Better strategies aimed at mental health in Ky. could improve health, economy and public policy
06/10/2014 06:55 PM
Knowing how to identify and properly treat mental illness could spark the single biggest shift in bringing efficiency to the health care system while improving Kentuckians lives, two experts said.
Currently Kentucky spends 4 percent of the $3 billion dollars in Medicaid managed care on mental health programs. But an estimated 40 percent of Medicaid enrollees have mental illnesses or issues — many that go undiagnosed, according to the Centers for Medicare and Medicaid.
Kentucky, unlike states like Colorado , hasn’t tracked how undiagnosed mental health issues, like depression or bipolar disorders, fuel other medical costs or spill into the school system in the form of behavioral problems — or fill up jails and prisons.
But Rep. Jimmie Lee, D-Elizabethtown and the chairman of the House budget panel that deals with health programs, said if Kentucky can get its approach to mental health right it would have broad effects across the board.
“The savings itself would promote the expansion of the system without having any additional revenue,” Lee said (at 3:40).
Lee and Steve Shannon, executive director of the Kentucky Association of Regional Mental Health Programs, said the health care system — and government-funded Medicaid — could save money by treating patients for physical and mental issues at the same location. Shannon said it’s like the “fram oil filter” model of pay now or pay later. It is time for the mental health system to pay early to avoid later costs, he said.
“Lets pay now and lets pay less now,” Shannon said (at 4:30). “Lets look at the whole person and lets not separate the brain from the body so when someone goes, lets really understand what is happening when they see a doctor and have that doctor realize ‘maybe this person does need to see a clinician.’”
The General Assembly passed a bill this session, House Bill 527, that would allow mental health centers to provide physical care by hiring a doctor or nurse practitioner — something both Shannon and Lee believe will help. But Shannon said people with mental illness die 25 years younger than the average age of death from preventable illnesses because they don’t get the care they need.
Shannon said dollars could be spent more wisely by looking at spending in areas like the corrections system.
“How much dollars are we spending in the corrections system for folks who could be in the community, never go to the corrections system, and never be seen there but be treated here and not have a record that reduces housing opportunities and employment opportunities, all those negative consequences,” Shannon said (at 6:30).
As for how the Medicaid managed care companies are handling mental health patients, Lee said representatives from the managed care companies have told him they will be changing the way they do business because it is effecting their bottom line. (See that conversation starting at 11:00 in video above).
Other bottom lines are affected by the way the state handles mental health as well. Lee said the state will have a budget shortfall for available behavioral health funds. And Lee and Shannon agreed any money saved through efficiencies in behavioral health needs to stay in behavior health and not be diverted else where as it has been in the past.
“That’s got to stop,” Lee said (at :30 in video below). “We can not treat and work with this population if you’re not going to let me or the folks that work with these dollars to keep those dollars within this budget in order to be able to expand on what we saved.”
Shannon said policy makers will begin to see that manifest itself in their own communities where more and more people are not getting the help they need.
“I like to say just because we don’t see someone, they don’t disappear, they end up somewhere. They are going to end up having problems in school as a kid and no one wants that to happen,” Shannon said (at 2:30). “But I think that is going to happen if we don’t figure out how to implement this and be prepared.”
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