In the past years there has been a “wall of separation” between medical and behavioral healthcare. This barrier, which exists most notably in different facilities and payment streams and an almost complete lack of communication or integration, has created the delusion that we better serve patients if behavioral health remains autonomous from the rest of healthcare. There are numerous studies published today that compare everything from annual treatment costs to average inpatient lengths of stay, and for “at risk” patients - patients who have both a behavioral health condition and a chronic medical condition (e.g., asthma, arthritis, diabetes, heart disease), neither behavioral health nor physical health practitioners are able to function efficiently while separated. In fact, 80% of patients with behavioral health comorbidities are seen in the general health sector regularly and for many professionals in the medical field it seems there are more people with serious mental illnesses in general medical populations than in the specialty behavioral health sector. Many studies find that 30 to 45% of people with these problems get little or no care for behavioral health when hospitalized for a medical problem. These are the patients who cost so much more to treat.
The problem is two-fold. It’s not just a matter that the mental illness or substance use issue is untreated or poorly treated due to an absence of services or coordination of services. When you don’t treat the mental health or substance use problem, you’re spending 80 to 90% more on medical services. Annual treatment costs for insured populations show that the average annual medical cost for a treated individual was about $2,700. But if that person has a chronic medical condition these costs double or triple easily. Add on a mental health condition or substance abuse issue, and you can double that figure again. This is where we in behavioral health have an opportunity to impact the total cost of healthcare. Behavioral health providers can make a big impact inevitably joining the national effort to reduce the costs in healthcare.
The Affordable Care Act, which will extend health care coverage to currently uninsured Americans, will dramatically change how substance use disorders and treatment is funded and the types of services that are reimbursed. Substance use treatment providers must start making changes now so they are ready when the Act is implemented in 2014. The major change will be that mental health and substance abuse treatment providers will be seen as part of the larger health care system. Both substance abuse treatment providers and primary care providers will need to look for ways to be more integrated and collaborative with one another. Behavioral health providers overall will need to become much more familiar with the other medical problems that patients often face, such as diabetes, high blood pressure and asthma. When they see clients who are exhibiting symptoms of these diseases, they will need to link them back to primary care for evaluation and treatment. This is a specific task that First Step already does as a standard practice with all patients.
Primary care providers will need to become much more comfortable in giving screening and brief intervention for patients at risk of substance abuse, and in knowing where to refer patients who need further help at all levels of risk. This will mean that mental health and substance abuse treatment providers will start seeing a broader spectrum of patients - not just those with full-blown addiction, but also those with milder issues that nonetheless could benefit from treatment.
Both primary care providers and behavioral health providers will need to better integrate their services for medication-assisted treatment for substance abuse as well, in order to ensure that patients who are receiving medication for opioid or alcohol dependence are also receiving the behavioral services they need. Medicine Assisted Treatment (MAT) is already a standard practice at First Step through their Addiction Medicine Program and current medical staff. Health care reform will allow patients to have a much broader choice of providers for substance abuse treatment and mental health services. They will begin to ask why they should choose Agency X over Agency Y - the answer is outcomes. As a result of this question being asked, mental health and substance abuse treatment providers will have to engage and motivate clients to choose them, using data to measure success. They will have to become more visible and competitive in the health care field they will now be a part of, instead of the specialty realm of behavioral health treatment services.
By collecting data and producing outcome measures using evidence based practices we will have a smoother integration with health care providers. First Step is confident that our services will demonstrate program efficacy to attract patients, and we are better equipped now more than ever to navigate the new health care system with our "Integrated Care" model. Better health, better care, lower cost. First Step delivers this mission with their standard of practice in Integrated Care, remaining patient centered at all times, and being outcome driven.