Hospitals and health systems are making investments to increase access to mental health services and transform how those services are delivered; however, addressing a critical mental health workforce shortage, MA reimbursement for mental health, and modernizing payment and regulatory policies are necessary to sustain those investments according to testimony provided at a January 17 Assembly Mental Health Committee meeting.
Testifying by invitation of the Committee, Pete Carlson, president – Aurora Psychiatric Hospital and Behavioral Health Services; Matt Sager, MD, psychiatric medical director, SSM Health; and, Matthew Stanford, WHA general counsel, each thanked the Committee and the Legislature for its new sustained policy focus on the importance of mental health and their efforts to advance accessible and well-coordinated care for individuals with mental health needs.
Carlson detailed several investments to increase behavioral health capacity and access by Aurora Health care, including $35 million in improvements at its Wauwatosa campus to expand inpatient beds. Sager similarly shared news of SSM Health’s multi-million dollar expansion and transformation of its behavioral health services at SSM Health St. Mary’s Hospital in Madison. Stanford said other hospitals and health systems across Wisconsin have also recently made or are making investments to improve access to behavioral health services.
But while capacity is being increased, “the need for mental and substance abuse treatment continues to greatly outpace access to such services,” said Carlson. To address that need, Carlson, Sager and Stanford emphasized the need to address mental health workforce shortages and payment and regulatory reform.
“Unless Wisconsin addresses the shortage of psychiatrists and other mental health professionals, Wisconsin faces a future of declining accessibility of mental health services caused by a lack of workforce to meet the patient demand,” stated Stanford. “WHA encourages the Legislature to continue to identify opportunities for the Legislature to address this shortage and looks forward to working to implement potential solutions with the Committee.”
Stanford also called on the Committee to continue to explore new care delivery policy and payment reforms that can encourage greater patient access to modern mental health care delivery models. He said that regulatory and reimbursement policy is lagging behind the care delivery practices being encouraged, particularly regarding care coordination and integration of mental health services with physical health services.
Carlson specifically highlighted last year’s Behavioral Health Care Coordination Pilot bill signed into law in February 2016 - though implementation has not yet begun by DHS - as an example of a Medicaid payment reform that changes from “a fee-for-service-based delivery model that focuses on ‘sick’ patients to one that is value-based and focuses on prevention of illness.” He highlighted a care coordination model at Aurora Sinai Medical Center that has resulted in a 30-50 percent drop in ED visits and a corresponding $4 million reduction in charges.
“We believe that these results provide an example that could be replicated to help alleviate state budget constraints and lead to better patient outcomes,” said Carlson. “We look forward to the implementation of the behavioral health pilot by DHS.”
Other groups at the hearing similarly expressed the need to review Wisconsin regulations, particularly regulations governing outpatient mental health clinics. Gregory Jurenec, representing the Wisconsin Psychology Association called for the Committee to eliminate what he described as an unnecessary and burdensome certification requirement for outpatient mental health clinics that is redundant with the professional licensure requirements of the psychiatrists, psychologists and therapists that provide services in those clinics.
“WHA echoes the concerns raised by the Wisconsin Psychology Association that Wisconsin’s outpatient mental health certification rule has become outdated and is a barrier to access,” says Stanford. “Revisiting DHS’s outpatient mental certification rule is a key priority for Medicaid reform identified last fall by WHA’s Medicaid Advisory Work Group.”
Other issues highlighted by WHA included the need for targeted emergency detention clarifications and that WHA looks forward to working with the Committee this year to provide such new clarification. Stanford also provided an update on the WHA Information Center’s successful launch of the statewide voluntary inpatient psychiatric bed locator system that makes it easier for emergency departments to identify bed availability for patients in need of inpatient psychiatric treatment. He said since the inception of the program, it has generated nearly 2,000 queries by emergency departments.