Supporting your desire to live free from self-destructive behavior as you embark on a life long journey of recovery.

Behavioral Healthcare Today by David Newton

Behavioral Healthcare Today is my perspective on the state of this important, and rapidly changing healthcare service. 

This information will be primarily presented by me (David Newton, MBA), Director of Operations for SCH, a passionate believer in the shift from fee for service to value based care in behavioral health and also a relatively frequent user of both “medical” and “behavioral” healthcare services.  This section is also open to additional contributors on an as appropriate basis. Some will be anonymous and some will be identified. I look forward to your comments and suggested topics.  


SCH participates in a visit to Congressman Roskam’s office to discuss the value of mental health.

On April 10, SCH was proud to send a representative to Congressman Peter Roskam’s office (US House of Representatives, Illinois’s 6th district) to discuss the value (financially, morally and otherwise) of providing people with mental health treatment.   This topic is of particular importance in today’s political environment given the movement to overturn The Affordable Care Act and more specifically the discussion around eliminating what is referred to as “Essential Health Benefits” in some insurance policies.  The discussion was initiated by Nancy Meier Brown, President of Meier Clinics Foundation, and we were joined by representatives from Timberline Knolls Residential Treatment Center, NAMI DuPage, Northwest Community Healthcare and Linden Oaks.

What we all know is that healthcare today in this country is a complete mess.  With total spend at nearly 20% of our GDP and with a system that is fragmented, unorganized and full of waste, what we have today is unsustainable and we all deserve better.  A system that is more fully integrated, more organized and measured based on its results is what we believe is the long-term solution.  What many don’t know, apparently, is that some don’t feel like mental health deserves the same treatment as other illnesses and diseases, as if disease of the brain somehow isn’t on the same level as disease, for example, of the heart.  Though we all know someone who has been touched with one form of mental illness or another (from depression to substance use disorder), the fact of the matter is many still don’t feel these diseases deserve the same level of compassion and treatment that other diseases have received for decades.  Maybe it is because of stigma or maybe it is because of the ignorant belief that mental illness is often a “poor choice” rather than an unavoidable disease…   For those of us in the room with Congressman Roskam last week, frankly we simply do not understand why or how we are even discussing eliminating mental health benefits given what we know and see every day, and what the data and literature all support.   Yet the conversation is happening, and that is why we were there last week.  To plead a case that needs to be plead.

Hopefully in an attempt to support our case, we were asked at the meeting to present the Congressman with some facts as to why it makes sense to continue to fund mental illness treatment.  Though to us this is intuitive and we don’t see cardiologists being asked to make the case for why heart disease treatment should be covered by benefits, the data he asks for exists, and we will of course oblige him with his request.  That said, this is yet another wake up call for all of us that our world of caring about those who struggle with behavioral health issues is under utter attack at the moment.  The parity law is great, but there is no parity, and things appear to be getting even worse.

Some of the data we will be presenting is as follows.

First of all, proper treatment works.  For major depression, panic disorder and obsessive compulsive disorder rates (of improvement) are about 70%.  This is comparable to rates of improvement for people who suffer from physical disorders, including diabetes and asthma at 70-80%, cardiovascular disease from 60-70% and heart disease at 41-52% (12). 

The National Institute on Drug Abuse estimates that every dollar invested in addiction treatment programs yields a return of between $4 and 7$ in reduced drug related crime, criminal justice costs and theft.  When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1! (13).

The US Department of Health and Human Services estimates that for every $100,000 invested in treatment for substance abuse (measured in California, New York and Washington), there are savings of $484,000 in health care costs and $700,000 of crime costs were shown to be avoided.  (14)  In a comparison of medical expenses of Medicaid clients who received treatment, the following savings were noted (measured in Washington):  $170.00/month for patients receiving inpatient; $215/month for those in outpatient treatment, and $230/month for those receiving medication assisted therapy (specifically methadone).  In California treated patients have been shown to reduce ER visits by 39%, hospital stays by 35% and total medical costs by 26% (14).

Just by integrating medical and behavioral services, The National Council for Behavioral Health estimates that between $26- $48 billion can potentially be saved!

