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Transformation or degradation: Progress and pretext

December 8, 2009
by Terry L. Stawar, Ed.D.
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I am proposing a moratorium on the use of the word “transformation” for the remainder of this century. The term has been so overused that it's lost its meaning and now is being slapped on any proposal that comes down the pike.

The final report from President Bush's New Freedom Commission was subtitled: “Achieving the Promise: Transforming Mental Health Care in America.” This report described in utopian terms how the system could be improved by increasing public awareness of how essential mental health is to overall health, making services consumer driven, eliminating discriminatory disparities, promoting early intervention, and implementing evidence-based practices and the effective use of technology. From this perspective, transformation held the promise of the implementation of the recovery model on a national scale.

However, back in 2005 Congress appropriated $150 million for "transformation grants." But these grants veered away from the New Freedom Commission’s goals and put the weight on the need to deliver “efficient and more economical" services, with the emphasis on economical. Transformation started to look like a euphemism for cost containment and managed care.

The recovery model and Medicaid managed care make for strange bedfellows. Can person-centered treatment planning really be based on qualifying for predefined service packets? Especially when the cookie cutter packets are based on diagnostic codes and scores on impersonal instruments, none of which that were ever designed for that purpose.

Instead of aligning Medicaid rules with recovery model goals, Medicaid managed care restrictions have been redefined as being transformational. The need for maintenance and sustenance services, the need for residential, vocational, and socialization services are all still being neglected under Medicaid’s outdated medical model which emphasizes only the narrowest view of medical necessity.

There seems to be some thought that by creating as many barriers to access as possible and reducing the profitability of providing services (lowering rates and increasing overhead), that this somehow equates to improving efficiency. Unfortunately the rain falls on the just and the unjust equally.

This is not a transformation, this is a degradation of the system.


Terry Stawar

President/CEO (LifeSpring, Inc.)

Terry Stawar


Terry L. Stawar, EdD, is President and CEO of LifeSpring Health Systems, a community behavioral...

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