11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

Ideas For Health Care Beds

While spending a lot of time in a hospital, nursing home, or private care facility, you want the most comfortable furniture, especially a bed, for the most comfortable stay possible. Health care beds can make sick people more comfortable if they have to spend lots of time reclining. Raising the head or legs may also be necessary to recover from some surgeries or illnesses. You need to consider a few things when deciding on the right kind.

A good model should provide comfort and safety for the person, and will make the caregiver’s job a little easier. It is important that the head and foot areas be adjustable to several positions. The rails on the side keep the person from accidentally falling out of the bed. They also give the person something to hold when getting up or down. Raising and lowering the entire platform is also important. A lower position makes it safer for a weaker person to both stand up and sit down. Caregivers appreciate a higher position, since they won’t have to bend over so far to tend to the patient.

If you choose a manual model, the caregiver must have enough physical strength to use the cranks that change the positions. Not everyone is strong enough to do this. With an electric model, the positions are changed by motors operated by buttons. Electric models may have more positions to choose from than manual ones. They also may be able to weigh the person without him getting up. Not to mention they are simpler to use and take less effort on behalf of the patient and the care giver.

Another thing that can make a big difference is choosing the right mattress. Mattresses can be filled with gel, air, or foam. Pressure sores may be avoided or treated with the right kind of mattress. Make sure to get sheets that match your chosen mattress. Different types of injuries need a different firmness and type of mattress.

These special items can be quite expensive, but some of the cost may be covered by your health insurance. The insurance company may require a statement of necessity from your doctor before they will cover it.

Health care beds can really help the quality of life for certain patients. Choose a provider that will help you both pick the best model for your situation and guide you through the process of finding the money you need to pay for it.

Improving Health Care in America’s Not That Complicated

Government intervention and oversight aimed at improving the quality of healthcare in America will be far less effective than improving the dialogue between doctor and patient. That belief is well-documented in “The Language of Caring Guide For Physicians: Communication Essentials For Patient-Centered Care” by Wendy Leebov and Carla Rotering.

In this book the authors offer a well-thought out and detailed methodology for doctors on how to raise the quality of care in their practices to build up client satisfaction and confidence. And when patients believe in their doctors they are more to listen to and follow their doctor’s directives, thus elevating their level of good health and lowering risks.

The authors stress that doctor-patient communication has a great impact on almost all areas of a medical practice. And that communication with staff also is key to an effective and successful practice. They point out that poor communication by doctors is a major cause for patients returning to the hospital after being discharged and is a major reason leading to medical malpractice lawsuits. They summarize the importance of this single factor in this statement: “The quality of your communication – the important spoken and unspoken conversations that reside between you, patients and families, and coworkers – has a far-reaching impact on outcomes, public perception, reputation, pay, job satisfaction and much more.”

This book not only provides very detailed training material but relies heavily on graphics to neatly and effectively summarize points within each chapter and at the end of each chapter. The authors are consultants and trainers who have dedicated much of their professional lives to elevating professionalism and compassion in the medical field. The Language of Caring Guide for Physicians, in my opinion, is a must read for doctors.

What to Look For in Home Health Care

In between full-time hospitalization and a healthy lifestyle lies an unfortunate middle ground known as home health care. Some people have conditions that are not so severe as to require constant care through hospitalization, but are serious enough that the patient needs regular attention from a trained professional. Should a family member need attention of this frequency, your daily commitments and lack of medical training may make it impossible for you to provide your loved one with the care they need. In this instance, you will need the help of a home health care service.

Hiring an in-home medical professional is not a decision people make many times in their lives. The subject matter is difficult enough that actually weighing the merits of different companies (especially companies that will be responsible for your loved one’s well-being) could feel overwhelming. What you need are a few simple points of comparison that will help guide you through the process.

Variety in Staff

Chronic disease is extremely difficult to predict. People recover at random, get worse without warning, and develop new symptoms with frequency. In order to provide your family member with care that will adapt along with their needs, you’ll require a company with a wide variety of trained staff members. Any company worth hiring should offer most of the following: specialized nurses, dieticians, physical and occupational therapists, speech-language pathologists, and religious consultants. These various staff members will be able to provide aid at every step of your loved one’s treatment and recovery. Regardless of what twists and turns their illness takes, you will be able to rest easy knowing that you’ve provided them with solutions to whatever arises.

Variety in Service

As with the need for variety in staff, you may not be fully aware of all the treatment options your loved one will need when they first enter into home health care. While a strong variety in staff will aid in quality of life and recovery, ultimately a medical professional will need to be regularly treating each new symptom as it develops. Some of the services you should look for include: wound management, radiology services, physical therapy, social work services, speech-language pathology, occupational therapy, post-surgery care, cardiovascular rehabilitation, orthopedic rehabilitation, neurological rehabilitation, pain management, urology management, and rehabilitation nursing. Talk to your family member’s doctors about the types of care they’ll anticipate becoming necessary, and compare it to the list of services provided by the company in question.

