FORMED IN FEBRUARY OF 2004, THE INDIAN RIVER MENTAL HEALTH COLLABORATIVE grew as an initiative of the United Way Community Planning Committee, which had been studying the perceived barriers to mental health for nearly 10 years.
During the past two years the Collaborative has been undergoing a strategic planning process to determine various initiatives to improve mental healthcare in Indian River County.
As we wrote in a previous Communiqué, one of the initiatives has been to embark on the development an innovative mental health “connections center,” where a fully integrated network of providers would eliminate the “fragmentation,” or “silos” of mental healthcare. It would point those in need in the right direction and prevent them from doing nothing because they can’t navigate the system and maze of healthcare providers.
During this strategic planning process, Lisa Kahle, Program Administrator for the Collaborative, has been working in conjunction with Michael R. J. Felix, MSHA, Co-founder of Community Health Development Specialists, Inc. (CHDS) in Allentown, PA. CHDS specializes in the development, implementation and evaluation of community health development strategies that improve the health status of populations.
Mr. Felix was previously the Chief Executive Officer of Felix, Burdine and Associates, Inc. (FBA) a nationally known community health development firm. He is an organizer by training and experience, specializing in the health strategy, planning, development and implementation of integrated community-based health and human service systems.
With this background, we wanted to share with you his views and insights on the future of healthcare. Rather than “reacting” to current conditions, he believes we should consider, embrace and “get in front” of healthcare, as it will evolve over the long-term.
To begin with, Mr. Felix believes all health begins at the community level and as our Nation’s health care system is undergoing a transformation each community has an opportunity to take a “transformative approach to healthcare through partnerships and collaborative action” like the example of the Mental Health Collaborative.
Mr. Felix believes there are multiple factors contributing to this metamorphosis: economic, political, health policy and social changes are focusing responsibility for health improvement at the individual and community level; community health and population approaches are emerging over the medical model; individual and shared responsibility for health and health related issues are emerging as a value; and the emphasis on measurable health outcomes, the patient experience and the cost of healthcare.
Throughout the U.S., many health systems have adopted the Triple Aim approach with its domains focused on the experience of the individual, the health of a defined population and per capita cost of that population. Mr. Felix suggests as more health systems implement the Triple Aim approach more integration of health and human services and new health networks will emerge in each community.
The Triple Aim approach is leading health systems in many communities to examine health outside the health system. For example, how they do or do not interact with the communities’ public health and human services, the costs, questions on quality, health outcomes and the ability for individuals to access them in a timely and affordable manner.
He believes that historically healthcare has revolved around the concept of the “disease-based approach to healthcare model that viewed individuals as ‘cases’ and undervalued the sociocultural and humanistic aspects of patient care.” (Source: Alexander Green / Western Journal of Medicine / March 2002) Healthcare must now take into account these “sociocultural and humanistic aspects.”
That means that in considering health, factors like income, employment, education, housing, transportation, the environment and culture all are part of the individual and population health. This broader definition of health also means more opportunity and responsibility for integrating individual and population health by those human service providers, civic organizations, the faith community, the media, educational systems, criminal justice and local government not traditionally part of the medical system.
Locally, the Mental Health Collaborative’a strategic efforts at integrating behavioral health in primary care, the mental health court and diversion approach, a connections program and the effort to improve population mental health literacy are creating new roles and opportunities for multiple community resources within the local health care system. Mr. Felix believes as integration unfolds at the local level, we will come to understand and embrace this broader definition of health and the many opportunities that it will bring for our communities to share resources.
Mr. Felix’s experiences in other communities where health and human service integration is unfolding suggest the process will continually improve. “It needs to be refined,” he believes. “Incentives and responsibility need to be better defined; for example; in the case of reimbursement for behavioral health, there should be strict adherence to parity laws, to ensure mental health benefits are not any lower than medical and surgical benefits provided by individual or group health plans.” Another refinement would be “ensuring companies provide mental health benefits required by the Affordable Care Act (ACA), which many do not.”
The way we finance healthcare, in particular, is undergoing a metamorphosis. Mr. Felix applauds the concept of value based care that reimburses healthcare providers, such as hospitals and physicians, on the basis of expected costs for clinically-defined episodes of care. A bundledpayment is also known as an episode-based payment, case rate, package pricing and episode-of-care payment. Rather than having Payers like the federal government and insurance companies pay for one incident at a time related to the same incident (fee for service), it would group them all into one and pay for the outcome. Payments are based on quality, outcomes and costs as well as the patient experience.
He also supports the “hospital readmissions reduction program” created by ACA where hospitals will be penalized if a patient is readmitted within 30 days for the same illness. And where hospitals will be penalized when patients acquire conditions like bedsores, or injuries by falls. Or overutilization of tests such as advanced imaging services. However, he suggests that these efforts need to be introduced into communities in a planned change manner to allow for the time it will require to change the health care infrastructure to meet these new requirements.
Health care experts predict that while there are currently approximately 5,000 hospitals in the US, 2,000 may go away entirely or be absorbed by other entities. Mr. Felix believes this will be truer in communities that wait to take action. Health systems that enter into partnerships with local safety net providers as Indian River Medical Center is doing with the Mental Health Collaborative can turn today’s challenges into opportunities for a positive outcome for the entire community through better integration and utilization of all the community resources for population health improvement.
Mr. Felix believes working towards the elimination of the “fragmentation” and “silos” of those providing healthcare by partnering and collaborating with other public and private sector health care providers will lead the U.S. to better population health.
Mr. Felix closed our conversation by noting that his experience has shown that successful transformation efforts require leadership. The MHC, Indian River Medical Center, the Hospital District, The United Way, the McCabe Foundation and other philanthropic and community leaders have pitched in and made a commitment to leading the community towards a mission “to establish a continuum of care for mental health made up of private and public funders, mental health providers and individuals who work in collaboration to increase access, decrease duplication, and facilitate community wide support of mental health issues.”
This good news partnership approach and its decade long history has set it on the road for the community to successfully reinvent a local population health improvement system.