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