Behavioral Health Performance in the Charity Care Environment


Saying that the field of mental health is rapidly changing is an understatement. Tight state budgets, healthcare reform, a new wave of managed care, health homes and advances in treatment technology are but a few of the seismic changes playing out across the country.

Learn more about Jackson County Community Mental Health Fund’s work:

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One in five people in Jackson Co. are affected by a mental illness >>

Locally the gap (chasm) between Medicaid eligibility and ACA eligibility continues. This gives the impression that the Mental Health Fund’s role as a fee-for-service payer of mental health care for uninsured will continue unchanged indefinitely. After all, thousands of still-uninsured in Jackson County residents rely on the same charity care services, agencies and payers. But beneath the surface, the forces driving the national behavioral health marketplace can affect how we work here.

Medicaid expansion in Missouri is hotly debated, but over the long term, I predict the argument is destined to be won for a number of reasons, not the least of which is pressure from healthcare corporations who see opportunities for expansion and profit by applying a disciplined business approach in the health home revenue environment. Whether in two years or 10, this will be a game changer.

In many other states managed care organizations have used both their considerable capital and clout to turn reluctant legislators into believers. Some of these corporations have used that position to dictate terms and eliminate competition. In other places they partner with niche providers and local payers in ways that blur the historic distinction between charities and ‘for profit’ companies.

The idea of fee-for-service payment is giving way to alternatives that place greater responsibility and financial risk on providers for quality and outcomes. Engagement, stability and functioning can be measured and incentivized. So can decompensation, incarceration and homelessness.

Historically, system-level measures for processes and outcomes in community-based mental health care have been rather elusive. But national projects and sophisticated approaches borrowed from health care are changing those expectations. It is not a stretch to envision how this could place the Mental Health Fund in the position of being accountable for efficiency and outcomes across 40 grantee agencies and 15,000 clients. Simple fee-for-service arrangements are not the way to get there.

My intention is not to frighten, but instead to caution against complacency, perhaps even turning environmental threats into opportunities. Creating meaningful partnerships, promoting quality, accountability for outcomes, robust measurement systems and maximizing revenue in a multi-payer environment are admittedly hackneyed advice. But, as in sports, practicing the fundamentals can’t guarantee success, but it will improve your odds.

You can learn more about Jackson County Mental Health Fund, which is not affiliated with the Foundation, by visiting its website.

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