Implications For The Future Of Behavioral Healthcare

The Supreme Court decision has been handed down. The field can now focus and re-dedicate energy and time to preparation for monumental changes that take full effect in 2014. Here’s a brief listing of what you can expect:

  1. Coverage for the uninsured expands vastly via the Health Insurance Exchanges established in each state by the State or the Federal government wherein Americans can shop for insurance coverage in an open and transparent marketplace, able to compare one health insurer to another and able to qualify for subsidies based on their income. For the most part, this population (expected to grow to 15 million Americans) will constitute a market reachable by way of contracting with commercial health insurers, managed care and managed behavioral healthcare organizations.
  2. Coverage of the uninsured via Medicaid Expansion wherein states will have access to new Federal funding at very high levels. Coverage will be expanded to cover otherwise excluded Americans like childless adults. Medicaid Expansion will produce the most significant impacts for those in the field who have historically focused on the indigent uninsured. Understand that most of the Medicaid expansion will materialize in Medicaid Managed Care Plans.
  3. Block Grants and other grant funding sources will very likely be re-purposed over time to cover the people and services left uninsured under the ACA. For the most part, we can expect that community-based wrap-around services and recovery support services will become the focus of grant funding.
  4. Behavioral health benefits will be required but will be managed closely. Mental health and substance use disorder services are among the 10 essential health benefits required under the plans offered through exchanges. Expanded coverage will, however, be likely to result in rigorous benefit management in order to make the most of finite resources. Providers must prepare for private sector behavioral healthcare business practices like credentialing, contracting, eligibility determination, understanding health insurance policies, obtaining authorizations, and billing for services.
  5. Behavioral Medicine – whole health, person-centered care – will expand in order to address the costs associated with people suffering from Multiple Chronic Conditions. Everybody needs to understand that highly integrated delivery systems, collaboration, care coordination and access to health information are absolutely necessary if we hope to “bend” the cost curve. The opportunity for behavioral healthcare providers is terrific where conditions like obesity, diabetes, heart disease and chronic pain have behavioral components that desperately need attention and cooperation between providers.
  6. New partnerships and business models need to be conceived, nurtured and deployed. Behavioral healthcare providers can now dedicate themselves to new partnerships. The future will be about mergers, joint ventures and exciting innovation.
  7. The market for behavioral healthcare will grow dramatically as will the need to recruit and retain a professional workforce. Assuming all stakeholders cooperate in the redesign of the system of care around the country, the need to treat vast swaths of untreated mental health and substance use disorders will produce unprecedented opportunities for growth in the field. However, 35 million newly insured Americans will stress and strain the aging behavioral healthcare workforce. Waiting lists are no longer acceptable so business process, workflow efficiencies, and an attractive career path will become essential to meeting the unmet needs of Americans. Understand that commercial insurers and Medicaid managed care plans will effectively raise the standards for professionalism, credentialing, and accreditation.
  8. Health information technology will continue to be critical to organizational success in emerging business environments. Health IT is an essential component of data and information exchange (i.e., billing, etc.) with payers and insurers and provides the backbone for collaboration between all healthcare providers. The business and clinical reasons driving investment and implementation are stronger than ever and time is running short. Behavioral healthcare providers must re-focus their time and efforts to identify, select and adopt certified systems.
  9. The Mental Health Parity and Addiction Equity Act (MHPAEA) and Essential Health Benefits need to be interpreted and operationalized at the state level. We must cooperate, agree on terms and take a firm position that can be shared with other stakeholders. We must take its place at the table and argue for a well-rounded scope of services, compliance with MHPAEA, and strong linkages between coverage and social services. We also need to know when to press for compliance; regulators at the Federal and state levels need to make Final Rules in these areas a high priority. Bear in mind that Essential Health Benefits must include mental health and substance use disorders treatment coverage, apply to both Health Insurance Exchanges and Medicaid Expansion.
  10. Financial savvy and a willingness to assume some financial risk will prove advantageous. As healthcare reforms continue to unfold, the spate of reimbursement reforms – pay-for-performance, shared savings, global payment – will increase. The hybridization of payors and providers in models like ACOs will increase. Behavioral healthcare providers need to expand their financial base, gain access to capital and reserves, and access financial expertise to navigate these new waters.

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