Behavioral Health Services Critical to Success of Managed Care in NYS

As New York State implements healthcare reform, Medicaid re-design, and the integration of primary care and behavioral healthcare, substance use and mental health disorder prevention, treatment, and recovery services will have to play an important role if the hoped for transformation is to be successful. At the first meeting of the Medicaid Re-design Team, discussion focused on the need to reduce unnecessary Medicaid expenses, improve patient health outcomes, and strengthen cross-systems collaboration. It was noted that New York State leads the nation in unnecessary hospitalizations and that unnecessary hospitalizations have accounted for a significant amount of the State’s unnecessary health care expenditures. Healthcare and Medicaid experts on the Medicaid Redesign Team pointed to the fact that 80% of the people who were unnecessarily hospitalized were persons with untreated substance use and mental health disorders. To address these untreated behavioral health issues at the same time that unnecessary hospitalizations will be addressed, New York decided to manage all Medicaid behavioral health services. This significant transformation, a shift from fee-for-service to managed care, is supposed to become operational in January 2015.

The economic impact of the failure to treat substance use and mental health disorders has been a major driving force in New York State’s Medicaid redesign efforts. Not only are untreated behavioral health issues at the center of unnecessary hospitalizations, they are also highly concentrated in the population of folks who have the highest levels of overall healthcare expenditures. Access to and utilization of treatment for substance use and mental health disorders drives down unnecessary use of expensive healthcare services and is a critical ingredient for the achievement of NYS’ healthcare service outcome and expenditure goals. Managed Care has been identified as the vehicle to improve health and behavioral health outcomes and to decrease unnecessary healthcare expenses.

The Medicaid Redesign Team created a Behavioral Health Workgroup to ensure that New York gets better behavioral health and primary care outcomes. A Children’s Behavioral Health Workgroup was also formed. These groups have been working with staff from the NYS Department of Health, Office of Alcoholism and Substance Abuse Services, and Office of Mental Health and have been helping to shape the framework that will be used when services become fully “managed” in January 2015. Advocates for community-based behavioral health services providers have been working with the Health Plans and Managed Care Organizations to try to create common understanding and commitment to quality care and quality outcomes using diverse services models.

A comprehensive continuum of substance use and mental health disorder prevention, treatment and recovery support services must be included in the behavioral health services package offered by Plans that manage Medicaid behavioral health benefits. Like other chronic conditions, there are varying degrees of severity for substance use and mental health disorders and a continuum of care is necessary to ensure that people can receive the appropriate level and type of care, including evidence-based acute care, behavioral health services, access to medication, care coordination, and recovery support services. Research shows that prevention and early interventions reduce the incidence of mental health and substance use disorders and other costly co-occurring chronic illnesses such as diabetes, hypertension, heart disease and certain cancers. These services must be included in the behavioral health services package. The important role of peer services is also increasingly being recognized and will be an important part of the continuum of managed services.

National and state healthcare reform presents us with a tremendous opportunity to improve public health outcomes, reduce costs, and ensure coverage and access to necessary care for all New Yorkers. With full implementation of the Affordable Care Act in the state, New Yorkers with limited or no access to behavioral health services in the past will now have coverage for these services. As we transition from fee-for-service to managed care we must all work together to ensure that a comprehensive continuum of behavioral health services is accessible in communities across the State and that those services are diverse, culturally competent, and available on demand.

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