One contributing factor to increased hospital readmissions and Emergency Department utilization is behavioral health. Whether a person suffers from substance abuse as a result of mental health issues or develops behavioral issues because of drug use, this person may visit the ED 100 to 200 times per year. A federal agency, the Substance Abuse and Mental Health Services Administration, has not been reauthorized since the 1990's even though 11 million Americans suffer from severe schizophrenia, bipolar disorder, and major depression.
We learned about the crisis, and a proposed solution, in a conversation this week with Kevin Scalia, the EVP of Corporate Development for Netsmart, the healthcare information technology company that recently acquired Allscripts' healthcare at home division. (See HCTR, 3/30/16, "Allscripts Reinvests in Home Care")
Scalia is urging both sectors, behavorial health and healthcare at home, to get behind Senate Bill 2680, the "Mental Health Reform Act of 2016." The House has already passed its version (H.R. 2646, the Helping Families in Mental Health Crisis Act) but without the amendments the Behavioral Health IT Coalition were expecting.
Lobbying efforts are now focused on the Senate bill and the restoration in an eventual conference committee of a provision that would give post acute providers the kind of financial support for deploying EMR systems that has been so successful for hospitals and physicians. That provision was removed from the House version before passage last spring
A bipartisan bill, S. 2680 was reported out of the Senate Health, Education, Labor and Pensions committee in March under the leadership of HELP Committee Chairman Lamar Alexander, R-Tenn., and Ranking Member Sen. Patty Murray, D-Wash. The House version was also sponsored on both sides of the aisles, introduced by Rep. Tim Murphy, R-Pa., and Rep. Eddie Bernice Johnson, D-Texas.
"The Senate has a once-in-a-generation opportunity to pass comprehensive mental health legislation by taking up S. 2680 in September before the fall recess," Netsmart's Scalia said. “Passage of this legislation would create the alignment needed for a conference committee to sync during this session of Congress on a final bill benefiting millions of people suffering from mental illness. It is urgent because, if they do not pass it and send it to the President's desk before the November election, all bets are off. Anything could happen, including years of delay."
Technology also in play
Scalia also told us that Netsmart and the industry coalition support passage of the so-called "Integrating Behavioral Health Through Technology Act" (S. 2691), sponsored by Sen. Sheldon Whitehouse, D-R.I. This measure would create a $250 million, five-state pilot program with health information technology financial incentives for psychiatric hospitals, community mental health centers, social workers, psychologists and addiction treatment providers.
Netsmart views Senator Whitehouse’s bill as an important first step to helping resource-challenged providers of mental health services fully utilize technology for coordinated, integrated care with physical health providers.
"Integrating mental health and addiction treatment services with the rest of medicine is essential to reducing the mortality rate among patients with serious mental illnesses," said Scalia. "Our interest in joining forces with Allscripts Home Care comes from our belief that post-acute and community-based services must be the first choice for care and treatment services. Our economy simply cannot sustain ED and hospital overuse."
"Meaningful Use was very successful," he continued. "It rolled $30 billion into EMR rollouts, so that today every hospital and physician that is going to have an EMR has one. Now, we are rolling into value-based payments, coordinated and integrated care to try to keep people out of hospitals, especially the chronically ill, which is where we spend so much money. So we have to look at who the most expensive consumers of healthcare are. They are people with behavioral health issues, people in long term care, and people who are chronically will and are being treated at home. What do all these care centers have in common? All of them were excluded from Meaningful Use EMR funds by the American Recovery and Reinvestment Act of 2009.
"If our goal is to keep people out of hospitals, we've taken the people who are the gatekeepers, who can best keep people out of hospitals, and we haven't given them any funding for technology to do home based care, care coordination and the like. So we started working immediately upon the passage of the HITECH Act to lobby on behalf of our behavioral health clients to get them included in the Meaningful Use program so they could afford the technology needed to integrate with physical health.
"Because at that point we had bifrocated the healthcare system where people who had mental health issues were treated in psych hospitals and community behavioral health centers and those people were dying 25 years earlier than people without a mental illness, not because of mental illness but because of co-occurring physical illnesses. If you went to a hospital with diabetes and bipolar disorder, they would treat your diabetes and not ask you about your bipolar. Our view is that we need to connect the head back with the body and integrate physical health with mental health."
Netsmart is urging all healthcare at home providers to join them in urging the passage of the "Mental Health Reform Act of 2016" (S. 2680) and the "Integrating Behavioral Health Through Technology Act" (S. 2691). A summary of 2680 is available here. If you do not already have the direct phone number for your Senators, you can call the Senate switchboard at (202) 224-3121 and ask for your Senator's office.
Netsmart is a founding member of the Behavioral Health IT Coalition, a consortium of 12 key organizations established in 2010 to advance public policy for technology to improve the lives of people with mental health and addiction disorders. Members include the National Council for Behavioral Health and the National Association of Psychiatric Health Systems.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org