Estimating Real Change in Health Care Linda Rosenberg, MSW Abstract The technology revolution has accelerated the pace of change and increased our tolerance for experimentation. The National Council for Behavioral Health owes it to those served by our member organizations to keep our eye on the future. To quote leadership guru Peter Drucker, “The greatest danger in times of turbulence is not the turbulence. It is to act with yesterday's logic.” Studies in this edition of JBHS&R address the capacity of different components of the current behavioral health workforce and examine training methods successful in preparing the workforce with the new skills and abilities which will be crucial in 2014 and beyond. “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.”1
I couldn’t agree more with Bill Gates. 2013 saw progress. But big ideas are exacted quickly; it is change that is incremental and requires patience and tenacity. We saw our persistence pay off last year with unprecedented bipartisan action in Washington:
The Excellence in Mental Health Act was passed by a nearly unanimous vote by the Senate Finance Committee;2 Mental Health First Aid trained more than 150,000 people; it was added to SAMHSA’s National Registry of Evidence-based Programs, and it continues to receive bipartisan, bicameral support in Congress and the White House; The Behavioral Health IT Act is on track to deliver coordinated, connected, and accountable care;3 and Parity had a final rule attached to it, meaning people will finally see equity in the care they receive.4 Some may say that we saw such progress because of the tragic Newtown shootings. While there’s no prosperity in tragedy, we’ve seen the public take heed of the critical need for earlier, effective interventions, and say so to their legislators, in a way that has been long coming. We also saw progress from the marriage of steady advocacy and public will. We’re on a road we long dreamed about. The Excellence Act is the most significant national investment in community services since former President John F. Kennedy signed the Community Mental Health Act of 1963. The Mental Health First Aid bill empowers and activates members of the public. The Behavioral Health IT Act will enable the vision of coordinated, integrated care.
Address correspondence to Linda Rosenberg, MSW, National Council for Behavioral Health, Washington, DC, USA. Email: [email protected].
)
Journal of Behavioral Health Services & Research, 2014. 97–98. c 2014 National Council for Behavioral Health. DOI 10.1007/s11414-014-9393-z
Estimating Real Change in Health Care
ROSENBERG
97
Coverage expansion is happening, one way or another. The integration of specialty care and general health care is underway, and care coordination is the expected way to improve the health of high need/high cost patients. As I travel around the country, I see the day-to-day realities of what health reform folks call “pockets of innovation”: mental health and addiction provider organizations using creativity and sheer will to expand service capacity, build partnerships with other community resources, and train their staff. Whether they participate in state Medicaid health home demonstrations, develop back office practices to accept insurance plans through the new Marketplace Exchanges, or contract with local medical providers to form Accountable Care Organizations, many fundamental health care practices are changing and affecting the way we do business and provide care on a daily basis. But what will the future look like? How will new payment structures, including bundled rates, episode-based payments, case rates, and capitation models, enable the promise of health homes and accountable care organizations? What will health care look like when new technologies, including electronic health records, big data analytics, and personal devices, transform the industry? With consumer demand for “when and where we want it,” will we deliver services in urgent care clinics, be available day and night via telehealth, and host consumer networking and learning platforms? Will consolidations and mergers achieve promised cost savings, or will we see behavioral health not-for-profits become part of hospital systems or insurance company partners? Will substance use disorders be understood as a public health crisis of a magnitude beyond any other? Will the substance use disorder and mental health advocates unite to ensure that a full range of community treatments and supports are available for chronic medical conditions in every community? In 2014, the answers to our questions will begin to emerge. The technology revolution has accelerated the pace of change and increased our tolerance for experimentation. The National Council for Behavioral Health owes it to those served by our member organizations to keep our eye on the future. To quote Peter Drucker, “The greatest danger in times of turbulence is not the turbulence. It is to act with yesterday’s logic.”5 Several articles published in this issue of the Journal of Behavioral Health Services & Research (JBHS&R) address the capacity of different components of the current behavioral health workforce and examine training methods successful in preparing the workforce with the new skills and abilities which will be crucial in 2014 and beyond.
References 1. Gates WH, Myhrvold N, Rinearson P (Eds). The Road Ahead, 2nd revised edition. Penguin Books, 1996. 2. Rosenberg L. A Bipartisan Holiday Success: Excellence in Mental Health Act. National Council for Behavioral Health. Available online at http://www.thenationalcouncil.org/lindas-corner-office/2013/12/bipartisan-holiday-success/. Accessed January 15, 2014. 3. Ingoglia C. Year in Review: Progress for Behavioral Health on the Hill. National Council for Behavioral Health. Available online at http:// www.thenationalcouncil.org/capitol-connector/2014/01/year-review-progress-behavioral-health-hill/. Accessed January 15, 2014. 4. Farley R. Historic Mental Health and Addiction Parity Rules Finalized. National Council for Behavioral Health. Available online at http:// www.thenationalcouncil.org/capitol-connector/2013/11/historic-mental-health-addiction-parity-rules-finalized/. Accessed January 15, 2014. 5. Drucker PF (Ed). Managing in Turbulent Times. New York: Harper Collins, 1980.
