Implications Of Care Essay

863 words - 4 pages

It is still too early to know if/how the ACA provisions for behavioral health services will impact the system as a whole, but a frequent scenario we see is that an individual who has either no or only limited behavioral health coverage through a private plan accrues many thousands of dollars in treatment expenses before becoming eligible for TennCare, the Medicaid Waiver program in Tennessee. Most of those dollars will have gone toward repeat stays in an inpatient level of care, with no provisions for ambulatory follow-up post-discharge due to fragmentation of the systems and no incentives for inpatient facilities to broker the follow-up care otherwise. Even when there is adequate and ...view middle of the document...

That said, the public sector is in the best position to drive benefits reform for behavioral health services. A new spin on the ACO model that is being driven by a few state Medicaid plans for their target populations is the Totally Accountable Care Organization, or TACO. According to the Center for Health Care Strategies (TACO Fact Sheet, 2014), TACOs:

represent an aspirational vision for a health care system where all physical health, behavioral health, long-term services and supports (LTSS), and elements of social services and public health are integrated for all populations. Ideally, these activities would be reimbursed under a global payment to align financial incentives and reduce costs. (p. 1)

The ultimate goal of TACOs would be an infrastructure with multi-payer funding streams that include Medicaid, Medicare and commercial insurance plans. TennCare, as an example of a program that could support TACO development, has been in place for twenty years now and is a good example of the evolution of medical, behavioral and LTSS. Behavioral health was carved in for the first two years, carved out again for ten years to try to ensure services received adequate funding, and was gradually carved back in (region by region) starting in 2007. We’ve learned a lot and we’ve achieved a lot over that period of time. Among our biggest wins has been the decrease in the number of state institute beds, which have been virtually cut in half by building out...

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