What`s on the horizon?

I was recently asked, “What looks to be on the horizon for the next generation of behavioral health leaders?” As we approach the end of a decade maybe it’s an appropriate time to look back to where we’ve been in the last 10 years and forward to where we seem to be headed. My crystal ball is a bit cloudy but here’s my two cents.

America is looking at a long term period of economic scarcity that will negatively impact all social services funding for at least the next decade. 

• The notion of what constitutes an “entitlement” is dramatically changing. There is growing acceptance that fewer and less generous entitlements await future generations, as over-all quality of life will have to decline to realign with the economic realities.
• It will be fully recognized that Medicaid is already the de facto national health insurance plan. Healthcare reform will just reinforce this fact. Individual states will seek and gain greater control over Medicaid spending, leading to greater disparities in benefits state to state. At the same time, the process will be politicized to a much greater extent than ever before. Ideology rather than human need or science will drive future Medicaid spending and priorities.
• The adoption of “Recovery models” has already lead to greater personal responsibility for treatment decisions on the part of the consumer. It will also lead to greater consumer involvement in paying for the cost of treatment. The sliding fee scale will have a lot less slide in the future.
• The Supreme Court’s 1999 " Olmstead Decision?" that services to persons with disabilities must be provided “in the most integrated setting possible” will drive a major second wave of deinstitutionalization much as O'Connor v. Donaldson was behind the first major wave starting in 1975. However some states will use transformation and deinstitutionalization as a political pretext for reducing the economic infrastructure supporting service delivery.
• Evidence-based practices will be given lip service, but unvalidated instruments and procedures will be continue to be employed to limit service access and eligibility to drive a political/economic agenda in many areas.
• Complicated Rube Goldberg-like managed care eligibility programs will provide a variety of loopholes for states and managed care entities to refused to pay for legitimately rendered services. Market share will be much less of a problems than just getting other entities to pay for the services that behavioral healthcare organization provided. Perverse incentives to obfuscate payment responsibilities will prevent simpler and more straight-forward approaches such as capitated plans from being utilized.
• The debate over funding for maintenance vs. rehabilitation services will remain a core challenge for future leaders. These leaders will have to challenge the long held notion that federal funding should only address services for patients who show progress. Maintenance of functional levels and prevention of deterioration must be made legitimate service goals.