Solutions to R.I.'s huge mental health costs

(1.29.2018)
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Blue Cross & Blue Shield of Rhode Island applauds Governor Gina Raimondo’s State of the State address and her acknowledgement of the challenges faced by Rhode Islanders in need of behavioral health care. These challenges are complex with no quick fixes or easy answers.

Solutions, however, can be guided by the findings of the Truven Health Analytics report commissioned by the state in 2014.  Truven made important observations about the status of behavioral health care, cost and supply and demand, including:
• In 2013, Rhode Island spent more than $813 million on behavioral health treatment, which represented 10 percent of the state’s total budget at the time.
• Twenty-four percent of adults in Rhode Island received mental health care, which is 9 percent higher than the national average, yet 7 percent of Rhode Island adults had a perceived unmet mental health care need, compared with 4.6 percent nationally.
• Adults in Rhode Island had the highest rate of psychiatric general hospital admissions among New England states and nationally. 
• Nineteen percent of youths aged six to 17 had a diagnosable mental health problem.
• Almost three percent of adults experienced “illicit drug abuse or dependence in the last year” compared to 1.7 percent nationally and 1.8 percent regionally.

The report reflects that Rhode Island’s spending on behavioral health has been driven by inpatient care and prescription medications, with underinvestment in patient-centered, community-based, recovery-oriented coordinated care. Our own data at BCBSRI is consistent with these findings.

At BCBSRI we are working to address the state’s behavioral health crisis with efforts to improve access and care coordination and remove barriers and stigma.  Some programs that have shown positive results include:
• HealthPath, a team-based coordinated home and community-based treatment approach;
• Mindful Teen, a collaboration with Bradley Hospital for high-risk adolescents; and
• CODAC, the state’s first Center of Excellence for Opioid Use Disorder Treatment, with its focus on medication-assisted treatment (MAT).

We are hopeful about our newest collaboration with Roger Williams Medical Center’s Addiction Service Center in a MAT program that bundles clinical and case management services.

And, like the governor, BCBSRI is raising awareness of the state’s behavioral health crisis. Just last month, we held our annual community meeting, where we focused on reducing the stigma associated with addiction so that we can better address the overdose epidemic. At that meeting, we pledged $20,000 to support the Anchor Youth Recovery Center, the state’s first youth-focused substance use disorder recovery community center. We are also active participants in state efforts such as the Governor’s Overdose Taskforce and the Office of the Health Insurance Commissioner’s CTC Integrated Behavioral Health Committee.

Even with these efforts, more is needed to drive meaningful change. It has been said that substance use disorder is “a disease of readiness”. Finding ways to encourage that readiness to seek and to stay in treatment are important priorities going forward.

We must collaborate with all parties to transform behavioral health care in a manner similar to our efforts around primary care. Working with the Office of the Health Commissioner, we can explore opportunities for payers to allocate dollars to affect this transformation. We will also promote a population health approach to behavioral health that emphasizes integration with primary care and focuses on care along a continuum, not just when people are in the most dire need of treatment.

One thing is certain: we cannot do this important work alone. In partnership with state, business, and community leaders, providers and payers, we are determined to be part of the solution. 

Kim Keck is the president and CEO of Blue Cross & Blue Shield of Rhode Island.

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