Thanks to Nancy Meier Brown for including us in this discussion, and thanks to the Congressman for taking the time to meet with us.  Clearly there is a lot of work to be done, and it will be done.  We have no choice.   Our patients and their families deserve every ounce of time we can devote to advocating on their behalf.  Please join us in the fight.


The customer is always right…
By: David Newton, Director of Operations

“The customer is always right” is a slogan by which most successful businesses live and die.  We learn early in our careers that we must listen to “the voice of the customer.” “No” is a word we don’t use when talking with customers, and a disappointed customer is one who will likely not be around for very long.  Solving problems and providing solutions for customers is what lies at the essence of all successful business, and as we do so we want a happy customer whose interests are aligned with ours and who feels taken care of and listened to.  Business people have entire departments (sales) dedicated to making sure that the customer is not only “always right” but also that they are never told “No” and that  ultimately, they are happy.  Success is optimized when there is alignment and a “Win-Win” dynamic in place. In this respect, medicine is not unlike any other business.  We are solving problems by saving lives. We want positive outcomes for our patients and we do well if they do well.  We too want happy patients, but not at the expense of quality of care, and this is where things differ. READ MORE 


What Does Repeal and Replace Mean for Mental Health Treatment in America?
By: David Newton, Director of Operations

Despite all of the politicians involved, this really is not a political issue. It will be resolved through legislation and a lot of politicking, but at the end of the day this issue affects every single one of us, directly or indirectly. We all care about people who struggle with these diseases. We all have family members and friends who struggle with these diseases. Mental illness does not discriminate based on one’s political beliefs, religion, gender, class, ethnicity, or the color of one’s skin. It affects every single one of us, it can be deadly, and we all care, regardless of our political beliefs. READ MORE


Prevention and Early Childhood Trauma – from a dad who could have done better
By: David Newton, Director of Operations

Solving the addiction crisis in America is arguably one of the most challenging crises we have ever faced, particularly in recent decades.  It is not the only one, but it is serious and wide spread.  Like many other complex problems, we face as humans, we will likely never eradicate the world of addiction.  There are cultural, biological, social, and genetic components to it which are all intertwined and which we are just now beginning to really understand.   READ MORE


SINGLE CASE AGREEMENTS, SELECTIVE CONTRACTING, AND DOING WHAT IS RIGHT FOR THE PATIENT

Having spent nearly 25 years in a business completely unrelated to healthcare before studying under some brilliant minds at Kellogg Northwestern and Harvard Business School as I was earning my MBA, I feel I bring a fresh, albeit sometimes naïve, perspective to the business of healthcare.  Wherever possible, I try to use this to our patient’s advantage. Our patients need and deserve as much advocacy as possible, to include from those who come from other industries and see best practices not being performed in healthcare. READ MORE


How Do We Make Decisions On Where To Go For Help When There Is No Reliable Data? OUTCOMES!

I read an article over the weekend which focused on helping the consumer find the right provider for mental health services when they may need it. READ MORE


A Disturbing Conversation with my 14 Year Old Son…

This is a kid who painfully and with a tremendous amount of sadness watched for years as his mom suffered/suffers from a major substance use problem, whose father was hospitalized for an eating disorder when he was a teen and whose step mother is arguably one of the nation’s most well respected psychiatrists in the field of treating substance abuse and eating disorders. This is a kid who has spent countless hours talking with his dad (and his step mom) about why he needs to be very careful with the choices he makes given his specific genetic predispositions for addiction as well as his the environmental and social factors he is faced with as he grows up on the Northshore of Chicago, a relatively affluent part of the city where much of the culture is ok with “some” use (of illegal and illicit substances) amongst teens so long as it is not “excessive”… Nearly every member on his maternal side of the family has a substance abuse and or fairly significant mental health issue and many on his paternal side have much of the same.  He himself already shows signs of obsessive thinking and addictive behavior with relatively harmless behaviors such as his phone use, girls and food. READ MORE


A Little Bit of Clarification On What We Mean When We Use the Word, “Value”….by David Newton

