Mental Healthcare Reform - Present Successes and Future Challenges

As healthcare reform is becoming a reality, therecustomers, but also as key players in these new
is much to celebrate within the mental healthhealthcare consortia.
community. This includes passage of a healthcareWe must become accountable for efficient and
reform package that includes parity for mentaleffective services that show results across all
health and addiction services, expansion ofhealth domains. We believe fee-for-service
Medicaid to 133% of Federal Poverty Level,reimbursement will slowly become a thing of the
inclusion of behavioral health organizations andpast. So, too, will be the ability to claim that
individuals with mental illnesses in the new Medicaidcaseloads are full with no-show rates of 50% and
medical home state option, and authorization andmore. We risk being left on the sidelines if we
increased funding for grants co-locating mentaldon't move with deliberate speed to ensure
health treatment and primary care. These and acontinuity and timely access to care; comply with
host of other provisions expand the opportunitiesthird-party payer requirements; coordinate care
for individuals with mental illnesses and addictionswith a full range of health providers; and if
to obtain and maintain insurance coverage andnecessary take on payers that refuse to honor
access needed services.the spirit and letter of the parity regulations.
But this is not the end of the mental healthcareWe must become increasingly customer-focused,
battle. Simply put, mental health advocates mustfrom the way we greet individuals who come
be ready to play in a new game, in a world wherethrough our door to the way we market our
increasing numbers of individuals - by virtue ofservices. We should expect that with more
Medicaid expansion, the emerging Health Insurancemoney available in healthcare - particularly for
Exchanges, and parity regulations - will havemental health and addiction treatment - that new
access to behavioral health services. We expectand well capitalized players will find behavioral
to see an additional 15 million individuals - anhealth, traditionally a financially unattractive
increase of 43% - eligible for Medicaid alone, withhealthcare sector, far more appealing.
more than 30 million individuals overall who will, inPeople will be insured and will have an increasing
the not too distant future, have insurancerange of options available to them. What
coverage.differentiates our mental healthcare services?
But this is far more than a matter of numbers -Why should an individual choose to receive
it's about working smarter. Advocates of mentaltreatment and support from us? Are we offering
healthcare anticipate that healthcare reform-drivenservices that will help them meet a full range of
service delivery redesign and payment reform willhealthcare needs? Are our services culturally
unfold at a rapid pace. In order to bend the costappropriate for the communities we serve? Can
curve, payment reform and service deliverywe help them understand and make appropriate
redesign will change how health, mental health, anduse of their insurance coverage? We must retool
substance use services are integrated, funded,our organizations with the knowledge that all
and managed. Providers must learn to practiceindividuals will now become true "consumers" of
healthcare the way healthcare will be done.healthcare services.
As mental healthcare providers and advocates,At the same time, we must also be aware that
we must become savvy about positioningour work is far from over at the state and
ourselves to take advantage of new markets andfederal level. Forty eight of 50 states are
new opportunities to help control the design andexperiencing severe budget shortfalls. The threat
delivery of healthcare services. We must begin tois very real and the mental healthcare advocates
build relationships within and across the entireare fighting hard to hold on to current funding as
healthcare sector. As we revisit the concept oflegislatures see an opportunity to continue to
"managing care" for individuals and wholewithdraw needed funds. This is surely a bad idea -
populations, we have to be certain that our focuseven the most generous healthcare benefits will
on person-centered, recovery-focused treatmentlikely not cover the full range of wraparound
and services is not subsumed by the drive tosupports that people with mental illnesses and
"bend the curve" in healthcare costs. We must beaddictions need to fully recover.
able to demonstrate our value not only to our