By Joseph F. Vitale and Robert Singer
Finding time to go to the doctor can be quite a hassle amid hectic work and family obligations. For low-income individuals, many of whom are covered by Medicaid, going to the doctor requires unpaid time off from work, securing child care and paying for transportation. All of these additional costs add up and can hinder one’s ability to pay for necessities such as housing and food. These costs multiply for individuals with a behavioral health condition, such as a mental health or substance abuse issue, because behavioral health treatment is rarely available in the primary care setting and therefore requires additional appointments.
In these circumstances, many patients ignore the condition and do not get the behavioral health treatment they need. When behavioral health conditions go untreated, they not only worsen, but also exacerbate the effects of other chronic medical conditions such as diabetes or heart disease. This pattern often leads individuals to seek costly treatment in hospital emergency departments and can result in inpatient hospitalization. Access to behavioral health treatment in the primary care setting could help avoid costly hospital visits and improve patients’ overall health.
Unfortunately, New Jersey’s policies don’t make things any easier for these patients or for the primary care centers providing them care. Government red tape makes it difficult for primary care centers to provide behavioral health care. Currently, ambulatory care facilities such as doctors’ offices, urgent care facilities or public health clinics must hold a separate license to provide behavioral health treatment, and they are required to provide behavioral health treatment in a completely separate space. These bureaucratic and physical barriers to care often require patients to make separate appointments to meet with separate practitioners. Existing state regulations, which evolved from the way the federal government has historically funded mental health and substance abuse services, have fragmented care in unnecessary ways. Because behavioral health issues can have direct correlation to a patient’s physical health, the fragmentation of physical and behavioral health care is detrimental to patients, their families and the state.
A new report from the Rutgers Center for State Health Policy funded by the Nicholson Foundation offers fresh evidence of the importance of integrating physical and behavioral health at primary care centers. The report found that 75 percent of New Jersey residents who frequently use the hospital suffer from one or more behavioral health conditions. Moreover, it found that more than one-third of hospitalization costs in 13 low-income New Jersey communities are associated with behavioral health conditions, to the tune of $880 million in annual inpatient costs.
The report also highlighted the role behavioral health issues play in the inefficient and often avoidable use of New Jersey’s hospitals. It found that as many as 40 percent of preventable inpatient hospital admissions could have been avoided if there had been high-quality ambulatory behavioral health care in the community.
The need to comprehensively treat the whole individual could not be clearer. The good news is that by adopting evidence-based models of care that integrate mental health and substance abuse into the primary care settings, we can improve patient outcomes and reduce overall health care costs.
As the ranking members of the Senate health committee, we understand the importance of integrating care for New Jerseyans in order to prevent expensive hospital stays. We must remove unnecessary barriers that exist between behavioral and ambulatory health care services. A single special license would be a common sense approach to cover all primary health care services including behavioral health services. This will make doctors’ offices, urgent care facilities and public health clinics one-stop shops for many medical needs.
With new policies in place, New Jersey’s Medicaid recipients and the state budget will benefit from the success of these new and proven models of care. Getting this under way quickly is crucial, because Medicaid has expanded to encompass 1.4 million people, costing $15.2 billion.
New Jerseyans who go to the hospital frequently with complex behavioral and physical health problems are sending us a message: Our current policies are not working for them. Let’s remove the barriers to integrated care and focus on doing what is best for New Jersey.
Read Senator Vitale’s opinion-editorial on the Times of Trenton’s website here.