This is the second in a series of live blog posts for the 2014 CFHA Conference in Washington DC. Check back for more!
Economics, Delivery System Reform and Behavioral Health Integration: Don’t Get Left Behind By Richard G. Frank PhD
October 16, 2014 6-8pm
|Stephen Mitchell: blogging like a champion #CFHA14 |
7:00 Dr. Frank opens his talk making the point that placing behavioral health on the same level as general medical care has been shown to be affordable. The Affordable care act fosters parity by “marrying it to a mandate.” Thus, behavioral health is provided on par with general medical care.
7:04 What this means is 30 million people will have behavioral health services at parity. Have you noticed more people getting better behavioral health services at general medical care standards? Folks who are working in the trenches what have you seen?
What’s working? What is not? How does the Affordable Care Act influence these failures and successes?
7:07 Dr. Frank points out healthcare has become incentivized. This is an economic idea influencing medical care. Incentives work theoretically in economics but they can’t factor in the human element. Theoretically incentives bank on everyone “doing the right thing.” Unfortunately not everyone “does the right thing.”
7:11 Patient-centered care in an organization like CFHA means meeting patients where they are. Parity allows patients not to be forced into certain care settings but provides parity across all systems. Thus, no one falls through the cracks. I like this idea but is there another way to motivate all these organizations outside of money? I think we could learn a lesson from the banking industry, the more money available the more incentive to cheat, not do the right thing.
7:17 I like the flipped view Dr. Frank addresses. We have research exploring how behavioral health has been brought to medical care, but we have little evidence on how medical care is brought to behavioral health. I like how this flipped view works against the power dynamics inherent in bringing behavioral health to the medical field (ie. Trying to convince the medical community behavioral health matters).
7:21 Dr. Frank makes a compelling point: Cost-effectiveness does not mean huge savings but quality care and quality services are provided. There are some things that are worth paying for because they enhance quality of life and care. It’s like building a home with high-quality materials rather than cheep materials. The cheap materials make the house more cost-effective in the short-term. Quality materials make the house cost-effective in the long-term. Which would you rather have? Healthcare reforms need to be made for the long-term.
7:25 Dr. Frank returns to his flipped perspective (medical care to specialty behavioral health) and gives some data on what helps this collaboration work.
7:28 You can get a lot of the work of integration done without co-location. Is this statement legit? Can behavioral health needs and medical needs be met without co-location? What needs can be met?
|Ben Miller: Making social media look cool #CFHA14|
Dr. Richard Frank, Assistant Professor for Planning and Evaluation for HHS, our opening speaker today at CFHA. Dr. Frank has done a tremendous amount of work around mental health. For example, consider how Dr. Frank and colleagues were instrumental in bringing about mental health parity. Kicking off this year’s conference is totally appropriate as the majority of Dr. Frank’s work has been focused on evaluation and policy around mental health.
1) Expand overage around behavioral health (e.g. mental health parity)
2) Create new organizational arrangements to advance integration and the like
Dr. Frank opened up his session describing the robust evidence behind integrated behavioral health and primary care. However, he didn’t stop there; in fact, he described how we need to continue to push for delivery reform where we move from volume to value. His brilliant expose on mental health parity, which should the holes (e.g. small employer market).
Dr. Frank then took a bit of a u-turn and got the audience to pay attention to the specialty mental health space. His logic? The recent focus on the patient-centered medical home in primary care has also sparked discussions in the behavioral health community about creating a similar model in specialty behavioral health settings to help meet the health care needs of patients with severe and persistent mental illnesses and substance abuse conditions. SAMHSA has recently published evaluation data on some of these projects.
Throughout his presentation, Dr. Frank reminded us that there is a robust evidence base and principles to follow for integrating care. “We can measure the things that promote this stuff; if we can hold that, we can embed within our accountable systems, those measures so we do not go off the rails.”
Bottom line (from my live blogging): We have the evidence; we have much of the know how; we should scale (for behavioral health in primary care); we still need more evidence for integration in other settings