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A Call for Excellence

Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

A Call for Excellence

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The 2014 National Council Conference left me feeling better than ever about the future for people with mental illnesses and substance use disorders. I am inspired by our members who won’t be lulled into inaction — a sentiment that was ever present during our time together.

As we continue to adjust operational and business practices to implement parity, the Affordable Care Act, and integrated care while exploring new clinical best practices, we can find motivation in the advice we received from former Secretary of State Hillary Clinton: dare to compete.

To thrive in the ever more competitive healthcare industry, excellence must be the goal. With the historic passage of the Excellence in Mental Health Act, behavioral health organizations designated Certified Community Behavioral Health Clinics will have an unprecedented opportunity to establish new standards in the delivery and coordination of care.  And they will receive commensurate reimbursement for these enhanced services. The Excellence Act is an eight state demonstration project projected to bring 900 million dollars into Medicaid for mental and substance use disorder services, the largest investment in generations.

As work was underway to ensure passage of the Excellence Act, Dale Jarvis was leading the National Council’s crowdsourcing project to define a Behavioral Health Center of Excellence.  Your contributions were clear — a Behavioral Health Center of Excellence must masterfully unite science and technology with the human touch.

During the Conference, we released a final white paper to further detail the specific elements of a Behavioral Health Center of Excellence, but at its core, the concept is simple: A Behavioral Health Center of Excellence must be viewed by all in the community as a great place to work and receive care — through the skillful blending of high tech and high touch.

There is no more business as usual. Imagine you’re a primary care physician treating a man with a serious heart condition. Where do you refer him? In the past, you might send him to a specialist who was in your class at school or with whom you have lunch every week. But you can no longer afford to do this because you’re going to be held responsible for the outcome.

You can’t send your patient to someone with high error rates, high costs, and poor outcomes. Instead, you need relationships with high-performing specialists. In other words, you must do business with centers of excellence.

Now, imagine that physician sees a person with a serious mental illness or addiction. If you’re a Behavioral Health Center of Excellence, you will be the go-to organization.

So, what does it take to become a Behavioral Health Center of Excellence? You’ve told us that there are five key elements to a Behavioral Health Center of Excellence:

  1. Provide world-class customer service built on a culture of engagement.Think about companies like Nordstrom, Google, Apple, and my favorite — Amazon Prime. We return to them again and again because they make it easy to be their customer. What does extraordinary customer service look like in our world? It’s more than knowing a person’s health condition; it’s about the willingness to hear his story. It’s about acknowledging the challenges she faces and knowing what services will help her rise above them. It’s about slowing down enough to care, and making their care your priority.
  2. Demonstrate excellent outcomes.You described helping a person identify their goals —  together, setting measurable targets. And together — using standardized instruments embedded in the electronic record — measuring progress. And if there is no progress, using software analytics to help redirect treatment, a Center of Excellence is measurement driven and technology enabled.
  3. Offer easy access.One measure of success is the healthcare providers’ ability to get those who are high-risk, high-need into your care that same day. We know people who receive a same-day appointment show up 90 percent of the time. At Lone Star Circle of Care in Texas, 90 percent of their patients have same-day access to care. And their Navigation Center lets people schedule appointments, ask questions, and receive support for managing their chronic conditions 24/7. Being high touch and high tech isn’t just the right thing to do — it’s the smart thing to do.
  4. Deliver comprehensive care. Centers of Excellence take into account everything that affects an individual’s health. MacArthur Genius and primary care physician Dr. Jeffrey Brenner tells us, “Healthcare is more than the pill we give you.” Housing is healthcare. Healing from physical and sexual abuse is healthcare. Freedom from addictions is healthcare. When the Center for Dependency, Addiction and Rehabilitation in Colorado, went smoke free, 50 percent stayed tobacco free when their treatment ended; and no one stayed away.
  5. Offer excellence value.Excellent value means accountability for both quality and cost. You offer world-class customer service, easy access, comprehensive care, excellent and measurable outcomes, and you’re more cost-effective than the alternatives. You described a Center of Excellence as offering healthcare, for mind and body, anywhere and anytime the customer needs it — at urgent care clinics, at the library, and even at home with a smartphone and monitoring devices.

We invite you to join our commitment to excellence, laying the groundwork to take the Excellence Act from an eight-state demonstration project to a nationwide behavioral health safety net. As our friend Don Berwick has said, “Our time has come.”  The law has been written. The table has been set. Now it’s time for the people who provide the care to improve the care. Truly, we are the only ones who can.

I look forward to your reactions, feedback and questions. Please email me at lindar@thenationalcouncil.org.