President’s Corner: Is it Time to be Bullish on Behavioral Health?

November 4, 2014 · Margaret E. O'Kane

The history of behavioral health care quality isn’t great: no real progress for 10 years.

As an optimist, I believe that’s about to change. Here’s why:

More Measures

Between 2013 and 2015, NCQA will more than double the number of HEDIS behavioral health measures.

New measures aim to minimize risk associated with use of powerful antipsychotic medications among vulnerable populations and to ensure they aren’t used as a “first resort” in children and adolescents. (See our State of Health Care Quality Report for the measures.)

More measures alone do not mean improved behavioral healthcare—but it’s a start. We’ll follow the old truism: “What gets measured gets improved.”

An Economic Case

It helps to be an idealist to believe in better care for better mental health, but now there is also an economic reason to want better behavioral healthcare.

People with mental illness tend to be high consumers of medical care, a fact that expansion of Medicaid under the Affordable Care Act will make harder to ignore as many more people with serious mental health issues have access to (expensive!) care. Even dedicated realists will learn there is a business case for an aggressive focus on behavioral healthcare.


Large employers have been required to offer comparable behavioral and physical health coverage since 2008. Beginning in 2014, small employers and individual market plans are required to do the same—in addition to covering 10 “Essential Health Benefit” categories, including mental health and substance use services.

Cost is a major barrier to appropriate care; the ACA could do a lot to remove this obstacle.

By making behavioral healthcare an equally covered benefit, the ACA could also make behavioral care an essential part of a complete health care system.

There is no guarantee that behavioral health care scores will improve. Hard work stands between the current mental health care system and the system that we deserve. Bridging the gap between health plans and behavioral health carve-outs—so that providers see the whole patient—will take time.

The optimist in me knows we can create a new history for behavioral healthcare quality if we choose to do so.

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