National Health and Health Care Reform Ron Manderscheid, PhD Global Health Sector, SRA Intl., Inc. & Bloomberg School of Public Health, Johns Hopkins University

Some Framing Issues  Stepping Out of Our Comfort Zone  Making New System Assumptions  Developing Key Action Vectors

Some Reform Drivers  Economic Meltdown (Health Reform must be related to National Economic Recovery)  New Front Office in Washington (New Approach to Health Reform—President’s 8 Principles)  New Approach to Entitlement Programs (SSA, Medicare, Medicaid)  Addressing Chronic Disease (Current Model Doesn’t Work!— )

President’s 8 Principles of Reform  Protect Families’ Financial Health  Make Health Coverage Affordable  Aim for Universality  Provide Portability of Coverage  Guarantee Choice  Invest in Prevention and Wellness  Improve Patient Safety and Quality Care  Maintain Long-Term Fiscal Sustainability

Sobering Statistics  Current Cost of Health Care: $2.3 T/yr.  Current Cost of Chronic Care: $1.6 T/yr.  Estimate of Waste in System: $685 B/yr.  Expenditures on “Health”: 5%  17% are uninsured (34% for MH/SU). 80% of public mental health consumers are unemployed.  US ranks in the low 30s on basic health measures—behind Slovakia and Cuba.

We Have Been One-Dimensional Focus Only on Disease: No Disease Disease

We Need to Become Two Dimensional Focus on Disease and Health: Health Health No Disease Disease No Health No Health

Model of Wellness and Illness (1981) New Thinking: Wellness Illness Recovery

Implications  Illness Dimension  Illness Care  Wellness Dimension  Promotion of Wellness and Wellbeing (sometimes called Positive Health or Health Promotion)  Representative Patrick Kennedy: “Stop it where it starts!”

Wellness Evolution  Preventive and Promotion Interventions for Persons  Preventive and Promotion Interventions for Populations  Population “Health Coaches”  Population Insurance

Moving Further Upstream  Healthy People 2020 Framework emphasizes health determinants and interventions to address them; health care is a secondary objective.

Healthy People 2020 Model

Some Key Behavioral Health “Needs”  Need to implement more consumer control of health care and health (upstream factors)  Need practical integration models: 25 years lost to premature death 25 years lost to premature death MH/SU comorbidities MH/SU comorbidities Comorbidities with physical illnesses Comorbidities with physical illnesses  Need to update an aging workforce  Need “comparative effectiveness” results  Need to stem erosion of financial tools  Need care coordinators and peer counselors

Expected Legislation  Senator Kennedy and Senator Baucus: Insurance Coverage: 47 million +18/20 million (?) Insurance Coverage: 47 million +18/20 million (?) System Reform: Medical/Health Home Model System Reform: Medical/Health Home Model Financing: Medicaid and SCHIP expansions, potentially Medicare, paid through employers who do not insure employees and recoup of HHS funds. Financing: Medicaid and SCHIP expansions, potentially Medicare, paid through employers who do not insure employees and recoup of HHS funds.  Senator Harkin Cover promotion and prevention interventions in insurance benefits Cover promotion and prevention interventions in insurance benefits

Key Unknowns  Impact of massive change on the health infrastructure.  Phase-in period that will be required.

Some Key Questions for Us  How will we develop and implement health promotion/disease prevention services? Or disease prevention services for the chronic physical diseases?  As the medical/health home is developed—major role for primary care— how will we change?

Some Key Questions for Us  FQHCs represent one medical/health home model. Are we working with them? Do we plan to do so? Other approaches to the medical/health home?  What would be different if principal funding for services were fully through an insurance model (by person)? How are we going to get there?

American Recovery and Reinvestment Act of 2009 (Conference Version)  Prevention and Wellness Fund: $1 B  Comparative Effectiveness Res.: $1.1 B  Federally Qualified Health Centers $2.5 B  HHS IT Initiatives $2 B  Workforce Training $500 M

Looking Forward  Representative Patrick Kennedy has announced a White House Conference on Mental Health and Neuroscience.  We all hope that this will represent an outstanding opportunity for behavioral healthcare.

 What Are Your 2-3 Key Action Vectors?

Contact Information  Ron Manderscheid, PhD  Director, Mental Health and Substance Use Programs  Global Health Sector, SRA Intl., Inc.  6003 Executive Blvd., Suite 400  Rockville, MD  (V)  (F)  (C)    Enhancing human health around the world, everyday.  Enhancing human health around the world, everyday.