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Key points
- Timely access to effective treatment for patients with mental health disorders is crucial.
- The U.S. faces a mental health crisis with rising suicides, underscoring the urgent need for systemic reform.
- Our healthcare system's trajectory necessitates a bold reimagining through value-based healthcare principles.
- Meaningful change requires adopting solutions like IPUs that center on patient value and outcome-based care.
By Lidia Moura, M.D., Ph.D., M.P.H., and Susanna Gallani, Ph.D.
Recent research indicates that when parents receive treatment for psychiatric and substance use disorders, the likelihood of family separation decreases significantly. Timely access to effective treatment for parents can be a decisive factor in preserving family bonds and preventing the escalation of mental health and substance use crises. The study's findings underscore the urgent need to address barriers to treatment access for vulnerable parents, particularly those involved with child welfare systems due to substance use disorders. Improving access to comprehensive mental health and substance use disorder treatment services can play a crucial role in promoting family preservation and child well-being.
However, our public mental health outcomes continue spiraling downward. This crisis has far-reaching consequences, where lives are lost not just due to healthcare inefficiencies or prohibitive costs, but to a failure of multiple systems. The U.S. faces rising suicides and untreated mental health conditions, highlighting an urgent need for systemic reform. Timely action must be taken to avert further loss, instill accountability, and ensure the well-being of our communities.
My push for mental health reform is deeply personal, sparked by my grandfather's suicide which deeply impacted my family and highlighted the struggles low-income families face with mental health issues. This tragedy, alongside my commitment to studying and understanding these systemic failures, has driven me to ensure that mental health care is accessible and prioritized for everyone.
This dedication was intensified by a distressing situation involving a friend’s son who, despite urgent need, faced long waits for mental health services. This incident underscored the critical gap in accessing timely mental health care, emphasizing the urgent need for systemic reform to provide immediate and preventive care. This narrative isn't an anomaly but a reflection of a wider crisis, where patients and caregivers navigate a complex system that prioritizes high-cost, low-value interventions, such as emergency room visits, over efficient and timely care, like mental health services in primary care settings. It also sheds light on the ethical dilemmas for those within the system, compelled to consider "skipping the line" for their loved ones—a decision entangled with ethical and fairness considerations.
Some healthcare professionals claim they are already focused on quality or argue that explicit quality measurement is unnecessary because quality is always considered. This perspective may hold where quality metrics are clearly defined and align with patient and caregiver expectations. However, when quality is measured coarsely, like the absence of death or complications, and financial benefits for payors and providers are disconnected from actual patient outcomes like patient satisfaction or improved mental health, frustration ensues from all sides. To be sure, no healthcare system openly admits to disregarding outcome improvement, yet many feel powerless to enact systemic change. Systemic change may feel as daunting as any attempt to reroute the Titanic when the iceberg was already in sight. Instead, the winning strategy may be initiating small, directed actions to steer clear of foreseeable icebergs and combat inertia, this is widely recognized as leading to tragic outcomes, including loss of lives.
We must understand value-based healthcare, VBHC, as a broad healthcare strategy that places patient value at its core. Many view VBHC merely as a payment model, leading to reluctance in adoption when national payment systems remain minimally changed. This narrow perspective overlooks VBHC's ability to improve patient outcomes markedly, make care delivery more efficient, and realign incentives towards what matters most: the health and well-being of patients and caregivers universally.
Our healthcare system's current trajectory, characterized by high costs, low value, and inefficiencies, necessitates a bold reimagining. The principles of value-based healthcare and the implementation of integrated practice units (IPUs)— multidisciplinary healthcare teams that work together to provide comprehensive care for specific health conditions or medical needs—offer a framework for addressing these challenges. By focusing on patient outcomes rather than the volume of services, and integrating care across traditional disciplines, we can dismantle the barriers to accessible, quality care. Much of this can be accomplished even before the payment system is aligned with these goals.
Despite nearly two decades since introducing these principles and numerous success stories, misconceptions about VBHC and IPUs continue, with critics questioning their practicality and impact. However, these models are not intended to be rigid, one-size-fits-all solutions but rather flexible frameworks designed to meet the diverse needs of patients and contexts. For example, a mental health IPU could offer comprehensive, coordinated care for individuals with severe depression, incorporating services ranging from psychiatry to cognitive behavioral therapy, each tailored to the patient's specific complexity and requirements.
The future of U.S. healthcare relies on adopting transformative solutions that center on patient value and outcome-based care. The decision we face: Accept the current system or embrace VBHC for meaningful change. Patients, caregivers, and the community can demand better healthcare and actively participate in its redesign. Let's choose to innovate and work toward an equitable and compassionate system, proving that meaningful change is achievable, even with restricted resources.
Lidia Moura, MD, PhD, MPH, is a clinical neurologist, Associate Professor of Neurology at Harvard Medical School and OpEd Project Fellow at Massachusetts General Hospital, with expertise in biomedical informatics, advanced general neurology, neurophysiology, epidemiology, and health services research. Susanna Gallani, PhD, is the Tai Family Associate Professor of Business Administration in the Accounting and Management Unit at Harvard Business School, where she studies performance management systems in healthcare.
