Financing services in the near future is the top concern of behavioral health professionals. According to Becky Vaughn, vice president of addictions for the National Council for Behavioral Health, that worry is quite justified.
While financing in the past has typically been centered on public funding, block grants or self-pay clients, the future is all about the card—the insurance card, that is.
“Everybody will have some kind of card, whether it’s an employer-based health plan card or a marketplace card or a Medicaid card,” Vaughn said, speaking at the National Conference on Addiction Disorders today. “The real question is: Are we ready to accept that card?”
With the Affordable Care Act and other favorable legislation, behavioral health is increasingly going to rely on commercial insurance. Even Medicaid is largely moving toward managed-care arrangements that have commercial insurers contracting with states to provide the program. In fact, only about 30 percent of Medicaid enrollment was allocated to managed care in 1995, but by 2012, the number reached more than 75 percent. Today, it's even higher.
Vaughn also cautions that when thinking about payment structure, providers must move away from strictly episode-based treatment models, particularly models that predetermine treatment by the length of time, such as 30 days or even 180 days.
“Stop it!” Vaughn said. “When was the last time you heard of a 30-day diabetes program? That is not the way we treat people.”
Instead she recommends that providers begin to focus on flexible programs that meet the needs of the patients similar to the way a primary care provider might manage patients with chronic disease. Medication-assisted treatment for addiction should be considered as well, just as insulin might be considered for a diabetes patient.
Vaughn noted two ways behavioral providers might fit into the healthcare system of the future.
1. Become integrated with primary care, either through general supportive referrals and partnerships or through more sophisticated arrangements such as shared clinical staff with connected EHR systems.
“Many providers are moving in that direction or they are already there,” she said. “That is definitely one of the models."
She said SAMHSA’s Center for Integrated Health Solutions has a portfolio of examples of unique provider partnerships that have successfully integrated behavioral health and primary care.
2. Become a center of excellence. The Excellence in Mental Health Act has already put the wheels in motion to create criteria that will allow behavioral health providers to earn higher pay for delivering more comprehensive care. Some examples of the expectations include more convenient hours, including patient input into care decisions, and relentless measurement of objective outcomes data.
"We must put these things in place so we get paid, and it can't amount to: ‘This patient is doing better because he said he is.’"
One take-away task Vaughn set for the audience is to go home and create a plan for connecting with retail health clinics—the MinuteClinics and others that often located in retail stores—because she views them as the next possible partner for integration.