The Public Mental Health The Public Mental Health SystemSystem

Current Practices and Current Practices and RecommendationsRecommendations

The Community Behavioral Health Association of MarylandThe Community Behavioral Health Association of Maryland

Behavioral Health Is Essential Behavioral Health Is Essential To Health (from SAMHSA report 4/5/10)To Health (from SAMHSA report 4/5/10)

Almost 25% of all adult stays in US community hospitals Almost 25% of all adult stays in US community hospitals involved mental health or substance use disordersinvolved mental health or substance use disorders

People with serious mental illnesses have shortened life-People with serious mental illnesses have shortened life-spans, on average living only until 53 years of agespans, on average living only until 53 years of age

44% of all cigarettes consumed in the US are by 44% of all cigarettes consumed in the US are by individuals with a mental illness or substance use individuals with a mental illness or substance use disorderdisorder

Almost one quarter (24%) of pediatric primary care office Almost one quarter (24%) of pediatric primary care office visits involve behavioral and mental health problemsvisits involve behavioral and mental health problems

Mood disorders rank 1Mood disorders rank 1stst in work loss costs, 2 in work loss costs, 2ndnd in total in total costs & 3costs & 3rdrd in health care costs in health care costs

People with mental health problems reported the highest People with mental health problems reported the highest rates of lack of health insurance of all disability groupsrates of lack of health insurance of all disability groups

The PMHS is a The PMHS is a Managed Care SystemManaged Care System

110,000 adults and children served110,000 adults and children served The mental health carve-out has ensured The mental health carve-out has ensured

appropriate use of scarce public dollarsappropriate use of scarce public dollars PMHS serves Medicaid, Medicare and PMHS serves Medicaid, Medicare and

uninsured recipientsuninsured recipients All services undergo pre-authorization and All services undergo pre-authorization and

utilization reviewutilization review Unlike other major components of health Unlike other major components of health

(hospitals, MCOs, etc.), community MH (hospitals, MCOs, etc.), community MH providers receive no regular inflationary rate providers receive no regular inflationary rate adjustmentsadjustments

Current Cost Containment Current Cost Containment and Quality Initiativesand Quality Initiatives

Bundled PaymentsBundled Payments- Two capitation projects- Two capitation projects- PRP case rates- PRP case rates

Evidence-based PracticesEvidence-based Practices- Assertive Community Treatment- Assertive Community Treatment- Supported Employment- Supported Employment- Family Psychoeducation- Family Psychoeducation

Integrated Care Integrated Care - Funded by MCHRC and private foundations- Funded by MCHRC and private foundations- Reverse Co-location- Reverse Co-location- Partnerships with PCPs and FQHCs- Partnerships with PCPs and FQHCs

RecommendationsRecommendations

Provide support and funding for behavioral health Provide support and funding for behavioral health medical homesmedical homes

Include behavioral health providers in incentive Include behavioral health providers in incentive payments for implementation of electronic health recordspayments for implementation of electronic health records

Include BH in HIE implementationInclude BH in HIE implementation Budget and plan for a significant influx of new users into Budget and plan for a significant influx of new users into

the PMHSthe PMHS Support implementation of IDDT and integrated care Support implementation of IDDT and integrated care

best practices.best practices. Support efforts to stem and reverse the workforce crisis Support efforts to stem and reverse the workforce crisis

(licensed clinicians and unlicensed paraprofessionals)(licensed clinicians and unlicensed paraprofessionals) Hold private carriers accountable for mental health txHold private carriers accountable for mental health tx