Posted: Monday, November 24, 2014

Dennis D. Keefe and Dale K. Klatzker: Integrated care boosts mental health in R.I.

From The Providence Journal, originally published November 22, 2014

The ongoing Journal series about mental health by G. Wayne Miller and others has brought well-deserved attention to a topic that is often overlooked. Mr. Miller rightly pointed out that Rhode Island once led the nation, developing a community-based system of care and closing institutions that were human warehouses.

That model of care now faces challenges.

One challenge is constrained state funding, a reality given Rhode Island’s severe economic and budget crisis in recent years. But this is not the only force of change. The state’s community mental health system is not immune to broader changes — many of them changes for the better —transforming the entire field of health care.

Many comments in the article and online, however, ignored this changing landscape, failed to think creatively about reform and perpetuated inaccurate stereotypes about large health-care systems.

Our comments here are based on our shared perspective as partners in a comprehensive health-care system, an accountable care organization, a term popularized thanks to the Affordable Care Act.

Care New England has built an integrated delivery system and accountable care organization carefully and deliberately. We are inspired by the powerful interconnection between primary health and mental health. We are driven by the recognition that mental illness is a chronic condition that must be addressed in a comprehensive and holistic way. After all, our head is connected to the rest of the body. People with depression — the single most common mental health diagnosis — are more likely to struggle with high blood pressure, diabetes, heart disease and more.

Integrated care is, quite simply, health care that recognizes the connection between mental illness and physical wellbeing. Integrated care is a pathway to better health. Done right, integrated care reduces costs because healthier people have lower health-care expenses. Healthier people are more productive at work and contribute more to the community, helping to build a thriving economy.

The ACA seeks to transform the way health care is delivered, focusing on prevention, wellness, integrated care and providing care when and where it will be most effective.

Achieving this requires health-care systems with the capacity to provide everything from community-based to clinic-based to inpatient and intensive hospital care. As well, those systems need to meet the full continuum of need, physical and mental.

This requires health-care systems that treat the whole patient. People should not go to one system for their physical health and then navigate — or worse, never connect with — a separate mental health system.

Accountable care organizations are built with this goal in mind.

At the same time, Rhode Island struggles with the fiscal challenge of rising need and limited resources. Yesterday’s model system is not today’s answer if it is unsustainable. A system needs to meet need, but it also needs to match the resources available. Rhode Island needs to intelligently and creatively “right size” health-care delivery.

Without a doubt, care is best delivered at the local level. That is as valid today as it was when our community mental health system was created in the 1960s. However, that does not mean there is no room for change.

Consolidation and community-based care are not incompatible. Care can, and should, be accessed on the local level. But we also believe patients are served best by a robust continuum of care. This also allows for administrative streamlining, strengthening the overall system by using resources efficiently.

We hope The Journal’s series sparks a lively debate about the future of mental health care — a debate informed by the broader changes taking place in health care, the way new systems of care can be more responsive to client needs, and a willingness to embrace change.

As Mr. Miller rightly pointed out, Rhode Island once led the nation.

We know Rhode Island can lead again.

Dennis D. Keefe is president and CEO of Care New England. Dale K. Klatzker is president and CEO of The Providence Center. This piece was also signed by Lawrence H. Price, M.D., acting president and COO of Butler Hospital.