Looking to a new horizon

As we move from advocating to implementing national health reform legislation, our certitude will decrease and our anxiety will grow. We will be moving into an unknown field of action, in which the vast majority of Americans will have personal health insurance through either a private or a public plan, yet we have a lot to learn about how this field operates. This dramatic change will reverberate across the health and specialty service delivery systems.

The increased level of personal health insurance coverage nationwide will promote integration of behavioral health and medical/surgical benefits due to the Wellstone-Domenici legislation and related health reform amendments. This new insurance framework will accelerate the move toward services integration that is already apparent in early form around the country.

Services integration will include medical/surgical care and behavioral healthcare, including both mental health and substance use care, and disease prevention and health promotion. The specific organizational form this integration will take will depend upon the specific population of individuals involved. Hence, we can expect several different models to emerge, including the behavioral healthcare medical/health home, the primary care medical/health home, and a collaborative model driven by effective care coordination.

Changes in the organizational arrangements underlying service delivery will be accompanied by changes in staffing, infrastructure (notably information technology systems), and financial and performance requirements. Some of these changes will be dictated by health reform legislation or ensuing federal regulations and programs.

How should we respond to all of these changes? Perhaps the best way to do so is to be guided by some key principles. Among others, the following would seem to be central:

• Goal attainment: The consumer comes first-addressing needs, sharing decisions, and promoting a full life in the community are essential components of this principle.

• Integration: Integrate what is needed. Many public and private consumers need a range of social services, including housing, employment training and supports, family services, and help with understanding benefits and accessing services provided through personal health insurance.

• Pattern maintenance: Be deliberate and plan ahead. You will need to introduce change, but this should be done in a thoughtful way. At the same time, you must continue to survey the environment to learn what early adopters are doing and see what degree of success they are achieving.

• Adaptation: Identify new partners. This will require you to learn new cultures, new terminology, and new ways of organizing care delivery. Recognize that these new partners will have the same assignment with respect to your organization. These partnerships will be both exciting and challenging.

These four characteristics-goal attainment, integration, pattern maintenance, and adaptation-are the key operations of all successful systems. A little reflection will help you understand why each is important for helping your organization address national health reform.

We literally have been waiting generations for the advent of national health reform. Now that the day has finally arrived, we surely want to do our best to be successful at realizing the dream of good healthcare for millions of Americans who have been deprived in the past.

Ronald W. Manderscheid, PhD, worked for more than 30 years in the federal government on behavioral health research and policy. He is the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors as well as a member of Behavioral Healthcare's Editorial Board. Behavioral Healthcare 2010 April;30(4):7