1. The Public Mental Health System Current Practices and Recommendations The Community Behavioral Health Association of Maryland

2. Behavioral Health Is Essential To Health (from SAMHSA report 4/5/10)  Almost 25% of all adult stays in US community hospitals involved mental health or substance use disorders  People with serious mental illnesses have shortened life- spans, on average living only until 53 years of age  44% of all cigarettes consumed in the US are by individuals with a mental illness or substance use disorder  Almost one quarter (24%) of pediatric primary care office visits involve behavioral and mental health problems  Mood disorders rank 1 st in work loss costs, 2 nd in total costs & 3 rd in health care costs  People with mental health problems reported the highest rates of lack of health insurance of all disability groups

3. The PMHS is a Managed Care System  110,000 adults and children served  The mental health carve-out has ensured appropriate use of scarce public dollars  PMHS serves Medicaid, Medicare and uninsured recipients  All services undergo pre-authorization and utilization review  Unlike other major components of health (hospitals, MCOs, etc.), community MH providers receive no regular inflationary rate adjustments

4. Current Cost Containment and Quality Initiatives  Bundled Payments - Two capitation projects - PRP case rates  Evidence-based Practices - Assertive Community Treatment - Supported Employment - Family Psychoeducation  Integrated Care - Funded by MCHRC and private foundations - Reverse Co-location - Partnerships with PCPs and FQHCs

5. Recommendations  Provide support and funding for behavioral health medical homes  Include behavioral health providers in incentive payments for implementation of electronic health records  Include BH in HIE implementation  Budget and plan for a significant influx of new users into the PMHS  Support implementation of IDDT and integrated care best practices.  Support efforts to stem and reverse the workforce crisis (licensed clinicians and unlicensed paraprofessionals)  Hold private carriers accountable for mental health tx