ABHW Perspectives Piece: New Directions Behavioral Health
ABHW spotlights our member companies in the Perspectives section of our website. Interviews conducted with ABHW’s members highlight programs and initiatives they are offering, their experience in the changing health care landscape, and other current topics of interest.
For this piece, ABHW interviewed John Quick, PhD. Dr. Quick has served as President and CEO of New Directions since founding it in 1994. During his two decades of leadership, New Directions has grown from serving 250,000 lives to more than 11.5 million lives today.
What do you think are the biggest challenges for MBHOs in the changing health care landscape?
One of the biggest challenges facing MBHOs is finding ways to integrate behavioral and medical care for our members in order to improve quality of life and quality of care. Equally challenging is for MBHOs and their provider networks to be good stewards of health care dollars for both our members and our customers. To do this, MBHOs must continue to lead change. We need to advocate for change in the training and development of behavioral health providers, and for the creation of more innovative reimbursement models. MBHOs must work to better integrate care with health plans, their case management teams, and with primary care. Our efforts to transform must be guided by data and advanced analytics.
At New Directions we are working to ensure a positive impact on the behavioral health services delivered by primary care, as this is where a significant amount of behavioral health services is being delivered. MBHOs that can integrate behavioral health with medical services at this level will provide significant value to the delivery system and the members they serve. This will require solving the financial sustainability challenge of integrated care in multi-payer settings.
Focusing on the treatment of autism continues to be an important objective for us. We believe treatment must focus on helping these individuals, and we are committed to understanding the variety of treatments that are available to members with autism and their families and determining what works best for whom.
Finally, we need a quality dialogue with the hospitals and facilities in our provider networks that focuses on readmissions, care transitions, and pay-for-performance reimbursement.
Why is integration of physical and behavioral health important? Do you have any special or innovative programs that integrate the two?
The data is quite compelling that behavioral health comorbidities have a profound effect on members’ quality of care, quality of life, and the cost for overall medical services. We believe that successful integration has the potential to exponentially expand the impact of our services and industry. Opportunities exist for MBHOs to have a positive impact on members’ quality of life while reducing overall medical spend. New Directions has extensively used co-location of services at our health plan partners to create environments that facilitate integration.
Integration in primary care is critical given the amount of behavioral health care delivered in those settings. For example, most data show that 70% or more of psychotropic medications are prescribed by primary care physicians. With respect to primary care, we need a new type of behavioral health provider and innovative provider payment models to create true integration. New Directions is now piloting team-based, member-centric programs in primary care settings. Our programs involve the selection of a unique type of behavioral health professional who can adapt his or her services to the pace and culture of a primary care environment. These practitioners become a member of the primary care team providing brief assessment, brief intervention, referral and case management, physician consultation, stepped care, and group work with members who have medical and behavioral comorbidities. Physicians involved in these pilot programs describe the impact of this program as “transformational” for their practices.
What are a few of the most important aspects of parity that you would like readers to know about?
Like all MBHOs, New Directions has fully supported mental health parity for our members. Behavioral health care cannot be treated differently if we are interested in the health of our members. Parity implementation is far from simple and the impact of its provisions are still unknown. While there have been great strides in research on behavioral health conditions over the past 20 years, the science of behavioral health conditions still lags behind that of most medical conditions. This impacts training programs and evidence-based practices. With the application of both parity and the Affordable Care Act, and the expansion of behavioral health services, MBHOs’ focus on quality management for behavioral health services is critical.
Does New Directions use telehealth services? Have you discovered any barriers to utilizing telehealth services?
We support the use of telehealth to increase access in underserved urban and rural areas and have explored various partnerships in this area. We also see great opportunity to use telehealth to provide screening and triage in primary care, urgent care, and emergency departments. Due to the existing shortage of psychiatrists, telehealth has the potential to increase access for members. In general, state laws and health plan policies have not kept pace with the advances in telehealth.
What do you see as your customers’ biggest concerns in this new era of health care? Are you seeing any changing trends or patterns in what your customers are looking for in their health plans?
With health care exchanges and increasing competition there is a renewed focus on opportunities to improve care and manage costs. The integration of medical and behavioral health care as well as managing the cost and quality of care is becoming increasingly important to health plans. We have seen health plans become more focused on the basics of care management, sharing risk with providers, moving to pay-for-performance, reducing administrative costs and gearing up their utilization management capabilities in order to be competitive in their markets.
HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT
Changes are occurring across the healthcare landscape, with a significant focus on integration of behavioral and physical health. This paper is intended to help inform these efforts by focusing on the long history Association for Behavioral Health and Wellness...[More]
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