Prevention’s role is to alleviate factors that lead to the need for treatment. Treatment refers to the interventions that occur to cure or lessen/manage the symptoms of a disease, illness or injury once it presents.
Prevention is intuitively the best strategy in mitigating social determinants of poor health that lead to high treatment costs. In an ideal world, financial resources would be skewed toward prevention as an investment in future health/wellness and to avoid the need for treatment whenever possible. However, even in public sector healthcare with its broader array of benefits and services, there are limited mechanisms for funding the earliest forms of prevention, as dollars must ...view middle of the document...
The issue is that, in order to use Medicaid dollars for those services, the member (a small child) must have a reimbursable behavioral health diagnosis and the service must be “medically necessary” as defined by the state. The informatics that point to the need for this large but tiny population lie within the healthcare system, but the limited resources to address those needs fall more within the realm of public health, education, and welfare. Personally, I have issues with labeling these children at such a young age, but since we have the informatics that tell the story of what is most likely to happen to these families without preventive measures, we are actually looking at the DC0-3R and how those diagnosis codes would map to reimbursable ICD codes. While we know we can’t fund all of the programming as it exists today, we think we may get approval to allow our systems to pay certain components that meet fee-for-service standards and hope the CMHCs will be able to find other sources of funding that will keep the programs in operation.
How resources are allocated and the strings that are attached to those allocations is just as much of an issue for other segments as is it is for the healthcare system. Gone are the days when big blocks of money were just handed over to go forth and do good things with no accountability for how it was spent or if there was a positive outcome. Scarcity, abuse and misuse resulted in rules and structure and specifications at every level, even at the expense of...
