New Mexico, and elsewhere represents a platform from which additional collaboratives can be created. These community collaboratives need to address issues and problems that are identified by persons who live in the community, such as childhood obesity, adult depression, etc. Appropriate performance measures will be needed to assess progress.

Creating behavioral health homes. A new opportunity exists to develop and implement “behavioral health homes,” similar in concept to “medical homes,” but suited to a different population. For about five percent of adults and ten percent of children, such behavioral health homes, led by specialists, could offer much more effective support for recovery and resiliency than medical homes led by primary care physicians. A behavioral health home could foster consumer empowerment, recovery, good peer support, and needed primary care services by linking specially-trained primary care providers with behavioral healthcare programs.

Currently, federally qualified health centers, or FQHCs, provide a model of what a behavioral health FQHC “look alike” could be. Current FQHC applications, available from the HHS Health Resources and Services Administration (HRSA), are built on specific criteria including population composition, percentage in poverty, distribution of minorities, geography, service needs, and availability. Behavioral healthcare providers need to explore and apply to become FQHC “look-alikes.” Once qualified, reimbursement rates under Medicaid for the FQHC “look alike” would rise to the level of those provided to an FQHC. This means that a behavioral healthcare provider could make more income.

These ideas represent just a few of the many “outside the box” opportunities that invite consideration as we await the arrival of nationwide healthcare reform. As others continue to speculate about who is winning in our reforming healthcare environment, those who imagine and seize opportunities like these to transform behavioral healthcare will already know. Go for it!

Ronald W. 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 March;30(3):37