[NYAPRS Enews] TU: Better, Less Costly Behavioral Health Care

[Harvey Rosenthal]

NYAPRS Note: This week, New York's Medicaid Redesign Team will go into
the details of numerous proposals intended to produce savings while
hopefully maintaining the strong lifeline and safety net Medicaid is for
so many vulnerable New Yorkers. Over 41 statewide and regional advocacy
groups representing consumers, families and providers are counting on
them to back a proposal to integrate mental health and substance use
services for those with ongoing, complex conditions and to effectively
link them to health, housing and support services. 

 

Better, Less Costly Behavioral Health Care

by Harvey Rosenthal  Albany Times Union Op Ed  February 22, 2011

 

One of the most important considerations facing state budget makers this
year lies in how to reduce costs and improve the care of "high cost,
high needs" people with ongoing and serious mental health, substance use
and medical conditions.

Gov. Andrew Cuomo
<http://www.timesunion.com/?controllerName=search&action=search&channel=
opinion&search=1&inlineLink=1&query=%22Andrew+Cuomo%22>  is right to
address concerns about both the cost -- these groups use 15 times the
amount of service than the typical Medicaid beneficiary -- and care
improvement. But the consumers in question and their families have a lot
at stake here. It's very important to choose solutions that
appropriately address both concerns.

While much of the rising costs for this group come from emergency room
and inpatient stays for health issues, most of these individuals don't
come into treatment through the "health door" but through the behavioral
health system. You can't serve them if you can't engage them in a
partnership with the care system. If the behavioral health system is the
one that appears most relevant and effective, then that's the system we
should build on if we're to do a better job.

While most of these folks get their health care through Medicaid managed
care plans, those plans don't have any significant experience or success
in properly engaging and serving a group that needs lots more outreach,
support, crisis assistance, rehabilitation and peer support than the
typical HMO Medicaid beneficiary.

In fact, a recent report focusing on how well we're engaging "at risk"
individuals in Brooklyn and the Bronx found that more than half of the
least engaged group were getting their health and behavioral health
through HMOs.

That's why advocates agree that the best way to assure that these groups
are properly engaged is through a better and more closely managed
behavioral health care system, with strong links to needed health care,
housing and local community supports.

Yet, there's a counter proposal to turn "carved out" Medicaid behavioral
health dollars, services and consumers over to the HMOs. While some say
that will better integrate services, we say it will result in the
disintegration -- as in disappearance -- of the community recovery
safety net we've worked so hard to develop and improve over the past
decade.

Once the state takes a big chunk out of this sector for budget cuts and
the HMOs take their 16 percent and then the specialty behavioral health
organizations they typically subcontract with take their cut, lots of
money, services, expertise and key elements of the safety net will
simply disappear.

We say let's go right to the behavioral health organizations, many of
which are showing impressive results and savings in partnering with
government to better manage the care of people with complex needs.

Let's improve our care systems, but let's start in the right place at
the right pace with the best plan that has the greatest chance to
succeed.

Let's move to a "managed behavioral health carve out" and build on the
system that best knows and serves some of our most vulnerable New
Yorkers. And let that system reduce costs by implementing innovations
that will improve the delivery and coordination of behavioral and
medical care, while greatly cutting down on costly and avoidable ER and
inpatient hospital visits.

In that way, both the state's taxpayers and its most vulnerable will be
winners.

Harvey Rosenthal is executive director of the New York Association of
Psychiatric Rehabilitation Services
<http://www.timesunion.com/?controllerName=search&action=search&channel=
opinion&search=1&inlineLink=1&query=%22New+York+Association+of+Psychiatr
ic+Rehabilitation+Services%22> .


http://www.timesunion.com/default/article/Better-less-costly-behavioral-
health-care-1024140.php#ixzz1EgTi3GOM

-------------------

 

Advocates: Carve Out Mental Health For Medicaid

The Medicaid Redesign Team meets twice this week, and behavioral health
advocates are urging MRT members to embrace proposal 93 on their list,
which calls for a managed behavioral health carve-out. A rival proposal,
91, accomplishes the opposite-moving behavioral health to general
Medicaid managed care plans. It has the support of health plans (Pulse,
Feb. 17, 18).

Advocates for a behavioral health carve-out argue that the model works
well in Pennsylvania, Massachusetts and Michigan. Pennsylvania's
Behavioral Health Choices program, for example, generated $4 billion in
savings from 1997 to 2007, according to advocates.

The model, they say, takes advantage of specialty expertise within the
behavioral health system. The carve-out proposal would move some
Medicaid beneficiaries into designated specialty behavioral health
organizations.

"The savings come from improved care coordination, which means fewer
readmissions and emergency room visits," said Harvey Rosenthal,
executive director of the New York Association of Psychiatric
Rehabilitation Services in Albany. Mental health groups such as the
Coalition of Behavioral Health Agencies also support the carve-out.

Rival proposal 91 "introduces HMOs to a whole other community, and
presumes the HMOs will understand our people," added Mr. Rosenthal.

By that, he meant Medicaid's high-cost, high-needs enrollees with
serious mental health, substance use and medical conditions.

 

http://www.crainsnewyork.com/article/20110222/PULSE/110219850

 

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