Opinion: Improving the Lot of Some of New Jersey’s Most-Overlooked Citizens

Joel C. Cantor | April 12, 2016 | Opinion
Integrating the treatment of debilitating mental-health problems and physical care can help relieve suffering and reduce some of the burden on the healthcare budget

Joel C. Cantor
Recent actions by the Christie administration are giving significant momentum toward improving the lot of many vulnerable New Jersey residents — people with persistent, disabling mental illnesses, addictions, and chronic homelessness.

In his 2017 budget address, Gov. Chris Christie committed over $100 million to increase payment rates for mental-health and addiction services in Medicaid, the state healthcare program for the poor and disabled. There are steep barriers to access mental-health and addiction care among low-income populations, and inadequate Medicaid payments are one cause of these obstacles. While not a panacea, higher rates surely will help enhance access.

Behavioral health services (which encompass both mental-health and addiction care) are especially important to Medicaid beneficiaries and, frankly, to the state treasury as well. A recent report by a Rutgers working group convened at the request of the governor that I co-chaired with Rutgers colleague Dr. Alfred Tallia, noted that 86 percent of the top one percent most-costly Medicaid beneficiaries have at least one behavioral health condition, including about one-in-three with severe, disabling mental illness.

The Rutgers working group also showed very high rates of potentially preventable hospital utilization among high-cost Medicaid patients. Programs that can address social and behavioral barriers to better health can reduce some of these preventable costs. It is a good start to raise payments for behavioral-health services to enhance the lives of these very ill patients, but that move can also potentially rein in high hospital spending in this group.

On April 7, the governor announced another important step to address gaps in care for people with mental-health and substance-use disorders. New Jersey will expand a little-known, but very promising program called Behavioral Health Homes that addresses physical illnesses of people engaged in treatment of their severe behavioral-health conditions. These programs, which will grow from four to 11 sites around the state, co-locate primary-care services, often delivered by nurse practitioners, in mental-health treatment settings.

Addressing the physical health problems of individuals receiving behavioral-health treatment is not merely a matter of convenience. People with conditions like schizophrenia, major depression, and bipolar disorders face serious challenges engaging with complex systems of care. By integrating medical services within community mental-health settings where these clients are most comfortable, the likelihood that they will get their physical ailments treated increases dramatically.

People with severe mental illness suffer a disproportionate burden of chronic physical conditions such as heart failure and diabetes. In fact, some medications to treat disabling mental-health conditions can have side effects that make chronic physical illnesses worse. Treating the whole person — both the mind and the body — is vital for people with severe mental illness.

In one other important recent move, Gov. Christie announced a statewide program to provide housing rental vouchers to 500 “… chronically homeless individuals and/or families who are high utilizers of public systems.” One hundred of the vouchers will go to veterans. The voucher program, called “Housing First,” is an evidence-based model that has been shown in rigorous studies to reduce hospital costs and encounters with the criminal justice system. Well executed, Housing First can even pay for itself, with savings across different public services offsetting new housing costs.

These steps by the Christie administration are important and they will strengthen the state’s safety net for some of the most vulnerable. They will make many people better off and they are likely to be cost-effective for state government. But there is much work still to be done. The Behavioral Health Homes and Housing First initiatives are an important step but they will not likely meet all need for such services. There are also additional barriers to good, well-integrated care that can be tackled.

A superb report released last week by Seton Hall Law School and sponsored by The Nicholson Foundation outlined some additional important steps to improve services for people with co-occurring physical and mental-health problems. The report identifies eight specific regulatory and reimbursement reforms that can break down barriers to good integrated care.

The Rutgers working group report, mentioned above, also outlines concrete steps that that can be considered to address complex social and behavioral drivers of high Medicaid costs and opportunities to improve health outcomes.

In New Jersey, Medicaid covers nearly one in five state residents, many of whom bear extraordinary burdens of illness and poverty. State policymakers are making important strides using the policy tools available through Medicaid and other programs to improve lives and government efficiency. But as the Seton Hall and Rutgers reports make clear, this important work is not yet complete.

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