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Only higher wages will solve workforce woes

February 21, 2018

It’s clear that the behavioral health workforce is stretched to its limit with no relief in sight. Truly the only way to fortify the workforce is to incentivize employable Americans to join the profession by offering decent wages and a reasonably comfortable lifestyle.

But where is the money going to come from to supply the paycheck that ultimately will energize a new team of clinical workers? We have some choices.

1. Get more money from public sources

Many not-for-profits continue to struggle with underfunded programs and Medicaid rates that don’t even cover the cost of delivering services. When I was chatting recently with Linda Rosenberg, president and CEO of the National Council for Behavioral Health, she told me even some of the directors of the provider organizations are thinking about career alternatives.

New appropriations of public funds to help pay workers to treat mental health and addiction disorders seem like a political longshot these days. It could happen in modest increments, but I wouldn’t count on major investment. Keep in mind that the money from the 21st Century Cures Act has already run out.

The best hope here is an expansion of Certified Community Behavioral Health Clinics (CCBHCs), which are currently operating in eight states. Early in the demonstration phase, the clinics are working to create a flexible payment model that would absorb the payroll costs of all the behavioral health professionals required to provide the care a community needs.

So far, the active CCBHCs have hired new clinicians in all eight states and have been able to expand services as a result, with a 25% increase in caseload. If the successful models could be adopted nationwide, think of all the psychiatrists and addiction professionals that could be added to the rolls in behavioral health.

2. Charge patients more

It’s not unusual for any provider to shift costs onto those who have the means to pay—such as those with decent health insurance or higher incomes. However, in behavioral health, the shift is already so great, it’s hard to image the market (or the mission) bearing much more.

According to the Kaiser Family Foundation, 26% of adults say they have problems paying their medical bills or simply aren’t able to pay them at all. And health insurance hasn’t proven to be the panacea to get them out of the financial fix.

Charging patients more is an extremely unlikely option for unearthing new funds to funnel toward the workforce.

3. Charge insurance companies more

Commercial payers want value propositions that demonstrate good clinical quality along with net cost savings. And the payers themselves will decide what qualifies as savings. Your call to action here is to understand your true delivery costs and your honest outcomes with incredible granularity.

It’s tough negotiating with payers, but some providers have been successful. This might be an option for some organizations, but results will vary widely.

Industry leaders and researchers agree that the pipeline of new clinical professionals will remain dry for the foreseeable future. Stakeholders must find a way to increase wages for experienced workers and develop a satisfying career path for new recruits.

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