Health Reform to Increase Number Receiving Medicaid Mental Health Services

The number of Medicaid beneficiaries using mental health and addiction treatment services is expected to increase from 2.1 million in 2006 to 4.4 million in 2019—the date when all health reform provisions are implemented to expand Medicaid coverage to low-income childless adults between the ages of 18 and 64. The number of 18-to-64-year-old adult behavioral health service users overall (counting those covered by Medicare, Medicaid, private insurance, and the uninsured) is expected to increase from 25.4 million in 2006 to 26.6 million by 2019.. The projected increase in behavioral health service utilization was based on research on non-elderly adults’ mental health status and insurance status by income level reported in the 2004–2006 Medical Expenditure Panel Surveys. (Open Minds, 10/10/11)

Mental Disorders & Medical Comorbidity

In the wake of national health reform, tens of millions of Americans will become newly insured. Given the high rates of uninsurance among people with mental illness, as well as the high rates of comorbidity between mental and medical conditions, the nation’s policy-makers will soon be confronted with how to best serve this newly insured population. To improve quality and reduce the growth of health spending, policy-makers must focus on particular subgroups most at-risk for high cost and poor quality—among them—those with mental health and medical comorbidities.

A new report from the Robert Wood Johnson Foundation’s Synthesis Project provides an overview of medical and mental comorbidity, with an eye toward current federal health reform efforts.
The Synthesis report includes the following key findings:

• Comorbidity is the rule rather than the exception. When mental and medical conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased costs.
• The pathways causing comorbidity of mental and medical disorders are complex and bidirectional. Medical disorders may lead to mental ones, mental conditions may place a person at risk for medical disorders, and mental and medical disorders may share common risk factors.
• Models that integrate care to treat people with mental health and medical comorbidities have proven effective. Despite their effectiveness, these models are not in widespread use.

Read the report and related materials.
Reposted at http://darkestcloset.blogspot.com/

Mental Health and Medicaid Costs: Why Ignoring Mental Health Is Expensive

http://www.huffingtonpost.com/michael-friedman-lmsw/mental-health-and-medicaid-the-_b_825047.html

Cost containment is one of the major goals of health policy reform in the United States. Because spending on mental health and substance abuse services (commonly called "behavioral health services" when referring to both) is less than 8 percent of all health spending, behavioral health seems an unlikely candidate for substantial savings. But that perception is wrong!

People with behavioral health conditions are at higher risk than others for physical illness and disability, and the cost of medical care for them is, on average, much higher than the cost of medical care for people without behavioral health conditions. Better behavioral health services for this population would be likely to reduce the costs of their physical health care and produce significant overall savings in health spending.

This view received fresh support this week from a very important report from the United Hospital Fund in New York City. Entitled "Providing Care to Medicaid Beneficiaries with Behavioral Health Challenges," the report reveals that Medicaid recipients with mental health conditions are 30 percent to 60 percent more likely to have hypertension, heart disease, pulmonary disorders, diabetes, and dementia. People with substance abuse conditions are 50 percent to 300 percent more likely to have heart disease, pulmonary disorders, and HIV/AIDS.

The United Hospital Fund report also documents far higher spending for Medicaid beneficiaries with behavioral health conditions than beneficiaries without behavioral health conditions. According to the report, average health spending for people with mental health conditions in 2003, (the year studied), was $28,451; for those without mental health conditions it was $15,964. Only 25 percent of the spending for this population was for treatment of mental disorders. "Mental health beneficiaries spending on physical health services ($21,002) was 32 percent higher than comparable spending for non-mental health beneficiaries."
For people with substance abuse conditions, average Medicaid spending was $27,839; for those without substance abuse disorders it was $18,051. Only 24 percent of the spending was for substance abuse treatment. "Substance abuse beneficiaries mean Medicaid spending on physical health services ($21,053) was 17 percent higher than comparable spending for non-substance abuse beneficiaries."

The difference in spending for inpatient services for people with behavioral health conditions and those without is particularly striking. "Average annual expenditure for inpatient treatment [for people with mental illness] was $7017 compared to $3629 for others." For those with substance abuse disorders, inpatient costs averaged $11,738 compared to $3,301 for others. Also striking is the fact that, "the seven-day hospital readmission rate of mental health beneficiaries was 50 percent higher than non-mental health beneficiaries. Substance abuse beneficiaries' rate was 150 percent higher than [others.]"

Prior work supported by the United Hospital Fund and the New York Community Trust sheds additional light on the link between Medicaid spending and the co-occurrence of severe behavioral and physical health conditions. A study led by John Billings showed that nearly 60 percent of all Medicaid spending in New York is for 10 percent of the beneficiaries. Two-thirds of these "high cost cases" had severe behavioral health conditions as well as physical health conditions. Most did not get adequate care until their physical conditions became critic and resulted in long stays in hospitals.

Is it possible to improve treatment for people with behavioral health conditions before they become critical and thus bring down overall spending?

