By Patrick Gauthier, Senior Consultant, Managed Behavioral Healthcare

After months of wrangling and a whole host of political maneuvers, the Senate on Monday cleared the first of three procedural hurdles to set up a final vote for HC Reform passage on Thursday. At this point, with the Democratic caucus united and holding the 60 votes necessary to close off debate, passage is all but assured. That version will then head to the House where anything can happen. Rather than take bets on the outcome, I want to focus on what the behavioral health field can expect after the holidays. There is so much more going on than meets the eye when the eye is trained only to cable news and Reform. It’s time we peeled ourselves away from CNN and started paying closer attention to the fan and all that is about to hit it.

I have assembled my New Years’ Resolutions and To-Do List for your information.

1. Prepare for Cost-Cutting and Efficiency. On the heels (we hope) of the recession and in anticipation of Parity and Reforms, every stakeholder in the healthcare system—states, counties, hospitals, physicians, behavioral health providers, payers and employers—is going to hunker down and figure out how to move forward on a tight budget. Behavioral health providers and payers need to figure out how to do this while they grow. Tricky but possible. Ask for help.
2. Implement Parity. While we were transfixed by Reform, Parity regulations were being drafted for release by January 1, 2010. With any luck, Labor, Treasury and HHS will be releasing clarification and guidance we have all been waiting for. With even more luck, the guidance will be unambiguous and without equivocation. We’re ready for something definitive that we can really deploy. Brace yourselves—good or bad direction notwithstanding—Parity will take many months to implement. MBHOs are about to get everything they ever wished for Christmas.
3. Change the Way We Do Business. No matter how things manifest between the House and Senate, there are a whole host of significant changes to health insurance that will require comprehensive attention. 2010 will be the year of Change Management in health care and health insurance. Market reforms, new grant programs, reimbursement pressures, oversight and accountability are bound to keep everyone busy, including MBHOs and their contracting providers. Providers who have relied on Block Grants have some serious change to consider assuming most of their populations are going to be eligible for new coverage with Reform.
4. Implement Health IT (EMR and Health Information Exchange). In order to make good on the HITECH provisions in ARRA and exploit the many billions in stimulus targeting Regional Extension Centers (RECs) and Medicare incentives, everyone and their brother is suddenly mass-producing, buying and implementing software and technology. Note to self: with every good gold-rush, there are charlatans and pirates to beware of. Behavioral health providers have largely been ignored in this process so their learning and adoption curve is steeper, longer and totally unfunded. Tele-health is already a player in behavioral health and recent broadband funding will only enhance that market. When it comes to technology adoption, behavioral health providers are urged to speak with experts and ask for guidance.
5. Manage Pharmaceuticals. This version of Parity will continue to accelerate the rate of psychotropic medication prescriptions issued from primary care physician offices. Prescription drugs are the only segment of behavioral healthcare that grew in the past 10 years. Meds will become more commonplace than ever propelled by the fact that many people believe they are both more effective and less costly than common mental health treatments. The truth is that outpatient psychotherapy combined with medication management is still the best course of treatment for the majority of sufferers.
6. Manage Mergers, Acquisitions and Partnerships. The scope of change will compel behavioral health providers to look at trends in medicine and finally begin emulating them. Providers need to follow in the footsteps of their medical brothers and sisters and join or form MSOs and IPAs. Doing nothing at this point is unwise and too expensive – especially as it relates to core services and technology. Partnerships will involve primary care and deep collaboration as Patient-Centered Medical Homes become the vogue.

Comments (0)

Subscribe to this comment's feed