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2014: Estimating Real Change in Healthcare

2014 National Council

“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.”

I couldn’t agree more with Bill Gates. 2013 saw progress. But big ideas are exacted quickly; it is change that is incremental and requires patience and tenacity.

We saw our persistence pay off last year with unprecedented bipartisan action in Washington.

  • The Excellence in Mental Health Act was passed by a nearly unanimous vote by the Senate Finance Committee.
  • Mental Health First Aid trained more than 150,000 people, it was added to SAMHSA’s National Registry of Evidence-based Programs, and it continues to receive bipartisan, bicameral support in Congress and the White House.
  • The Behavioral Health IT Act is on track to deliver coordinated, connected, and accountable care.
  • Parity had a final rule attached to it, meaning people will finally see equity in the care they receive.

Some may say that we saw such progress because of the tragic Newtown shootings. While there’s no prosperity in tragedy, we’ve seen the public take heed of the critical need for earlier, effective interventions — and say so to their legislators — in a way that has been long coming. And we also saw progress from the marriage of steady advocacy and public will.

We’re on a road we long dreamed about.

The Excellence Act is the most significant national investment in community services since JFK signed the Community Mental Health Act of 1963. The Mental Health First Aid bill empowers and activates members of the public. The Behavioral Health IT Act will enable the vision of coordinated, integrated care.

Coverage expansion is happening, one way or another; the integration of specialty care and general healthcare is underway; and care coordination is the expected way to improve the health of high need/high costs patients. These trains have left the station.

But what will the future look like? How will new payment structures — bundled rates, episode based payments, case rates, and capitation models — enable the promise of health homes and accountable care organizations? What will healthcare look like when new technologies — electronic health records, big data analytics, and personal devices — transform the industry? With consumer demand for “when and where we want it,” will we deliver services in urgent care clinics, be available day and night via telehealth, and host consumer networking and learning platforms? Will consolidations and mergers achieve promised cost savings, or will we see behavioral health not-for-profits become part of hospital systems or insurance company partners? Will substance use disorders be understood as a public health crisis of a magnitude beyond any other? Will the substance use disorder and mental health advocates unite to ensure that a full range of community treatments and supports are available for chronic medical conditions in every community?

In 2014, the answers to our questions will begin to emerge. The technology revolution has accelerated the pace of change and increased our tolerance for experimentation. The National Council for Mental Wellbeing owes it to those served by our member organizations to keep our eye on the future. To quote leadership guru Peter Drucker, “The greatest danger in times of turbulence is not the turbulence. It is to act with yesterday’s logic.”

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