Implications of Care

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It is still too early to know if/how the ACA provisions for behavioral health services will impact the system as a whole, but a frequent scenario we see is that an individual who has either no or only limited behavioral health coverage through a private plan accrues many thousands of dollars in treatment expenses before becoming eligible for TennCare, the Medicaid Waiver program in Tennessee. Most of those dollars will have gone toward repeat stays in an inpatient level of care, with no provisions for ambulatory follow-up post-discharge due to fragmentation of the systems and no incentives for inpatient facilities to broker the follow-up care otherwise. Even when there is adequate and timely ambulatory follow-up, the most impaired individuals have no other resources or supports such as case management, in-home treatment and psychosocial rehabilitation through a private health insurance benefit package. Side Note: While not precisely on topic, I have to mention this readmission scenario played out as recently as last week with the teenage son of a former colleague of mine, who now has two acute episodes of care under his belt within the span of less than a month due to a lack of timely ambulatory follow-up care (even though his initial acute episode occurred through a facility that has a continuum of acute and ambulatory care services, the facility did not ensure a timely MD appointment after discharge). This was particularly frustrating for the parent, who has worked in public sector behavioral health and is aware of how the system could have worked for his son had his commercial insurance benefits resembled a Medicaid benefit package. In his case, he will most certainly take on the role of care coordinator and likely pay ou... ... middle of paper ... ...on at the health plan level and as we work with providers on integration strategies) and could assist our private sector brethren in achieving the same. The money is always the issue, but what is lacking in the private sector benefit causes a spillover effect into the public sector anyway, in the form of tax dollars spent on Medicare, Medicaid, and other health and social programs. Medicaid alone already consumes at least 20% of every state budget in the U.S. (Bolch, 2013). Why not say “uncle” and unite forces to leverage all dollars available through less expensive and more effective services? TACOs, anyone? References Bolch, M. (2013). Costs Drive MEDICAID'S REALITY. Managed Healthcare Executive, 23(2), 26-37. TACO Fact Sheet (2014). Centers for Health Care Strategies, Inc. Retrieved on 2/28/14 from http://www.chcs.org/usr_doc/TACO_Fact_Sheet_FINAL.pdf
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