Do They Take Your Insurance

It’s an obvious point, but one worth stating. Medical care in a form, particularly long-term care is extremely expensive. You need to make absolutely certain that the company you choose will work with whatever forms of medical compensation your loved one is able to access.

It is perfectly natural to feel overwhelmed by this sort of decision. You are trying to look objectively at a situation absolutely fraught with emotion. Try to strip away the people involved and itemize the quality of the business itself, and the commitment they have to their clients. This way you’ll be able to make the best decision for your family member without compromising your emotional strength.

Leadership Model For A 21st Century Health Care Organization

There is a growing trend for leaders to break the old autocratic model of leadership to newer models using the concepts of shared and participatory leadership. With the every increasing complexity of health care delivery and the new skilled work force, leaders will have to communicate in an atmosphere where a reaching organization objective is a shared responsibility. According to Bennis, Spreitzer and Cummings (2001) in the future the landscape of health care organization will become more decentralized, which will promote agility, proactivity, and autonomy. Future leaders may move away from singular roles to shared leadership networks that may themselves alter the foundations of the organization. The demands for shared leadership or leaders shifting roles on teams will continue to increase. Health care organization will foster the development and empowerment of people, building teamwork and shared leadership on all levels. The leaders of the future will be guides, asking for input and sharing information. Telling people what to do and how to do it will become a thing of the past (Bennis, Spreitzer and Cummings, 2001). In the 21st century the dynamics of health care will offer leaders who have the ability to motivate and empower others a platform to maximize an organization human resources. Leadership will have to be committed to encourage a two way communication in which the vision meets both the organizations objectives and the employee’s needs. This assignment will develop a leadership model for the 21st century that addresses the role of commitment model of shared and participatory leadership in health care organizations.

Commitment model of leadership

Fullam, Lando, Johansen, Reyes, and Szaloczy (1998) suggest effective leadership style is an integral part of creating an environment that nurtures the development of an empowered group. Leader effectiveness is simply the extent to which the leader’s group is successful in achieving organizational goals (Fullam et al., 1998). In the 21st century health care organizations will need leaders that are committed to developing employees in a team environment. In an environment where leadership is transferable according to objective commitment leadership has a shared purpose. Kerfoot and Wantz (2003) suggested in inspired organizations where people are committed and excited about their work, compliance to standards and the continual search for excellence happens automatically. In these organizations, compliance continues when the leader is not present. This type of leadership requires the team leader to use all available means to create three conditions among individuals: (a) shared purpose, (b) self-direction, and (c) quality work. Leaders who create commitment among their employees believe in creating a shared vision that generates a sense of shared destiny for everyone (Kerfoot & Wantz, 2003).

Involving others in leadership is a unique process which is deeply rooted in individuals believing they are a part of the process of meeting organizational objective and purpose. Atchison and Bujak (2001) suggest involving others in the process is important because people tend to support that which they help to create. People resent being changed, but they will change if they understand and desire the change and control the process. Sharing information promotes a sense of participation and allows people to feel acknowledged and respected (Atchison & Bujak, 2001 p. 141).

Toseland, Palmer-Ganeles, and Chapman (1986) suggest when individual leaders cooperate and share their expertise and skills, a more comprehensive decision making process can be achieved rather than when leaders work independently. For example, in a geriatric team, a psychiatric nurse may lead a group focused on heath concerns, a social worker may lead a therapy group, or a mental-health therapy aide may lead a structured reality-orientation group (Toseland et al., 1986). Shared commitment form the leadership in the future will help to develop, coordinate, and integrate the complex and ever changing health care setting for the 21st century.

Respect for authority and work ethic

Haase-Herrick (2005) suggested shared leadership gives the opportunity to enhance or build trust among individuals. Leadership is mobilized around refining the roles of individuals creating positive health practice environments that support the work of the group (Haase-Herrick, 2005). Leadership ability to lead a team in ways that build morale and reinforce work ethics empowers others to perform to their potential in a group. Leadership is the ability to lead individuals towards achieving a common goal. Leadership builds teams and gains the members shared commitment to the team process by creating shared emotion within the group (Pescosolido, 2002).

Collaboration among leaders in health care

There are new models that are emerging which add a new perspective on how to produce effective collaboration within leadership. Wieland et al., (1996) discussed transdisciplinary teams in health care settings, where members have developed sufficient trust and mutual confidence to engage in teaching and learning across all levels of leadership. The collaborating is shared but the ultimate responsibility for effectiveness is provided in their place by other team members. The shared responsibility for example might be a situation where clinicians on a team each serve in a leadership role regardless of their particular disciplinary expertise (Wieland et al., 1996). The shared commitment model of leadership allows for the independence and equality of the contributing professions while pressuring team members to achieve consensus about group goals and priorities. It is important to emphasize the importance of collaboration in a complex and changing health care environment. The focus on the primary purpose for partnership of leaders will ultimately rest on the shared belief in meeting organizational goals though a collaborative effort. Atchison and Bujak (2001) suggest it is important to reemphasize the importance of keeping everyone informed on the primary purpose of achieving success though a collaborative effort. Clarifying expectations and specifically illustrating how proposed changes are likely to affect the participants is important in achieving commitment leadership (Atchison & Bujak, 2001)

Leadership competency on all levels

The ability to lead in the 21st century requires leaders to be competent in motivating and empowering others to perform to their maximum potential. According to Elsevier (2004) leadership is the ability to lead a team or number of individuals in ways which build morale, generate ownership and harness energies and talents towards achieving a common goal. The leadership competency is all about motivating and empowering others while accomplishing organizational objectives. Leadership is the vehicle in which the vision is clarified though the encouragement of two-way communication on all levels of the organization (Elsevier, 2004).

