A New Era of Behavioral Health Systems

Reflections on the NYAPRS Executive Seminar

As I sat in the audience of the New York State Association of Psychiatric Rehabilitation Services (NYAPRS) Executive Seminar, I came to the realization that one of the largest efforts to reform the delivery of Medicaid services to some of the most costly users of healthcare in the New York State is about to become a reality. The theme of the seminar “Healthcare Reform is Here: What Lies Ahead…And What Really Matters” certainly rings true. This massive undertaking is not the first of its kind, but it is the largest and will have far reaching impact. I believe that federal agencies, state authorities, providers and managed care companies are all closely monitoring the positive and negative impacts this effort will have on the recovery of people with behavioral health issues.

It’s important to acknowledge that the planning, development and initial implementation of the behavioral healthcare system in New York has not, by any measure, been a smooth and flawless planning time. Areas such as technology, the creation of uniform data sets, service integration models, and complexities in running multiple lines of business at a service delivery level were under addressed, not addressed at all, or mishandled. This isn’t because of incompetence or some motive-driven reasoning, but because the undertaking of something this huge is very complex. As a result, some components of the reform have been rushed and others continue to be delayed, with both scenarios causing some disruptions at the service delivery level.

For example, Health Homes, one of the key components to behavioral healthcare reform in New York, were left to their own devices to create infrastructure to manage the complex information that needs to be obtained, exchanged and used among providers. Although specifications were originally set in place, many Health Homes have created archaic or homegrown structures rather than taking advantage of the latest technology and best practices. Care coordination entities like Health Homes must operate systems that have complete interoperability functionality. Sharing information among multiple entities is crucial in creating a new type of behavioral health system that addresses the full spectrum of needs of a consumer. I also believe that if you have multiple Health Homes within a jurisdiction, it is harmful to require multiple, different data sets from agencies providing care. Having to report on different standards becomes a burden to service providers, which causes extra time, resources and ultimately, creates roadblocks to truly value-based services for the consumer.

While New York has had challenges, it has also had successes, in large part due to the dedication of those implementing such a massive reform across such a huge service area. Some of those include:

  • The inclusion of stakeholders and those that give consumers of services a chance to participate directly in the planning.
  • The creation of technical assistance centers and learning communities to ensure that all parties involved can share best practices and learn from each other.
  • Weekly calls with government representatives to ensure consistent and clear communication among stakeholders.

While healthcare reform aims to reduce high service costs, it is also creating a paradigm shift. A shift to a system that includes the best of what already exists — programs like PROS and peer support and crisis diversion – and includes greater care coordination, the integration of behavioral health and primary health, peer outreach programs and HCBS waiver services. Through this reform we can create a healthcare system that supports self-driven, recovery-oriented, value-based services and one that is respectful to those receiving services.