Behavioral Health: Access Issues

Behavioral Health: Access IssuesAllen J. Brenzel, M.D., MBAMedical Director, BHDIDCabinet for Health and Family Services

Overview

Prevalence of Behavioral Health Conditions

Insurance Coverage

Mental Health Parity

Workforce and Network Adequacy

Public Sector Supports

Integration of Health and Behavioral Health

BH Disorder Prevalence by Payor

Source: 2012

NSDUH survey

Prevalence BH Disorders

Prevalence BH Disorders

Prevalence of BH Disorders

ADHD is most prevalent current diagnosis in children age 3-17 years

Diagnosis of BH disorders increases with age with the exception of autism (6 to 11)

Boys more likely to have ADHD, behavioral or conduct problems, autism, anxiety, Tourette syndrome and cigarette dependence

Adolescent boys more likely than girls to die by suicide

Adolescent girls more likely to have depression or alcohol use disorder

BH Disorders in CSHCNs

These children are not immune to BH disorders (Prevalence are at least as high)

Risk of behavioral health consequences from

p

ainful and repeated medical procedures

s

ide effects and consequences of aggressive medical treatments

p

rolonged separation from caregivers

n

eurocognitive co-morbidity of condition

social isolation

thwarted drive to independence

Injury to self concept and self esteem

BH Disorders in CSHCNs

Family Impact can be significant

i

ncreased rates of depression and anxiety

i

ncreased risk of marital separation and divorce

Danger of the concept of the “brave little soldier”

There may be protective factors associated with chronic medical conditions

Treatment Rates

Studies indicate that of adults with Major Depression less than 50 percent get any form of treatment and of those who do only, 30 percent get treatment that is considered evidence based

Estimates suggest that only 30 percent of children with behavioral health conditions get any form of treatment.

70 to 80 percent of psychotropic medications are prescribed in primary care

Overview

Prevalence of Behavioral Health Conditions

Insurance Coverage

Mental Health Parity

Workforce and Network Adequacy

Public Sector Supports

Integration of Health and Behavioral Health

When children acquire health insurance they receive more timely diagnosis of serious health conditions, experience fewer avoidable hospitalizations, have improved asthma outcomes and miss fewer days of school

Institute of Medicine

Also true for Behavioral Health Morbidity

Access: Insured Rates 2012

> 20% Un-Insured

Access: Insured Rates 2015

< 12% Un-Insured

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)

R

equires

group health plans and health insurance issuers to ensure that

financial requirements

(such as co-pays, deductibles) and

treatment limitations

(such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are

no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.

CMS – Final Rule on Parity

Applies certain Provisions of MHPAEA to Medicaid Managed Care Organizations

Covers MCO’s, alternative benefit plans, and CHIPs

Bans financial and treatment limitations for BH Services different than other health benefits

MCO’s must make available to beneficiaries and providers the criteria used making medical necessity determinations

Enrollees must be provided with specific reasons for denial of

reimbursement

ACA Mandatory Benefits/Services

10 Essential Health Benefits (EHBs):1. Ambulatory patient services2. Emergency services3. Hospitalization4. Maternity and newborn care5. Behavioral health including substance use disorder services6. Prescription drugs7. Rehabilitative and habilitative services and devices8. Laboratory services9. Preventive & Wellness services and chronic disease management10. Pediatric services, including oral and vision care

These apply to plans listed on the Health Benefit Exchange and any Medicaid Expansion covered beneficiaries.

Workforce- Child Psychiatrist

Workforce – Child Psychiatrist

Workforce – Other providers

SMHA Expenditures for BH in FY ‘13

NRI Survey 2013

Community Mental Health Centers

Individuals Served (2013) by CMHCs

147,000 with Behavioral Health

Dx

27,236 with Dual BH and SA

3,673 with primary Substance Use Disorder

Percent SMI and SED Served in KY

SMI 49

%

SED 60%

Estimated

86,217

SMI Population in Ky.

Estimated

51,169 SED Population in Ky.

Served 42,357 SMI

Served 30,871

Source: Ky DBHDID CMHC database

Penetration Rate

Overview

Prevalence of Behavioral Health Conditions

Insurance Coverage

Mental Health Parity

Workforce and Network Adequacy

Public Sector Supports

Integration of Health and Behavioral Health

TRADITION

Behavioral

Health Care is

Traditionally Separate from

Medical Care

The Case for Integration

WorkforceCurrent outcomesRates of untreated BH disordersPoor medical outcomes for those with BH conditionsAttitudes and stigmaEvidence of at least cost containment and better patient satisfaction

Cabinet for Health and Family Services

Cabinet for Health and Family Services

Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013

Models on Integration

Contracting with single entities as opposed to Behavioral Health CarveoutsPatient Centered Medical Homes (PCMH)Health Home Models

Cabinet for Health and Family Services

Thanks

Cabinet for Health and Family Services