Today when we speak about the American health care system, everyone talks about how we must “bend the cost curve” downward. Ironically, behavioral health leaders are also chanting this mantra, even though this approach in reality will surely compromise the principles and practices of behavioral health. Bending the cost curve down can only reduce true availability and quality of behavioral health care.
Think about it:
How many private psychiatrists accept Medicaid today? How many more psychiatrists will be induced to accept it when reimbursement rates are further compressed?
How does reducing inpatient stays to 5 days or less help consumers needing intermediate residential support or being administered psych0tropic medications needing 6-8 weeks to fully manifest results?
What does such a state mean for those with severe and persistent mental illness who are “dual eligibles” (on both Medicaid and Medicare), as may account for at least 50% of those with psychiatric disabilities?
The national health care debate may be focusing more on emotion (i.e., increasing access) than on reason (i.e., improving delivery). The focus should not merely be on provider cost-reduction. It should concentrate on patient/consumer care value-maximization. Cost-reduction alone inevitably leads to reduced availability and quality. Value maximization leads to better care over a correct continuum, which ultimately reduces costs even more and better. We should not be be bending the cost curve down; we should be bending the value curve up.
The basis for this idea is the concept of value in health care, as being developed by thought leaders like strategists Michael Porter and Robert Kaplan at Harvard Business School. The concept of value is now being much discussed in the world of general healthcare. It is time to begin discussing it in the world of behavioral healthcare. PsychOdyssey is developing its own ideas and resources about this important subject. We are pleased to share some of them here, to help all of us to imagine a mental health system based on value, not just outcomes.
PsychOdyssey briefing paper (8 pages, double spaced; reading time: 5 minutes):
PsychOdyssey slide presentation:
Professor Michael Porter explains the concept of value in health care at Harvard’s Center for Public Leadership (90 minutes):