Stop the Promotion To Restore Mental Health Access

Critical attention is needed to address claims of "value" for any number of recent health innovations. Enough is enough. It is about time to turn from distraction to needed action.

Rapid Change Is Costly and Distracting

In this health policy period of incredibly rapid change, it should be apparent that change comes with high cost and often accomplishes nothing at all. Half of ACOs have fallen by the wayside. Meaningful Use is being left behind. Medicaid expansion was held hostage and even with expansion it still fails for primary care and mental health due to payments too low. Medical homes have finally gained the close examination required of such a costly endeavor at $105,000 per primary care physician more in cost of delivery per year. Physicians now spend hundreds more hours a years on EHRs leaving less time for patient care and for generating revenue to support care delivery.

A narrow focus upon "quality" can be very costly - especially when "quality" is difficult to define.  Substantial dollars can be spent for no change in quality at all. Such is the case when primary care or mental health or geriatric outcomes are about factors that cannot be addressed by clinical means. It is not the clinical focus that matters when situations, relationships, determinants, and other patient factors dominate the outcome influences.

Mental health care is clearly understood as a major problem in the United States. There is one major reason: insufficient mental health team members. Is this workforce even on the agenda to rebuild? From the above, it appears that we are going the wrong way by spending more dollars on everything except more team members delivering care.

Common sense demands the answers to a few basic questions:
  • How long will it take before more dollars are invested in building a mental health workforce that is reasonably sufficient for 15 years from now - a minimal amount of time required for rebuilding such a workforce?
  • How long will it take before more dollars are invested in sufficient primary care - a key requirement for mental health recovery since 47% of mental health care is delivered by primary care?
  • How long will it take to reverse policies that have put small practices and small hospitals in decline - the front line of access for mental health and primary care?
  • How does spending tens of thousands per physician for digital changes, $105,000 more per physician for medical homes, and $40,000 more for quality changes this year help when the top priority should be supporting more team members to rebuild primary care and mental health care delivery capacities?
The cost cutting focus across our nation since 1980 has infected every area of society - schools, health care, roads, bridges, pipes, etc. Teachers, nurses, public health, primary care, and mental health team members are human infrastructure - essential for an efficient and effective nation but compromised by payment designs. Physical infrastructure is also compromised by lack of payment support. Each year or two our nation falls behind a trillion dollars in rebuilding and maintenance costs.

But somehow our leaders seem to believe that there is some magic potion that can be applied to make bargain basement infrastructure work better. They are more willing to spend more on the head, but not on the arms and legs to do the work. The time for head games has long passed.
 
While some focus on innovation, others are still attempting to provide primary care and mental health for tens of millions of people despite payment sufficient for only millions of people and bare bones care at that. 

A top priority should be placed on the people who need care and those who care for them - not the largest corporations and the latest innovations.


Grassroots Local Focus Is Required

Mental health care needs more support to fuel more outreach into homes, families, and communities - not more different sources inreaching into their pockets stealing access to care.

The stimulus for this piece was another Commonwealth posting that Medical Homes May Help Improve Mental Health Issues. "We found that in the U.S., the patient-centered medical home model appears to be associated with better care experiences for adults with mental health issues." Not that "patient centered' or "medical home" or "mental health" have specific outcome definitions or approaches



Recent Posts and References  

Thanks Obamacare No Thanks - The sickest in America have had insurance coverage. ACA does not need claims of benefits that are not benefits and lack of attention from serious consequences

The Consequences of Innovation Procrastination - Delays in indicated care result in harm to patients. Distractions due to innovation result in harm to millions who need care delivery, not rearrangements, confusion, reorganization, and rapid change.

Feeling Bad About CMS Feeling Good
It takes more than a feeling to lead in health care. Health care design must work for Do No Harm rather than I Feel Good - especially when it comes to constant changes.


The Massive Failure that is Primary Care Payment
Like past policies, ACA did not address cognitive vs procedural to balance workforce but it did take on quality payment with costs and questionable benefit.

Lack of Accountability for Accountable Care
Health Care Who Is it Good For? Count the billions in corporate earnings and the millions in CEO salaries to see who wins and who loses 2010 to 2016 and beyond

Innovation Incapacitation
We are so focused on innovation that we cannot even take care of the basics - Commonwealth Foundation is supposed to be about access. A foundation truly focused upon the access to care foundation could be powerful in shaping needed change. But why does it promote innovations that cost more and divert front line workforce from being able to deliver health access? Why does Commonwealth consider access to insurance to be access to care?

Safety Net Must Sunset and Front Line Health Access Should Rise

Experimental Innovation or Basic Infrastructure? Wouldn't it be nice if we actually funded infrastructure and basics instead of trying to substitute innovation or other distractions?

For Better or For Worse in Quality - More for fewer and less for more - thus continues the new innovative designs - same as the old designs

Are We Moving Away from Achieving Value in Primary Care? - Quality is over 60% about the patient, situations, relationships and has very little to do with clinical intervention - but this does not prevent serious exaggerations of "so-called value."

Time for Quality in Quality Studies - The Best Studies from the best institutions and journals have led the nation astray in quality studies and we continue down this pathway.

Pressures Mount for ACA Reforms or Revisions - It has taken too long for critical voices to be heard about the consequences of experimentation plus change that is too quick, too costly, and impairs access to care. Compromise may be most specific to small practice and small hospital settings and those that they attempt to serve.

IOM Should Learn About Social Determinants Not Preach Them - Too many IOM studies fail basic research design tests and often for failing to understand important influences of health care outcomes - like social determinants and patient situations and relationships.

The Federal Cause of Shortage Areas and Access Barriers - It is the Federal Design for payment that shapes the breadth, depth, and locations of shortage areas. It is about concentrations of Medicaid and Medicare patients with lowest payment for health access by federal design.

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