Question

1. What incentives could be created by changes in payment or policy for patients, hospitals, pharmaceutical companies, or states to help alleviate mental health issues?

2. Base on the current Opiod crisis across the U.S. Answer the following:

a. What roles did hospitals, providers, pharmaceutical companies and Center for Medicare and Medicaid Services (CMS) play in the current opioid crisis?

b. What payment incentives contributed to their behavior?

c. What changes would you recommend to the current situation.

d. Explain how your proposed changes will impact the situation in a year and in a decade.

Answer 1

1) Cost Control
Many states have engaged managed care companies to try to stem the runaway costs of Medicaid. Some began over 20 years ago. But the early years of managed medical care, especially for mental and substance use disorders, often were characterized by profit seeking that drained money from patient care and generated corporate windfall profits. Those excesses appear to be over, at least in this country, as clinical performance goals drive contracting and consumer advocacy organizations and governments have learned to better protect their interests.

2) Patients and Families First
A remarkable change in the culture of health care is underway and rapidly unfolding. Instead of “the doctor knows best” or delivering services for the convenience of providers we are witnessing an inversion: Services must now meet the clinical and personal need of recipients, not of those delivering or paying for them.

Recipients of services, patients and families, wisely want to be informed partners in their health care. “Nothing about us without us” is one way this has been articulated. For this to happen, medical information must be transparent and comprehensible. Data on the performance of providers (and governments) also must be publicly available, comprehensible and meaningful.

Advocates for mental health (and addictions) service recipients and families know that what works best are comprehensive, continuous, evidence-based services delivered at times and in places that allow recipients to not have their work or family responsibilities disrupted. The use of hospitals, which by their nature abridge liberty, is the least desirable alternative for someone with an acute mental illness. Everyone has something to gain from preventing involuntary treatments delivered late in the course of an illness in settings removed from family and community.