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Outpatient Behavioral Health Summit Pennsylvania Community Providers Association December 2009. Dale Jarvis, CPA Bea Dixon, PhD MCPP Healthcare Consulting Inc. Seattle, Washington. Movie: Summit Planning.
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Outpatient Behavioral Health Summit Pennsylvania Community Providers Association December 2009 Dale Jarvis, CPA Bea Dixon, PhDMCPP Healthcare Consulting Inc. Seattle, Washington
Healthcare Reform and the Integration of Primary Care and Behavioral Health Dale Jarvis
Health Reform: Implications for the Healthcare and Community Behavioral Healthcare Systems Healthcare Reform Legislation will result in the remakingof the public behavioral healthcare system
The Behavioral Health “Tipping Point” My Hypothesis: • We have finally reached the tipping point in understanding the importance of treating the healthcare needs of persons with serious mental illness and the behavioral healthcare needs of all Americans • Behavioral healthcare has become very important to managing Total Health Expenditures in the U.S. and bending the cost curve • This will drive widespread integration of Primary Care and Behavioral Health in the form of the Person-Centered Healthcare Home and will create greater demand for mental health and substance use treatment services • These changes will bring enormous opportunities and challenges to the Community Behavioral Healthcare system, which will need to demonstrate that it can provide evidence-based, high quality care that produces outcomes and manages total health expenditures
The Overall Design for Healthcare Reform • U.S. health care reform legislation has been designed to address three issues
The Overall Design for Healthcare Reform The Path to a High Performance U.S. Health System – A 2020 Vision of the Policies to Pave the Wayidentified 10 Health Care Reform Policies that can save $3 trillion over 10 years (Commonwealth Fund 2009)
Person-Centered Healthcare Homes • 45 percent of Americans have one or more chronic conditions. • Over half of these people receive their care from 3 or more physicians. • Treating these conditions account for 75% of direct medical care in the U.S. • Person-Centered Healthcare Homes is a key strategy
Person-Centered Healthcare Homes Healthcare Home Principles • Ongoing Relationship with a PCP • Care Team who collectively take responsibility for ongoing care • Provides all healthcare or makes Appropriate Referrals • Care is Coordinated and/or Integrated • Quality and Safety are hallmarks • Enhanced Access to care is available • Payment appropriately recognizes the Added Value
Person-Centered Healthcare Homes It’s all about Improving Quality andmanaging Total Healthcare Expenditures!
Person-Centered Healthcare HomesThe Group Health Cooperative Experience • 2002-2006: increase in patient access but also increase in provider burn-out • 2007: healthcare home pilot for 12 months with 30 minute visits and: • 15% more docs and 44% more mid-levels • 17% more RNs and 18% more MAs/LPNs • 72% more pharmacists
The Behavioral Healthcare Landscape The Safety Net Behavioral Healthcare System faces even greater challenges • Life expectancy of US: 78 years (purple) • Life expectancy of US SMI: 53 years • Life Expectancy of Sub-Sahara Africa: 50-55 (orange)
Morbidity of Persons with Mental Health Disorders • One behavioral health condition doubles medical expenditures, emergency room visits and hospital admissions for Medicaid enrollees • 49% of Medicaid beneficiaries with disabilities have a psychiatric illness (this is new information; previous studies that excluded pharmacy claims calculated the rate at 29%) The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic ConditionsCenter for Health Care Strategies, Inc., October 2009
Reform Impact: More Consumers with Coverage • 31% to 43% increase in Medicaid enrollees, depending on the bill • Large reduction in uninsured (54% to 67%)
Reform Impact: More MH/SU Consumers with Coverage • There are approximately 17 million Americans with Medicaid Coverage or are Indigent and Uninsured needing mental health services in a year; 54% (9 million) have Medicaid coverage • Under the Senate Finance Committee Bill, at least 2/3 of the uncovered would likely shift into Medicaid or an Exchange, raising the coverage level to 84%
The Role of CBHOs in a Reformed Environment Community Behavioral Healthcare Organizations (CBHOs) have two important roles in a reformed health care environment that addresses the needs of persons with serious MH/SU disorders: 1) Serving as an integral part of Medical Homes and 2) Providing Specialty Behavioral Healthcare Services.
