Finding the Opportunities in National and NYS Healthcare Reform

Bill HudockSenior Public Health Advisor

Center for Mental Health ServicesSubstance Use and Mental Health Services Administration

“It was the best of times, it was the worst of times”

Charles Dickens

Today’s Health Reform Drivers

• States Facing Unprecedented Financing Problems• Federal Government Deficits – End To Stimulus • Rate of Increase in Cost of Healthcare Moderated in 2010, but still

2-3 times that of Core Inflation• High Unemployment Leads To More Demand on Public Systems• Employer Costs of Healthcare 2-3 Times Greater Than In Other

Countries• Value of U.S. Healthcare Inconsistent. Great Disparities in Access.

High Cost• Perception of Public Is Confused, Angry, Conflicted• Focus Will Be On Demonstrating Value and Efficiency• Concern On Protecting What Is Left May Hide Opportunity For

Change

Patient Protection and Affordable Care Act Patient Protection and Affordable Care Act (ACA)(ACA)

The Act Does Several Things:• Expands Insurance Coverage• Institutes Insurance Reforms• Builds Infrastructure To Provide Improved Health Outcomes• Puts In Motion Structural Changes To How Healthcare Delivery

Is Structured & FinancedGoals of Act Are To:• Increase Access• Provide Comprehensive Care Better Health Outcomes• Control Costs

Impact on Coverage Expansion

Prior to implementation of coverage expansion:• 39% of individuals served by State Mental Health

Authorities have no insurance• 61% of the individuals served by State Substance

Abuse Agencies have no insuranceMany of these individuals will be covered in 2014 (or

sooner)—most likely by the expansion in Medicaid

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What Health Reform and Parity Means To The Vision of Transformation and Recovery Based Systems Change

Drivers•Value

•Cost•Affordability

•Disparities

•Perception

Opportunities•Prevention/Treatment and Personal Responsibility Focus•Need To Demonstrate Impact•Compare To Alternatives•Key Will Be To Show Savings•Multiple Funding Streams•Broad Based vs. Focused•Who Is Covered, Who Left Out?•Is This Essential?•Who Benefits, Who Pays?

Implications For States & Providers

• Need For Infrastructure To Work With Insurance• Grant Funds Reconceptualized To Not Duplicate

Insured Benefits• Medicaid Changes and State Insurance Mandates• Integration of MH/SU with Primary Care• Health Homes and Accountable Care Organizations• Electronic Health Records• Payment Reform Pilot Programs• Evidence Based Practices• Licensure and Credentialing Standards

Building Strategies

• ACA Will Meaningfully Help Those Who Are At Risk For or Need Behavioral Health Services

• Change Is Complex and Imperfect – It Takes Time• New Partnerships and Ways of Doing Business Will Be Needed• We Who Serve Others Will Need To Keep Up With The

Changes• We Who Understand the Importance of and Effective

Approaches to Recovery and Consumer Involvement Need To Lead

• Sustainability Will Be Based On Ability To Educate, Inform, Persuade, Perform, Measure

“We are continually faced with a series of great opportunities brilliantly disguised as insoluble problems.”

John W. Gardner