Leaders in the 21st century will have to be competent in identifying change as they occur and encourage others to adjust to those changes for the mutual benefit of achieving objectives. Elsevier (2004) suggest leaders will have to be comfortable with change because which change comes new opportunities for collaboration among followers and peers (Elsevier, 2004). Improving the results of change initiatives while making sure those changes are fully understood will be a priority for leaders who choice to lead by commitment leadership.

Leadership as a changing agent

Longest, Rakich and Darr (2000) suggest organizational change in health care organization does not occur absent certain conditions. Key are the people who are catalysts for change and who can manage the organizational change process. Such people are called change agents. Anyone can be a change agent, although this role usually is played by leadership. Change agents must recognize that any organizational change involves changing individuals. Individuals will not change with out motivation introduces by the changing agent. The changing agent must create a body of shared values and attitudes, a new consensus in which key individuals with in an organization reinforce one another in selling the new way and in defending it against opposition (Longest, Rakich and Darr, 2000). As health care organizations change in the 21st century successful leaders must have the skills that are necessary to make change possible with in teams of individuals. Longest, Rakich and Darr (2000) suggest one of the important category of change is team building or team development, which “remove barriers to group effectiveness, develop self sufficiency in managing group process, and facilitate the change process (Longest, Rakich and Darr, 2000). A leader who leads by commitment must seek to minimize the resistances to change by building a consensus of objectives with in the organizations culture.

Conclusion

Leadership in the complex health care environment in the 21st century will need individuals to be committed to the promotion of team effectiveness. Sarner (2006) suggest leadership is a “power- and value-laden relationship between leaders and followers who intend real changes that reflect their mutual purposes and goals.” In plainer language, leadership is the dynamic that galvanizes individuals into groups to make things different or to make things better — for themselves, for their enterprise, for the world around them. The essential components of leadership have remained more or less constant: intelligence, insight, instinct, vision, communication, discipline, courage, constancy (Sarner, 2006). In the 21st century leaders must know how to gather, sort, and structure information, and then connect it in new ways to create clear objectives that satisfy both the organization and individuals needs. The important skill that can be learning during this process of leadership is the ability to listen to colleagues and collaborators for the sole purpose of foster a shared consensus. In order to communicate a vision in the future a commitment leader must work with others and sometimes defer some part of the leadership process to ensure organizational objectives are achieved.

References

Atchison, T. A. & Bujak, J. S. (2001). Leading transformational change: The physician-executive partnership. Chicago, IL: Health Administration Press.

Elsevier, R. (2004). Leadership and change orientation. Competency & Intelligence 12(2), 16-17. Retrieved October 8, 2006 from http://web.ebscohost.com/ehost/delivery?vid=14&hid=16&sod

Haase-Herrick, K. (2005). The opportunities of stewardship: Leadership for the future. Nursing Administration Quarterly, 29(2), 115-118. Retrieved March 23, 2006, from Ovid Technologies, Inc. Email Service.

Kerfoot, K., & Wantz, S. (2003). Compliance leadership: The 17th century model that doesn’t work. Dermatology Nursing, 15(4), 377. Retrieved June 3, 2005, from http://proquest.umi.com/pqdweb?index

Longest, B., Rakich, J. S. & Darr, K. (2000). Managing health services organizations and systems (4th ed.) Baltimore, MD: Health Professions Press, Inc.

Pescosolido, A. T. (2002). Emergent leaders as managers of group emotion. The Leadership Quarterly 185(2002), xxx-xxx. Retrieved October 5, 2006 from http://www.unh.edu/management/faculty/ob/tp/Emergent%20Leaders%20as%20Managers%20of%20Group%20Emotion.pdf

Sarner, M. (2006). Can leadership be learned? FastCompany.com Retrieved October 8, 2006
from http://www.fastcompany.com/articles/archive/msarner.html

Toseland, R. W., Palmer-Ganeles, J., & Chapman. D. (1986). Teamwork in psychiatric settings. National Association of Social Workers, Inc. Retrieved May 29, 2005, from [http://www.apollolibrary.com/srp/login.asp]

Wieland, D., Kramer, J, Waite, M. S., Rubenstein, L. Z., & Laurence, Z. (1996). The interdisciplinary team in geriatric care. The American Behavioral Scientist. Retrieved May 1, 2005, from [http://proquest.umi.com/pqdwebindex=1]