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Agenda calls for action to fix mental health system

December 15, 2017

The 21st Century Cures Act authorized a new committee to drive improvements in the system of care for those with serious mental illness (SMI) and serious emotional disturbance (SED). On Thursday, its initial report was delivered to Congress with 45 specific recommendations.

According to the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), its report is not meant to gather dust but instead should serve as a guiding document for federal action in the years to come. The public-private committee will meet at least twice a year and is scheduled to follow up with a list of accomplishments in December 2022.

“We have an unprecedented time in our history where we have a congress that has given us the ability to look at these problems and make changes and implement new kinds of innovations and basically do the work to improve care for people with serious mental illnesses so they can recover in their communities,” says Elinore F. McCance-Katz, the assistant secretary for mental health and substance use at SAMHSA, who also chairs ISMICC. “And we have a president and an administration that supports that.”

McCance-Katz tells Behavioral Healthcare Executive that ISMICC has received positive response from stakeholder groups, and she is hopeful that this is the time for change in the care delivery system.

CCBHC expansion recommended

In “The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers,” behavioral health leaders, with the cooperation of at least 10 federal agencies, outlined practical actions needed to improve cost, quality and access. Across all the recommendations, a central theme can be found: Today’s fragmented mental health system must revolutionize in a dramatic way to offer coordinated, whole-person care.

For example, ISMICC calls for expansion of the Certified Community Behavioral Health Clinic (CCBHC) project. CCBHCs aim to design a sound payment mechanism that reimburses providers fairly for much-needed comprehensive care. Currently, eight states are working to craft the new delivery model over a two-year period, but advocates have long called for expansion to more states and federal support beyond two years.

“The idea is we keep people out of emergency departments because we know emergency departments do not serve people with mental illness well when they are having acute exacerbations of their illnesses,” says McCance-Katz. “The idea of integration is one, [as] we know from medical models, that works well, and we believe it’s a model worth pursuing for the seriously mentally ill who tend not to get services they need and require.”

CCBHCs have already shown evidence of improved care delivery. A survey produced by the National Council for Behavioral Health in November found workforce expansions have occurred in all the demonstration areas thus far, with a total of 1,160 new staff hired—including psychiatrists and staff with addiction specializations. Additionally, 87% of the clinics report they have been able to serve more patients thanks to the new capabilities.

Charles Ingoglia, the National Council’s senior vice president for public policy and practice improvement, says the CCBHC structure is similar to that of the federally qualified health centers, and the model will ultimately bring parity to the safety net.

“It is the means by which clinics will have the capacity to expand the workforce, to increase the number of people served, while offering evidence-based care, and to do a better job of coordinating care across systems,” Ingoglia says.

He says he shares the hopefulness of ISMICC, applauding the excellent work of the committee and recognizing the breadth of its report to Congress.

“As wonderful as this report is, we do need action in terms of increased funding and increased parity enforcement,” Ingoglia says.

Payment concerns

Indeed, ISMICC recommends that provider reimbursement for the delivery of behavioral health services should equal that of other health services. While it’s certainly an issue of parity, McCance-Katz notes that higher payment would encourage more health professionals to enter the behavioral health specialty and improve access.

“From my perspective, decisions need to be made that mental healthcare and the care and treatment of mental health and substance use disorders is so important, is so prevalent, is such a problem in our society, that we need to make it possible to get care by making payment and reimbursement to the providers of those services equal to those on the medical side,” she says.

CCBHCs receive enhanced payments from Medicaid, which allows them to offer more services from more professionals that might not otherwise see reimbursement.

“When we underpay our providers, when we have fragmented care, people do not get the services they need,” McCance-Katz says. “And it condemns them to the impairment of mental illness and makes it impossible in some cases for them to function in day-to-day life. It isn’t right. We shouldn’t be doing that in the United States.”

As for its next steps, ISMICC will aim to prioritize the list of recommendations.

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