The providers in Behavioral Healthcare typically have treatment specialties. Three primary categories to consider are:
The National Council on Alcoholism and Drug Dependency estimates that over 23 million Americans (age 12 and older) are addicted to alcohol and other drugs. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), just under 11% (2.5 million) received care at an addiction treatment facility in 2012. SAMHSA also estimates that the market for addiction treatment is about $35 billion per year.The fatality rate from drug overdoses is climbing at a much faster pace, leaping to an average of 15 per 100,000 in 2014 from nine per 100,000 in 2003. The trend is now close to the HIV epidemic in the late 1980s and early 1990s, according to Robert Anderson, the C.D.C.’s chief of mortality statistics.
Largely, the issues stem from abuse of both legal (Schedule 2 / C-2 / prescription drugs) and illegal (Schedule 1 / C-1 / heroin, crystal methamphetamine, etc. non-prescription drugs) substances. While the manufacture, distribution, prescribing and dispensing of C-2 products has always been closely managed and regulated, further measures of control are necessary to address what is generally referred to as the "opioid crisis". It will involve additional layers of diagnosis and prescribing protocol, categorization of patients, tracking and associated analytics ( both required and voluntary ) across multiple points of care including pharmacy (retail, mail order, specialty, hospital / institutional), physician practice, hospital / health systems, oncology, surgery centers and other patient care venues where pain management therapies are utilized. It will also encompass behavioral healthcare providers involved with substance abuse recovery to more closely assess patients to determine the origin / method of access patients have with obtaining prescription medication for unauthorized use so trends / and solutions can be more quickly identified. These measures will also be reflected in more tightly managing the prescribing of medications like methadone used to help patients wean themselves through the recovery process.
Reimbursement changes/challenges continue based on diagnosis, facility/institution classification and behavioral, medical and pharmacy benefit coverage guidelines. There are numerous regional and metropolitan providers with further defined specialties across the United States. About 1 in 5 Americans experience a behavioral healthcare issue each year.
There are about 14,500 behavioral healthcare providers. The largest 50 organizations control less than 20% of the market. Some operate their own freestanding facilities, others manage networks of providers and in some cases, do both to widen their each and have more revenue streams. About 40% of substance abuse treatment providers provide special care programs for women. There is significant consolidation underway in this highly fragmented sector although it trails the consolidation trends seen in other healthcare sectors like hospital, health systems, long term care, assisted living and surgery centers.
In November, 2013, regulations to fully implement the Mental Health Parity Act of 2008 were issued. Insurers are now required to cover mental health illnesses to the same degree as physical illnesses. The regulations apply to most health plans presently in the nation plus the new ones which will be marketed as part of healthcare reform.
For behavioral healthcare providers, this will help them administer care, obtain reimbursement and align protocols. For consumers / patients, the removal of pre-existing condition clauses and coverage for evaluations and screenings will enhance their ability to get coverage for care and access to some of the medications necessary for behavioral healthcare treatment. For insurers, it will provide guidance in determining benefit designs and plan coverage. The risk management professionals within the insurance and employer segments will be challenged with evaluating the additional cost streams associated with wider coverage --while both clinical and financial stakeholders will be assessing care / cost variables leading to positive outcomes.
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