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Five reforms to help adults with serious mental illness

September 02, 2010

A new report, developed by a group of 65 prominent figures representing all aspects of the behavioral healthcare field, calls on government agencies to implement five recommendations to drive ongoing health system reforms essential for serving adults with serious mental illness (SMI).

According to the report, adults with SMI, who comprise just six percent of the U.S. population, rank among the highest-cost Medicaid beneficiaries, yet die an average of 25 years sooner than the general population, often from preventable, co-occurring diseases including asthma, diabetes, cancer, and heart disease.

The report grew out of a November 2009 forum, the National Action Meeting on Fostering System Reform for Adults with Serious Mental Illness, which was hosted by Ron Manderscheid, Executive Director of the National Association of County Behavioral Health and Developmental Disabilities Directors (NACBHDD). The meeting was funded by Janssen Pharmaceuticals, which, under recently passed federal laws, had no input on the planning, conduct of, or conclusions reached by the forum.

The goal of the meeting was simple, Manderscheid explains: to clearly define needed solutions for adults with SMI, together with a “practical agenda with a reasonable chance of adoption by Congress and the Obama Administration.” On the eve of health reform, meeting participants sought to unite around strategies that could reshape the nation’s approach to mental health service delivery, improve system and service efficiency, and greatly improve individual outcomes.

From among 18 proposed recommendations, participants selected five recommendations that are now the focus of a concerted advocacy effort. These, recommendations, detailed in the report, are:

1. Design and implement, through HHS, a robust set of performance measures, including consumer measures, with risk adjusted financial incentives.
2. Close the 25-year gap in life expectancy by designating adults with SMI as a “health disparities group” through action by Congress and relevant agencies within HHS.
3. The federal government should require and provide incentives for an electronic health record that supports behavioral health content.
4. Federally sponsored primary care medical homes should be required to include behavioral, substance use, and mental healthcare.
5. The federal government should define medical necessity to align with research on the range of services required by persons with serious mental illness.

“This report represents the consensus of the field,” says Manderscheid, who explains that the recommendations are the basis for “work on regulations—mostly with federal agencies. Our focus will be on impacting regulation, agency practice, and implementation in the field.” He adds that, beyond the recommendations, there’s also consensus around a new approach by behavioral healthcare to integrate with the rest of the U.S. healthcare system, a key component of system-wide reform.

“The world has changed. Adults with serious mental illness used to be treated as a separate group,” he explains. “The feeling was, ‘SAMHSA takes care of this group.’”

But that’s all changed now. One big example is the recommendation to designate adults with SMI as a “health disparities population,” a change that, according to Manderscheid, “no one has ever talked about before.” Though such a designation would require action by Congress and HRSA (the Health Resources Services Administration), it would result in tracking and monitoring of disparities encountered by adults with SMI by HRSA and create new opportunities to focus HRSA and other federal resources to address these disparities.

Among other likely outcomes that would result from implementation of the report’s recommendations are:

• Standardized definitions of service, outcome measures, and performance measures across states and within licensing and practice standards.
• Consistent access to behavioral health information needed by healthcare providers for continuity of care or emergency care
• Reduced fragmentation and duplication of services, as well as improved outcomes, through more individualized care within Person Centered Medical Homes or Person Centered Healthcare Homes.
• A national definition of “medical necessity” that sets a national standard for all payers to follow by paying for a scope of services that meets the needs of individuals with SMI, service providers, and payers.

For additional details, consult the complete report, Recommendations to Foster System Reform for Adults with Serious Mental Illness.

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