Behavioral health has been treated as a separate entity in the healthcare world for as long as anyone can remember, but that may not be the case when accountable care organizations begin take hold in 2012.
“Accountable care is about your medical neighborhood and behavioral health is part of that structure,” said Ted Rooney, project leader for Maine Health Management Coalition.
According to the National Institute of Mental Health, an estimated one in four adult Americans suffer from a diagnosable metal disorder in a given year, and it’s the leading cause of disabilities in the United States.
The Agency for Health Research and Quality ranks behavioral health as one of the top five most costly health conditions in terms of both affected patient population and expense. Those who account for the expenses almost doubled from 19 million in 1996 to 36 million in 2006.
“This increase does not include over 20 million adults who suffer from a diagnosable disorders due to social stigma, access to care or ability to pay,” said Brian Nagle, vice president of product marketing for MEDecision, during a Webinar on behavioral health utilization management.
Including this population in an ACO is likely to reduce costs because many people delay care and end up racking up more costs as they go undiagnosed.
“For patients with complicated and chronic illnesses one of the usual conditions associated with them is depression,” said Chet Speed, vice president of public policy for the American Medical Group Association. “Part of making an ACO patient-centered would include having behavioral health services.”
“Many feel that ACOs is the right thing to do,” said Speed. “Because of the emphasis on cost and quality and if the reimbursement structure, it may be a financially viable entity.”
Payers haven’t figured out how to pay for this integrated care. Some officials say bundled payments may be the solution.
The MHMC is trying to support efforts to find “some combination of payment with some combination of care,” said Rooney. “And where does behavioral health fit in?”
Some resistance has also been discovered among solo doctors in all sectors of healthcare – and that may be a barrier to physician buy-in for the ACO structure, including behavioral health practitioners.
“It’s much easier to work as a solo person, not to collaborate,” said Rooney.