CMSA Today - Issue 2, 2016 - (Page 16)

Collaborative Care Integrating and Coordinating Specialty Behavioral Health Care with the Medical System The Kennedy Forum Highlights New Policy Recommendations BY BILL EMMET and GARRY CARNEAL, JD, MA C ollaboration is a core theme in case management. However, one of the key challenges for case managers is the fragmentation of the U.S. health care delivery system, especially in the way payers reimburse for care. How medical services are reimbursed can vary greatly depending on the types of services, geographic location, type of health insurance, and other factors. One of the more recent drivers for integration was the passage of The Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (MHPAEA), with the goal to end discriminatory health care practices against those with mental illness and/or addiction. MHPAEA prohibits health plans from applying financial requirements or treatment limitations to mental health or substance use disorder (MH/SUD) benefits that are more restrictive than those applied to medical/surgical benefits. Most notably, the law aims to remedy discriminatory practices in both the "quantitative" and "non-quantitative" limitations plans apply to access to addiction and mental health care services. Quantitative limitations include financial and durational caps on care, while non-quantitative limitations include the application of medical necessity criteria and other management techniques. Final regulations went into full effect starting Jan. 1, 2015, for all plans covered by MHPAEA. With a year under our belts, enforcement activities are picking up with the federal government and at least five 16 CMSA TODAY Issue 2 * 2016 state insurance departments auditing health plans, along with the specialty behavioral health care organizations supporting payers, for potential parity violations. The New York Attorney General's office also fined a handful of health plans and their contractors last year. As a result, payers have new incentives to integrate behavioral health care coverage with mainstream medicine. BEHAVIORAL HEALTH NEED Case managers on the front lines understand how MH/SUDs remain a significant comorbidity in any given chronically ill targeted population. One in four individuals will struggle with a behavioral health issue at some point in their lives. In fact, these disorders are responsible for nearly 25 percent of all worldwide disability as well as substantial increases in overall health care costs. Although effective treatments exist for most behavioral health conditions, many people don't receive the care they need due to lack of access, poor quality care, and "Patients with mental health and substance use disorders have higher overall health care costs two or three times greater than those without." ineffective coordination between the medical and behavioral systems. While barriers such as long wait times, cost, and stigma surrounding mental illness explain why so few people access specialty care, the reality is that the specialty mental health care system is underequipped to treat the vast number of people with MH/SUDs. More than half of counties in the U.S. do not have a single practicing mental health professional, a problem particularly acute in rural areas. THE KENNEDY FORUM FOCUS GROUPS In 2014, Patrick J. Kennedy founded The Kennedy Forum to help build a stronger bridge between behavioral health and mainstream medicine. In his recent book, A Common Struggle, Kennedy chronicles his years of addressing his own mental health and substance abuse issues. Through his leadership, he has achieved national recognition as a leading policy thinker and consumer advocate on how to improve mental health and addiction services. In his book, Kennedy also provides a riveting account of how MHPAEA finally became the law of the land after many years of false starts and various legislative proposals. Over the past year, The Kennedy Forum hosted a series of focus groups with a wide array of stakeholders around the country to better understand the issues of access and treatment of patients with behavioral health

Table of Contents for the Digital Edition of CMSA Today - Issue 2, 2016

President's Letter
Association News
CMSA Corporate Partners
Index of Advertisers
The Ever-Changing Concept of Patient-Centered Care
Integrating and Coordinating Specialty Behavioral Health Care with the Medical System

CMSA Today - Issue 2, 2016