Although there are disputes about how to structure a system to improve care for people with both physical and behavioral disorders, there is consensus that earlier interventions with this population could avert health crises and thus reduce health spending. And the fundamental elements of an effective system seem clear enough. Those at highest risk need to be identified before they are in crisis; history of payments by Medicaid makes this possible. Aggressive outreach is needed to locate and engage people at high risk before they are in critical need. Those not identified until they come to emergency rooms, as they frequently do, need to be linked to community-based services immediately. Physical and behavioral health services for them in the community need to be integrated. And fundamental life needs must be addressed -- particularly the need for stable housing, without which little else can be accomplished.

None of this is easy to do; but if it is not done, people with both serious behavioral health conditions and serious physical health conditions will continue to be the high cost Medicaid cases. And most Medicaid spending will continue to be for the 10 percent of Medicaid beneficiaries who have the greatest needs.
Our health care system can continue to largely neglect mental illness and substance use disorders, but at great avoidable cost. Bottom line: forget about mental health, forget about savings.

What Americans Really Think about Healthcare Reform

http://pgionfriddo.blogspot.com/2011/01/what-polls-say-about-our-attitude.html

What did the politician say after bumping his head while walking along a sidewalk as he waved to his constituents?   “I never look at the poles.”

Whether political leaders admit to looking at the polls or not, when you look beyond the headlines some current polls are saying a lot about how people feel about health and mental health policy issues. 

In the spirit of post-State of the Union bipartisanship, let’s hope that President Obama and Congressional leaders use three recent polls to listen to us about health reform, and to educate us about mental illness.

First, this is what the President and members of Congress will hear if they listen to what people are telling pollsters about the health reform law.

• We like a number of the elements of health reform, and don’t want them repealed.
• We’re not afraid that health reform will affect our existing health coverage.
• We don’t think the current law went too far.

The headlines from three January polls suggest that we remain divided about the reform law, with slightly more opposing it than favoring it. 

A Rasmussen survey found that 53% of voters favor repealing the law and 43% do not.  In the most recent ABC News/Washington Post Poll, 50% said they opposed the health reform law versus 45% who favored it.  An AP-GfK poll found the public evenly split on the new law, with 41% saying they opposed it and 40% saying they favored it. 

But when we listen beyond the headlines, we hear a different voice. 

In the AP-GfK Poll, only 26% supported repealing the law in its entirety.  An earlier Rasmussen poll also found a minority for full repeal of the law – 39%. In the ABC News/Washington Post Poll, 18% said that they favored total repeal. 

Support for full repeal isn't very high, and the reason is that we like many parts of the new law.  In the AP-GfK poll, the public supported by 50%-34% the prohibition on insurers denying coverage based on pre-existing conditions (such as cancer, mental illness, diabetes, and heart disease), and by 59%-34% the prohibition on insurers cancelling coverage because someone becomes sick.

We're also not afraid that the law is going to have an adverse effect on insurance we have and like.  In the Rasmussen poll, only 34% said that they thought the law was likely to force them to change their existing coverage.  

There are also a lot of people who think that the law should go farther.  In the ABC Poll, one in four said that the reason they opposed the law was because it didn’t go far enough.  Over half of those who supported it agreed with them, also favoring a reform law that would go farther than the current one does. 

These are a lot of numbers to absorb all at once, but the bottom line is pretty straightforward, and paints a far different picture from the headline.  35% said the law went too far, 19% said it was just right, and a slight plurality – 38% - said it didn’t go far enough. 

Politicians who ignore this message do so at their own peril. 

Second, here is why the President and members of Congress need to provide leadership in educating us about mental illness in the aftermath of the Tucson tragedy.

• We believe erroneously that mental illness causes violence. 

Some people with mental illness commit violent acts, but mental illness is not usually the reason.  One quarter of our population has a diagnosable mental illness each year, and this group is no more likely to be violent than the other three quarters.  Substance abuse (but not substance abuse treatment), juvenile detention, physical abuse, and past history of violence are predictors of future violent behavior, but mental illness is not. 

We need leaders who are willing to speak that truth to us.   

As was noted by researchers at the University of Tulsa in 2008, media reporting on events like the Tucson shooting makes a difference in how people react to the event, contributes to misperceptions about people with mental illness, and deflects attention away from the actual context of violent acts.  

Leaders need to speak up before our responses to violence do more harm than good.

In the ABC News/Washington Post Poll, 83% said that they would support increasing federal funding to add people treated for mental illness to the federal gun registry in an effort to prevent them from buying guns, and 71% said that they would support this for people treated for substance abuse.

source: ABC News/Wash Post Poll 1/11

We are so scared of mental illness that 83% of us would waste precious tax dollars creating a registry that would violate the confidentiality of one quarter of our population while doing nothing to address the real causes of violence in our society.

That’s hard to understand, but I guess we all bump into polls sometimes and come up rubbing our heads.