98
The Journal of Behavioral Health Services & Research
41:2
April 2014
I couldn’t agree more with Bill Gates. 2013 saw progress. But big ideas are exacted quickly; it is change that is incremental and requires patience and tenacity. We saw our persistence pay off last year with unprecedented bipartisan action in Washington:
The Excellence in Mental Health Act was passed by a nearly unanimous vote by the Senate Finance Committee;2 Mental Health First Aid trained more than 150,000 people; it was added to SAMHSA’s National Registry of Evidence-based Programs, and it continues to receive bipartisan, bicameral support in Congress and the White House; The Behavioral Health IT Act is on track to deliver coordinated, connected, and accountable care;3 and Parity had a final rule attached to it, meaning people will finally see equity in the care they receive.4 Some may say that we saw such progress because of the tragic Newtown shootings. While there’s no prosperity in tragedy, we’ve seen the public take heed of the critical need for earlier, effective interventions, and say so to their legislators, in a way that has been long coming. We also saw progress from the marriage of steady advocacy and public will. We’re on a road we long dreamed about. The Excellence Act is the most significant national investment in community services since former President John F. Kennedy signed the Community Mental Health Act of 1963. The Mental Health First Aid bill empowers and activates members of the public. The Behavioral Health IT Act will enable the vision of coordinated, integrated care.
Address correspondence to Linda Rosenberg, MSW, National Council for Behavioral Health, Washington, DC, USA. Email: [email protected].
)
Journal of Behavioral Health Services & Research, 2014. 97–98. c 2014 National Council for Behavioral Health. DOI 10.1007/s11414-014-9393-z
Estimating Real Change in Health Care
ROSENBERG
97
Coverage expansion is happening, one way or another. The integration of specialty care and general health care is underway, and care coordination is the expected way to improve the health of high need/high cost patients. As I travel around the country, I see the day-to-day realities of what health reform folks call “pockets of innovation”: mental health and addiction provider organizations using creativity and sheer will to expand service capacity, build partnerships with other community resources, and train their staff. Whether they participate in state Medicaid health home demonstrations, develop back office practices to accept insurance plans through the new Marketplace Exchanges, or contract with local medical providers to form Accountable Care Organizations, many fundamental health care practices are changing and affecting the way we do business and provide care on a daily basis. But what will the future look like? How will new payment structures, including bundled rates, episode-based payments, case rates, and capitation models, enable the promise of health homes and accountable care organizations? What will health care look like when new technologies, including electronic health records, big data analytics, and personal devices, transform the industry? With consumer demand for “when and where we want it,” will we deliver services in urgent care clinics, be available day and night via telehealth, and host consumer networking and learning platforms? Will consolidations and mergers achieve promised cost savings, or will we see behavioral health not-for-profits become part of hospital systems or insurance company partners? Will substance use disorders be understood as a public health crisis of a magnitude beyond any other? Will the substance use disorder and mental health advocates unite to ensure that a full range of community treatments and supports are available for chronic medical conditions in every community? In 2014, the answers to our questions will begin to emerge. The technology revolution has accelerated the pace of change and increased our tolerance for experimentation. The National Council for Behavioral Health owes it to those served by our member organizations to keep our eye on the future. To quote Peter Drucker, “The greatest danger in times of turbulence is not the turbulence. It is to act with yesterday’s logic.”5 Several articles published in this issue of the Journal of Behavioral Health Services & Research (JBHS&R) address the capacity of different components of the current behavioral health workforce and examine training methods successful in preparing the workforce with the new skills and abilities which will be crucial in 2014 and beyond.
References 1. Gates WH, Myhrvold N, Rinearson P (Eds). The Road Ahead, 2nd revised edition. Penguin Books, 1996. 2. Rosenberg L. A Bipartisan Holiday Success: Excellence in Mental Health Act. National Council for Behavioral Health. Available online at http://www.thenationalcouncil.org/lindas-corner-office/2013/12/bipartisan-holiday-success/. Accessed January 15, 2014. 3. Ingoglia C. Year in Review: Progress for Behavioral Health on the Hill. National Council for Behavioral Health. Available online at http:// www.thenationalcouncil.org/capitol-connector/2014/01/year-review-progress-behavioral-health-hill/. Accessed January 15, 2014. 4. Farley R. Historic Mental Health and Addiction Parity Rules Finalized. National Council for Behavioral Health. Available online at http:// www.thenationalcouncil.org/capitol-connector/2013/11/historic-mental-health-addiction-parity-rules-finalized/. Accessed January 15, 2014. 5. Drucker PF (Ed). Managing in Turbulent Times. New York: Harper Collins, 1980.
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The Journal of Behavioral Health Services & Research
41:2
April 2014
