2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Healthcare Reform: The New School Lunchroom

What does the new healthcare environment have in common with a high school lunchroom? Many Behavioral Healthcare providers have been experiencing anxiety as they hear and read about all the fundamental ways their work, organizations, and very lives are about to transform. “It’s all going to change,” and “Hospitals are going to be our payors now,” and “Health Homes/HIEs/RHIOs/ACA/ACOs are going to put us out of business,” and so on. It’s worth pulling apart some of these strands to see what we’re really talking about.

A big question in our field has always been how we can use our resources to drive outcomes more efficiently. Today, in all likelihood, you provide services using a combination of funding streams. Probably most of your revenue ultimately comes from Medicaid or Medicare, and probably you are being paid on a fee-for-service basis. Additionally, it’s safe to assume that you’ve been trying to make the work you do ever more efficient and effective, and basically, trying to do more with less. For the most part, you’ve thought of your organization as a self-contained unit. Sure, you get referrals from other organizations and sure, you’re a big part of the communities in which you work. But generally, this conversation has been about how your organization can drive outcomes more efficiently to sustain itself.

It’s your context that’s changing. Almost all the new ideas, projects, experimental payment structures, and acronyms are built around the idea that providing real care for people who don’t have the resources to pay for care themselves is going to require multiple specialized providers—the entire community—to work together. It’s the community that will be providing care now, not the individual organization. It’s you, and the hospital, the shelter down the street, the DD organization across town—everyone. That is why you are suddenly feeling like you need to care about what your local hospital is doing and how it will affect you. That is why this process feels like finding a seat to eat your lunch on the first day of high school. You don’t know the angles, don’t know who your friends are, and don’t know who’s nice and who’s a bully. You are now part of a web of organizations that offer a wide range of healthcare services to a particular population, and you are going to need to figure out how to work in that context.

The truth, though, is that this is less about changing how you operate than it is about changing how you relate to other service providers. Primary care’s “integration” with Behavioral care is not a physical, organizational integration. Rather, it’s a data integration that allows each care provider—Primary or Behavioral—to leverage the information being collected by all the other providers in a person’s life. At Foothold Technology, we’ve been working steadily to provide a range of tools that enable providers to do two broad but crucial things: 1) Share clinical data safely and in real time with other providers in your community, and 2) Tell your story with solid support from the objective clinical data in your Electronic Health Record (EHR). These two “new” ideas address the vast majority of the changes that are currently coming at you. In both cases, they’re about finding a way for you to be financially sustainable and to become a crucial part of the care network in your community. In both cases, they will enable us to address the fundamental challenge posed by the small number of dual or multi-diagnosis individuals who utilize a vastly disproportionate percentage of the monies available for care.

Put bluntly, keeping Behavioral Healthcare recipients out of the ER when they would be better served by calling or visiting you is the key to all the Healthcare Reform that comprises our current national conversation. By using an EHR that enables you to share data with your local hospital and fellow BH providers while enabling you to tell powerful stories about the value you bring to your local community within this larger national conversation, you will have done nearly all you need to do to survive and thrive in our new world.

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