By Richard Frank, Sherry Glied
This note represents a response to issues raised and the request for information associated with the white paper by Senators Bennet and Cornyn: “A bold vision for America’s mental well being.” Our discussion touches on several of the issues raised by the white paper. Specifically, we discuss work force challenges, financial alignment as it pertains to crisis response, the need for greater accountability, and the implications for existing financing programs. We highlight several points.
- Crises response services require policy responses to work force constraints that could be focused on three types of actions: 1) those involving insurance regulation such as MHPAEA enforcement and network adequacy standards; 2) scope of practice regulations; and 3) application of technology.
- Coordination is needed at both the state and federal level of government to align Medicaid, block grants, state and local funds, and private insurance both to establish initial capacity and to cover recurring variable costs. The ARPA opportunity and MHSBG set aside create two new funding elements. The Behavioral Crisis Services Expansion Act would mandate private insurance to cover behavioral health crisis services among further augmentation of block grants. Thus, block grant dollars can be used by states to establish the requisite capacity such as mobile treatment teams, crisis beds for adults and youth, and training of necessary personnel. Medicaid and other insurance can be responsible for paying for the services supplied from this newly established infrastructure.
- Promoting improved performance and greater integration can be advanced by building on the alternative payment mechanisms that exist in major public health insurance programs. This approach would introduce greater accountability through establishing performance metrics that reflect the use of modern clinical science, reward integration of behavioral health and other medical care, and bolster accreditation systems used by government to ensure the adequacy of providers to meet the needs of their populations. Medicare Advantage, MSSP, and Medicaid Managed Care all use risk-based payment systems that are flexible in how funds are deployed to meet the needs of the covered populations.
- The behavioral health delivery system has long suffered from fragmentation in funding. Building on existing programs that pay for the bulk of health care for large segments of the U.S. population is the most likely path to reduce the impact of payer fragmentation, offer consistent signals to the market about the importance of high quality behavioral health care, and begin to realign all segments of the accountability system for behavioral health.
Read the full comment letter here.
Sherry Glied is on the board of Geisinger. The authors did not receive financial support from any firm or person for this article or from any firm or person with a financial or political interest in this article. Other than the aforementioned, they are currently not an officer, director, or board member of any organization with an interest in this article.
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