Download - Sebastian Rosenberg
BRAIN & MINDRESEARCHINSTITUTE
Mind the GapChallenges for Developing and Implementing an ABF model for Mental Health
Activity Based Funding Summit – 11 May 2012
Brisbane
Sebastian Rosenberg | Senior Lecturer
Topics to be discussed
› Introduction
› What we know about mental illness
› Key issues confronting mental health
› Key issues confronting ABF
› Fears about ABF
› Hopes for ABF
› Jobs to do
› Other issues in mental health beyond ABF
Background to this Paper
3
Lilian LazarevicSebastian Rosenberg
Published by the Mental Health Council of AustraliaMarch 2012www.mhca.org.au
What we know about Mental Health 1
› 38% of people in care in 1997
› 35% in 2007
› 13% of the burden of disease
› 6% of total health funding
› 1 in 5 adults per year
› 75% of all mental illness <25yrs
› Treatment rates for young men (16-24 yrs) are just 13%
What we know about Mental Health 2
› $6bn in spending each year
› Around 7% of this is community-based NGO PDRS type services
› Vast majority of the remainder is spent on hospital based mental health care, mostly acute
› Post-vention?!
› No evidence to support hospital-based mental health care (Knapp, Hawthorne etc)
› Considerable evidence that community-based mental health care is both effective and popular
Better Access Scheme: Nov 2006 – Nov 2011
$1.6bn spent on 15m services
Policies, Plans, Strategies and other diversions
Key Issues Confronting Mental Health 1
› How to reduce hospital-centric service?
› How to build earlier intervention?
› Services of the future are not built yet
› How to get fair share of funding?
› How to build modern workforce?
› What is the role of the new mental health commissions?
› How to entrench consumer rights?
Key Issues Confronting Mental Health 2
› Accountability: we don’t know:
- Suicide rate
- Death rate following contact with a service
- Homelessness
- Employment rate
- Education completion rate etc…
› Community-based reporting infrastructure weak
› No lingua franca – apples and pears, variability
› Standards exist but not applied
Key Issues Underpinning ABF
› Allocative and Technical efficiency – bang for buck
› Do no harm (at least at first)
› Common approaches
› Capacity to compare
› Hospital focus of ABF reforms
› Fairness, transparency
› ABF has led to a degree of specialisation in services – how would this work in mental health?
ABF Fears
› Will reinforce hospital as locus of care
› DRGs have weak explanatory power (better than nothing)
› DRG cost data in mental health not seen as reliable
› No robust classification for ED, outpatient or sub-acute care
› Will provide disincentive to develop new models, particularly in the community
› Will entrench disadvantage in mental health funding
ABF Hopes
› Provides a common way of describing care
› Growing community sector
› Historical/block funding delivered poor outcome
› Transparency to ensure MH$ spent in MH
› Benchmarking, comparison of different approaches – palpably lacking
› Access to new, rare growth funds
› Need to drive new service models – what is a hospital-based community mh service?
Jobs to Do
› Engage service providers in genuine work to build new classification systems and/or re-develop existing ones (MH-CASC etc)
› Urgent requirement to strengthen governance arrangements so that the mental health sector can engage in ABF work
› Need to ensure the ABF pricing model provides the right incentives
› Need for a relationship to be built between the IHPA and the mental health sector
› Need to consider overseas approaches
Payment by Results UK Model etc.
› Years to develop
› 21 ‘care clusters’ for contracting or commissioning services
› Clinical Decision Support Tool and Clustering Tool based on concept of ‘need’
› Standardised packages of care designed for each care cluster
› UK only shadowing implementation because of perceived high financial risk to providers
› Canadian InterRai SCIPP System – inpatients only
Other Issues Affecting Mental Health
› Getting the mental health commissions to work together
› Medicare locals as purchasers of community mental health care
› CoAG investment in sub-acute care – what is sub-acute mental health care?
› Partners in Recovery and individualised packages of care
› A National Mental Health Report Card - housing, employment, experiences of care
Conclusion
› There is strong evidence to support the delivery of community-based mental health care over hospital-based care
› ABF is coming to mental health, sector needs to join the debate
› Urgent need to build classification and costing infrastructure to support a system of ABF that is consistent with the evidence about what works in mental health care
› National readiness review across acute, outpatient, ED and community mental health services is required
› What to buy vs. How to buy – replicating last year not sufficient
