Accessing Behavioral Health Services in Rural Communities
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1 Accessing Behavioral Health Services in Rural Communities Presentation in Discussion Group 3A: Addressing Quality and Access: Promoting Behavioral Health in Rural Communities Workshop on Achieving Health Equity: Promoting Cognitive, Affective, and Behavioral Health Equity for Children, Families, and Communities The National Academies November 14, 2017 Keith J. Mueller, PhD College of Public Health, University of Iowa
2 TAKEAWAY MESSAGES Access is a function of affordability and availability Affordability is a function of cost of care and insurance policies (including public programs) Availability is a function of provider capacity, transportation, and use of technology An important principle: form follows finance
3 AFFORDABILITY FOR RURAL RESIDENTS Recognizing variability in health plan offerings, including premiums, cost-sharing, and networks Consumer education to understand those differences when making choices Public policies that influence the choices Specifics: covering conditions (beware riders), including providers, medication formularies, benefit design (copayment, deductible, co-insurance)
4 AFFORDABILITY FOR RURAL RESIDENTS Eligibility requirements for public programs Provider networks Benefit design
5 AVAILABILITY OF SERVICES IN RURAL COMMUNITIES Scarcity of high level professionals (maps to follow) True for nearly all health professions, including primary care Especially true for behavioral health professionals
6 Mental Health Professional Shortage Areas (HPSA) Source: HRSA Data Warehouse Quick Maps - Mental Health Health Professional Shortage Areas (HPSA)
7 Mental Health Professional Shortage Areas (HPSA) HHS Region 10 (Alaska not to scale) HHS Region 9 Source: HRSA Data Warehouse Quick Maps Mental Health Health Professional Shortage Areas (HPSA)
8 Mental Health Professional Shortage Areas (HPSA) HHS Region 8 Source: HRSA Data Warehouse Quick Maps Mental Health Health Professional Shortage Areas (HPSA) HHS Region 7
9 Mental Health Professional Shortage Areas (HPSA) HHS Region 6 HHS Region 4 Source: HRSA Data Warehouse Quick Maps Mental Health Health Professional Shortage Areas (HPSA)
10 Mental Health Professional Shortage Areas (HPSA) HHS Region 2 HHS Region 1 HHS Region 5 HHS Region 3 Source: HRSA Data Warehouse Quick Maps Mental Health Health Professional Shortage Areas (HPSA)
11 AVAILABILITY OF SERVICES IN RURAL COMMUNITIES Institutional care: state decisions to rely on community-based care, closing regional facilities Hospital-based care when rural hospitals are closing
12 FORM FOLLOWS FINANCE Redesign underway in anticipation of, and response to, changes in payment structures Examples: Care management payment codes, Global budgets, Pay for performance, shared savings models Push: toward payment linked to value, defined as outcomes per dollar spent, including sustaining well-being (from episode-based to person-based)
13 EXAMPLE IN EVOLUTION OF ACCOUNTABLE CARE ORGANIZATIONS Model attracts those interested in rethinking how health care dollars are spent Strategies include care management and extending beyond traditional medical models Spread of this model includes rural places, seen in two maps
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16 NEXT STAGE: ACCOUNTABLE HEALTH COMMUNITIES Broadening network of participating local organizations to include social services In turn broadens focus of organizations approaching care management one patient population at a time Specific CMMI program that includes limited rural participants
17 WILL CHANGES REACH RURAL COMMUNITIES? Patient-centered medical homes have arrived ACOs have proliferated Role of technology to consider: use of telehealth in consultation and service delivery AHCs in some rural places New models can work in rural places
18 AND THE FUTURE IS Person centered health homes Holistic approach to health and well-being Incorporating behavioral health services, clinical and social Financial incentives driving desirable system change
19 FOR FURTHER INFORMATION The RUPRI Center for Rural Health Policy Analysis The RUPRI Health Panel Rural Telehealth Research Center The Rural Health Value Program
20 KEITH MUELLER Interim Dean, College of Public Health Gerhard Hartman Professor, Health Management & Policy Director, RUPRI Center for Rural Health Policy Analysis 145 Riverside Drive, S153A, CPHB Iowa City, IA
21 COLLABORATIONS TO SHARE AND SPREAD INNOVATION The National Rural Health Resource Center The Rural Health Information Hub The National Rural Health Association The National Organization of State Offices of Rural Health The American Hospital Association
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