Three months in and one thing we have seen is that some of our peers in the field of addiction either don’t understand what we are talking about when we use the word, “value” or they feel threatened by it because somehow they think it equates to less care or lower quality of care for our patients.  In fact, this couldn’t be further from the truth.  We are huge advocates for both increased access and more care for mental health.  By shifting and re-framing the conversation from the “price” of siloed mental health care to one of total value delivered to the patient by providing integrated care, we feel we can realign the interests of payers, patients and providers in a way that ultimately results in higher quality of care at a lower TOTAL cost to the payer. READ MORE


A CASE IS MADE FOR INTEGRATION AND COORDINAATION OF CARE…by David Newton

When asked (almost every day) how behavioral health will ever be able to make the switch from volume based reimbursement to a more value based model, I often times find my head spinning with all sorts of unanswered questions; 1) How will we ever be able to properly risk adjust for this inherently unpredictable patient population who often present with what may look like one primary yet in reality have complex co-occurring diseases, and if we can’t properly risk adjust we can’t shift any of the risk to providers? 2) How will we be able to define an episode of care when many times these illnesses are life-long chronic diseases (meaning the “episode” is their entire lives)?  3) How can we as providers agree to share in the risk with these patients who, unlike many patient populations, do have more power to “cause” a relapse despite the best efforts of even a coordinated and highly integrated care team?….  I begin to try and answer some of this, and then I am reminded of just how complicated this journey is.  Some days the path seems clear.  Other days, however, I am tempted to pick up the phone and call Professor Porter and Dr. Lee and ask them how in the world we are going to make this happen. READ MORE


LET’S JUST START BREAKFAST WITH THIS….by David Newton

Mental Health does not get the same treatment from payers as other medical issues, and it should…. “Let’s just start breakfast with that…”

As musician Ben Harper passionately said in a recent interview for radio station KEXP in Seattle when talking about ongoing racism and what inspired one of his most recent songs, “Call It What It is”, I too was “grabbed by the back of my neck” to write about something that isn’t right.

READ MORE


SECOND CHANCES AND HOW I GOT “BACK HERE”…by David Newton

I graduated undergrad from an extremely small liberal arts school in Southern California called Pitzer College with a degree in Sociology and Third World Politics. I was an idealist with a desire to make a difference in a world I felt was plagued by greed, fear and capitalism. After a year of working for a non profit in Los Angeles making no money and not getting very far in trying to change the world from the outside, I got scared, I pivoted and shortly thereafter I took a job in the direct response business selling and buying commercial print. This move was the farthest thing from changing the world but I needed income and I made the choice at the time to sacrifice my ideals for what felt like a reality I could not change. READ MORE


Anonymous, A North Shore Teenage Perspective

What is it like being a sober kid on the North Shore?
Well to start off, it’s pretty messed up. All of the people around you or at least 95% are drunk every weekend, who knows probably high too, and despite that it is illegal to drink under 21, you are the one that is looked at differently. People either idolize you for having your own morals, not caring, and doing what you want, or they think that you’re unsocial, think you’re better than them, or blatantly a loser. Why it’s so messed up? Is because everyone knows who is drinking and who’s not. READ MORE


Anonymous, Teenage child of an alcoholic

My mom has been an alcoholic for as long as I could remember and it has not affected me in a positive way. I am terrified of being yelled at, I am scared to trust, and I have an extreme amount of stress. I love my mom but her partying at 3am in the morning has done no good for me or the rest of my family. The worrying began when I was much younger, when I would worry if my mom was coming home that night. The stress has continued throughout my life. READ MORE


REDESIGNING BEHAVIORAL HEALTHCARE DELIVERY IN THE FACE OF OBSTACLES- IMPROVING OUTCOMES WHILE REDUCING TOTAL COST…by David Newton

THE SCOPE OF THE PROBLEM:  In 2013, it is estimated that Americans spent over $200 Billion treating Mental Health conditions, more than on any other medical condition including heart conditions, trauma, cancer and diabetes. (1) This does not include an additional $193.2 billion in lost earnings per year caused by those with serious mental illness (2).  Approximately 1 in 5 adults in the US experiences mental illness in a given year (3), and approximately 1 in 25 adults in the US experiences a serious mental illness in a given year that substantially interferes  with or limits one or more major life activities (4). READ MORE


 

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