Effective Communication: A Shared Illusion

Shaw_George-001I wrote last week in my post, Mental Illness Is A Community Disease that I was planning to participate in today’s public listening session held in connection with the development of new criteria that will impact Certified Community Behavioral Health Clinics (CCBHC). Mandated under Section 223 of the Protecting Access to Medicare Act of 2014, the intent is to strengthen community mental health systems by establishing higher standards of care and better coordination and communication across individuals, organizations and agencies that provide assistance and care to individuals in their communities.

Among the five topic areas discussed today (see previous post), not surprisingly I found Care Coordination to be the most interesting because of the parallels I recognized between mental/behavioral health and post-acute/long-term care. These include:

both groups of individuals typically require help from both community-based services and supports, as well as healthcare providers, and the lack of sharing of timely information across those entities in both instances is a challenging obstacle to managing care;

both groups rely heavily on Medicaid to fund needed services and care – and so both are likely to increasingly have to navigate the world of managed care – which doesn’t bode well in light of the point above;

both groups have evidentially achieved significant benefit from taking a holistic approach to care;

there is a need with both groups to understand and address the impact that varying levels of cognitive awareness can have on patient activation; and

the ability to achieve sustainable wellness in both groups is often primarily dependent upon the ability to maintain meaningful, long-term connectivity with care providers (in particular where medication management is concerned).

Most importantly however, germane to – yet beyond just – the importance of care coordination, a key take away from today’s sharing of thoughts, insights and the occasional organizational promotion and positioning was the shared impact that ineffective communication has in mental/behavioral health as it does in post-acute/long-term care. And really, across all of healthcare as has been discussed here before.

Effective communication is an art form, but it’s an art that can be taught and learned among willing participants. All too often, however, that willingness comes from a desire to be heard rather than to be understood – and to understand. George Bernard Shaw (pictured above) once wrote that, “the single biggest problem in communication is the illusion that it has taken place.”

Despite, or perhaps in good measure because of, all the technological advancements that have achieved miraculous achievements in healthcare we still fall well short of our potential to reduce human suffering because of a basic inability to communicate effectively.

I would like to see more sharing of experiences and best practices in care integration between mental and behavioral health and post-acute/long-term care: each probably could learn a lot from the other. But that would involve effective communication . . .


Mental Illness Is A Community Disease

For those Pub patrons interested in being kept informed on happenings affecting the futureneeding-mental-health-care of mental health policy in the US. the Substance Abuse and Mental Health Services Administration (SAMHSA) will be holding a public listening session next Wednesday, November 12th, to solicit input and feedback on the establishment of criteria for  the Certified Community Behavioral Health Clinics (CCBHC) Demonstration Program, as outlined in Protecting Access to Medicare Act (P.L. 113-93, Section 223).

    The demonstration program was originally introduced as the Excellence in Mental Health Act by Senators Stabenow (D-MI) and Blunt (R-MO) and U.S. Representatives Matsui (D-CA) and Lance (R-NJ) and is an effort to strengthen community mental health systems by establishing higher standards of care and better coordination and communication across individuals, organizations and agencies that provide assistance and care to individuals in their communities. 

Under provisions of the Act, which was an extender bill used to delay until March of next year pending cuts to Medicare, a maximum of eight states will be selected to participate in a two-year demonstration program whereby the federal government will pay a matching percentage to those states for providing medical assistance for mental health services equal to what Federally Qualified Health Centers (FQHCs) currently receive for primary care services. This is strictly an outpatient clinic initiative (i.e., no funding for inpatient care, boarding, residential treatment).

Example services to be provided by CCBHC’s under the demonstration program include 24-hour crisis management, screening assessments and diagnostic services, outpatient mental health and substance-abuse services, primary care screening and peer support and counseling. The HHS secretary is to determine criteria for a clinic to be certified by a state as a CCBHC no later than September of next year. Next week’s session will solicit input on criteria such as,

  • staffing requirements: e.g., qualifications, areas of experience & expertise, licensing and credentialing, recruiting;
  • availability, scope and accessibility of services: e.g., looking beyond crisis management, determining basis of financial responsibility, evidencing service and referral relationships;
  • care coordination: e.g., relationships with other providers, integration into and with community services and agencies, enabling technical requirements;
  • governance, accountability & reporting: e.g., organizational authority, measuring outcomes, evidential reporting.
  • The secretary is also directed to provide guidance for the establishment of a prospective payment system for this demonstration program, no later than Sept. 1, 2015.

    As I have shared in this space numerous times before, mental and behavioral health services are underfunded and inadequately available to meet the growing needs across the country. We are learning more every day of the evidentiary benefits – to the individual and society – of taking a holistic approach to individual health and welfare. I am hoping to learn more next week whether and how this demonstration program might lead to addressing this critical concern – and I will report back what I learn.