California State University, Northridge Certificate in LGBTQ+ Health

System Transformation: What Does the Future Hold?

We know that the mind and body are inseparable, so it’s no surprise that the evolution of behavioral health services will continue to be a story of convergence and consolidation, increasingly informed by science, financed by investments intentionally calibrated to drive progress, and guided by leaders prepared to meet the ever-changing needs of local communities. Here’s what we believe the future holds:

A bridged gap between professionals and communities: Integrating behavioral and physical healthcare is old news, but the inclusion of new partners able to attend to the “social determinants of health” by addressing issues like housing, food security, unemployment, and transportation will grow in sophistication and coordination. The interweaving of professionals and community supports will be increasingly seamless. Healthcare payers will align with funders from other systems to align resources and make investments that facilitate community wellness. Such cross-sector collaboration will engage public health, education, older adult services, law enforcement, housing, human services, criminal justice, child welfare, etc. in resource sharing to address mutual agendas using agreed metrics to measure and guide intervention.

Deconstructed supports: Behavioral health centers will increasingly direct comprehensive and multi-component services occurring in every milieu and neighborhood. Nearly all consumers will have access to peer specialists or community health workers working side by side with their licensed professionals. All treatment plans will include adjunctive interventions in the home, school and employment settings. All treatment outcomes will be measured not in de-contextualized DSM symptoms but in functional capacities and quality of life within specific environments and relationships. Service consumers will have options and their input and feedback will routinely and fluidly be elicited to inform service delivery design and facility improvements.

A real role for families: In the future, all healthcare will be “person-centered and family-engaged.” Privacy laws like HIPAA will be better understood and no longer used to marginalize consumers’ family members. Consumers will remain the focus of treatment but will be strongly encouraged to allow their family members to serve as partners in care with treatment teams, including defined roles and coaching to observe and report on treatment effects. Their own behavioral well-being, strained by caregiver duress, will be routinely assessed, monitored and supported.

True rapprochement between the behavioral health and substance abuse worlds: Neuroscientific findings proving the connections between mood and anxiety disorders and substance use will lead insurers to insist that behavioral health and substance abuse services co-locate and integrate. This momentum will ensure that therapeutic and medication assisted treatment are provided based on each person’s needs and wishes, unrestrained by provider biases, and informed by science.

A healed rift between behavioral and physical health: In the future, all medical settings of every subspecialty will have behavioral health providers on their teams to provide services tailored to a consumer’s given condition (be it cancer or Crohn’s disease), psychological status (merely stressed or sunk in despair) and social stratum (resource-rich or low income). All independent behavioral health agencies will have established ties and easily accessed communication systems to surrounding medical facilities to share patient data, medication lists, and treatment plans for far better care coordination. Consumers and family members will no longer feel that one “healthcare hand” doesn’t know what the other hand is doing.

A command of complexity: Behavioral health agencies are already ahead of their physical health counterparts in identifying the highest-need consumers and creating wrap-around services to keep them out of emergency rooms, hospitals, and jails. They will continue to refine their approach to those at highest need by further extending into these and other sectors and community settings and networks. In the future, complex care management will be more advanced and effective, using predictive analytics, rather than hospital readmission rates and related metrics to identify consumers who require more intensive services across multiple settings. Outreach, engagement, and intervention will benefit from local liaisons and advisors whose community health workforce will be best able to engage high risk individuals and populations.

Expanded Ease of Access: Most outpatient services will include interprofessional, cross-trained and highly collaborative teams able to offer individualized care when and where needed and as informed by meaningful demonstration of success with similar conditions. Consumer feedback and data analytics will guide ongoing attention to ensuring that teams are culturally and linguistically competent, and providers will have support to identify and address even their unconscious biases. Cross sector collaborations will support stratification and intervention to deploy these interprofessional teams, including medical and social experts, who will treat consumers holistically in their homes, communities and, when critical, within facilities. Telehealth and telemetrics will routinely and seamlessly reinforce care delivery at every stage of treatment and provide access in areas and settings facing provider shortages.

A firm grasp on value: Costs for this “go-anywhere/do-everything”, team-based care will be borne by shared savings, reductions in hospital utilization, and braided/blended funding from across the health and human service systems. Increasingly consolidated, multiservice providers will be organized into integrated networks to share resources and efficiencies. They will benefit from quality indices and population health strategies that help them pivot proactively to address emerging issues and target high-need/high-cost consumers with new or more intensive services. The result will be better overall care for all, especially the most vulnerable and populations that are currently devastated by health disparities.

Daring leadership: Leaders who thrive in the future will continue to be those who are bold, compassionate, and ready to take risks. They will direct organizations that attend to provider wellness and wellbeing with as much attention as to consumer wellness and wellbeing. Data-informed management systems will target provider support and training for providers based on measures of their performance outcomes, productivity, and satisfaction. Leaders will be supported by involved board members who share a commitment to progress and innovation.

Robust and transparent quality systems will guide and inform efficient and productive team-based care in a culture that promotes ongoing improvements to respond to continually evolving health, behavioral health, and human service needs within each neighborhood and for the full array of diverse populations served.

These prognostications are informed by national trends, the goals set by and for emerging networks, and new financing structures that will drive continual innovation. We can see the potential highlighted within emerging CBO consortia (such as Communities Together for Health Equity), among provider networks (such as Behavioral Health Care Collaboratives like Coordinated Behavioral Care), and in models, such as Certified Community Behavioral Health Care Centers. Transformation efforts and new financing structures, and upcoming opportunities, are setting the stage for continual evolution.

The way we get there is through a deep dedication to quality. Quality defined both by the client standing in front of us and sound science. An embracing of analytics that arms us with information that drives a culture of continuous quality improvement. We also enable this future with the partnership and collaboration of our payers willing to incent innovation and empowering providers to solve problems creatively leveraging the strengths of the individual and culturally dynamic community resources. Using leading edge technology to communicate with clients using the media that work for them whether text, social or other.

The question recurs whether value-based and alternative payment arrangements can truly incent quality care and innovation. How do we avoid teaching to the test and how do we preserve effective but undercapitalized community-based care that has been keeping people safely in the community and out of hospitals and institutions for decades? Through provider led networks that embrace a spirit of integration, coordination and mutual accountability. If and only if financing rewards not just the critical outcomes of reductions in hospitalizations but also recovery-focused outcomes. And if payers are willing to invest in the transition from here to there — empowering providers to take risks and to engage increasingly sophisticated tools, data and technology to do so with eyes open and full information.

Have a Comment?