Whether the behavioral health industry deserves the failing grade it recently earned from the National Alliance for the Mentally Ill (NAMI) is a matter of bitter debate between behavioral health companies and the national advocacy organization.
But, one behavioral health expert, John Petrila, chairman of the Department of Mental Health Law at the Florida Mental Health Institute, said that if grades are to be passed out, the industry and purchasers should be graded together because both have a hand in shaping the design of public sector programs.
Clarke Ross, executive director of the American Managed Behavioral Healthcare Association (AMBHA), a trade association, said much of the responsibility for improving contracts must be put on the states.
"States clearly need to improve their purchasing, he said. "What typically happens is states assign a very bright person on staff, who may be a health planner to do the procurement. But they don’t know anything about managed care and procurement."
In a "ferociously competitive" environment that encourages underbidding. some firms have confessed that they "can’t provide the full range of services" that are expected, said Laura Lee Hall, Ph.D., lead author of the NAMI report, Stand and Deliver: Action Call to a Failing Industry.
The industry maintains that states are making the real decisions about funding and therefore about what services will be available to their populations in their behavioral health programs.
NAMI’s Ms. Hall doesn’t let the industry off the hook easily, however. She said BHOs have much more power than they acknowledge to ensure that housing and rehabilitation services are included in contracts and that critical medications are on the formulary.
BHOs have a responsibility to tell state or country purchasers if the amount allocated for a contract is inadequate, she said.
Mr. Petrila agrees that companies could play a larger role in working with states and local governments to define what they are purchasing, particularly with regard to the continuum of services such as drop-in centers. The companies are "not powerless," he said.
But, how much of a role behavioral health organizations (BHOs) can play and should be expected to play in shaping the programs is another area of discord between NAMI and the for-profit firms.
Mr. Ross said that it would be dangerous for BHOS to be "in the face of the purchasers, antagonizing them." States generally don’t consult with BHOs in advance about how to structure a program, he said, arguing that it is more productive for the firms to advocate for change through AMBHA.
"It is not usual in my experience that major companies are invited to be authors of an RFP (request for proposals)," said Ian Shaffer, chief medical officer of Value Behavioral Health.
Bob Egnew, behavioral health director for California’’s Monterey County and past president of the National Association of County Behavioral Health Directors, said there are several "complicating factors" that make it difficult for states to work with BHOs in shaping the program before it is bid out. The biggest is "the litigious nature of behavioral health care companies." States cannot sit down any have a dialogue with any one company without worrying about a lawsuit from one of its competitors, he said.
Mr. Ross said he would encourage states to use a request for information process (RFI) to help get input from the firms on how to structure RFPs.
Contact Mr. Petrila at 813-974-9301 or Ms. Shaffer at 703-205-6701. Copies of the NAMI report (Book # 140) are available to non-members for $12.95, 200 N. Glebe Road, Suite 1015, Arlington, VA 22203-3754. Contact Jackie King at 703-516-7961.
NAMI report card on behavioral care spurs debate about responsibility for flaws in state programs
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