Mental Health Care in Today’s World: Parity in Payment, Parity in Performance

Mental health providers have struggled for decades to achieve parity in payment for services. Now that parity is being achieved, a new standard of quality and performance responsibility is expected. On the other hand, mental health care has been isolated from the medical side of healthcare either by accident or design even though the profession has known for over a century that we humans do better when we are treated medically and mentally as the whole. Large green-lawned campuses with imposing old empty buildings stand as monuments to the past idea of “warehousing” patients with mental health disorders.

On the other hand, if mental health providers want to enter the main stream of medicine, where they belong, performance measures rise to an increasing level of importance. Replacing the brick walls with the overprescribing of psychotherapeutic medication is not acceptable in current times. A recent Modern Healthcare article underlined the problem by noting that many children receive “treatment from practitioners who lack sufficient expertise to manage drug therapy effectively. Medications may be overprescribed when concurrent behavioral health therapies are not available or are underutilized.”

On the physical health side of the equation outcome metrics now drive the payment process in the shared savings generated by Accountable Care Organizations. Preventative measures are a significant measure of quality performance. Limited emergency room (ER) utilization and inpatient (IP) management measures can lead to care improvement on both sides of the health care equation. Requiring providers managing the primary diagnosis would encourage primary care doctors to pay more attention to depressive disorders as well as having mental health providers paying attention to the schizophrenic patient who is diabetic. Psychiatric physicians must become more like physicians in a real sense just as primary care doctors become more sensitive to treating the “whole” person.

The idea of value-based payments is becoming real across the full spectrum of health care. Mental health providers are then not paid to manage a volume of patients (consumers) by keeping them out of society’s view, but rather to help them become a valuable, productive part of society. Warehousing patients behind a “pill wall” is no different than the brick walls of the past.

Beyond ER or IP utilization mental health providers can easily be responsible for careful and balanced medication management as well as the standard wellness preventive measures. We are, after all, fully integrated human beings. Chronic care principles apply as easily to congestive heart failure as they do to chronic bipolar disorder. It is timely to include mental health in payment parity and now performance parity. Welcome home.

Craigan Gray

About the Author

Craigan Gray, MD, MBA, JD

Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings rich experience from private practice, hospital leadership, and governmental health-benefit programs. Prior to joining Salient, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. In addition to an MD degree, Dr. Gray holds an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.

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