Health care in Maine must change

Hyperbole has its place in good writing, but it can also obscure an otherwise reasonable debate. Crank up the imagery, toss in some loaded language and a few insults attributed to “people I know” and a normal, everyday column arguing for benchmarks and results-oriented government programming becomes an emotion-laden rebellion against fiscal discipline and change.

In a recent column in the Bangor Daily News (June 19), Dr. Erik Steele portrays Maine’s behavioral health system reform – and many of those associated with it – with melodrama and inaccuracy.

Steele talks about budget cuts when none exist and treats the idea of managed care as a bogeyman that should be feared.

There have been no cuts in funding from the behavioral health budget. This reform effort manages growth in spending by ensuring that those with a behavioral illness receive the right service, at the right time, for the right duration of time and at the appropriate cost.

The numbers clearly show why change is necessary. The cost of mental health services is growing at an unsustainable rate. From fiscal years 2003 to 2006, expenditures have risen by 90 percent, while the number of people receiving services increased by 34 percent.

Maine spent $442 million on behavioral health in fiscal year 2006 and was projected to spend $1 billion during the next two fiscal years. In fiscal year 2007, our initiatives reduce growth by $33 million, in essence, netting a budget increase from the previous year of $25 million.

It is clear that business as usual will not work, particularly when the amount of money spent does not have any correlation to eliminating problems with access or coordination of care.

Second, Maine is not instituting managed care in the usual sense. When we designed our reform plan, we listened to the provider community and took their ideas to heart.

Unlike some managed care systems that pay a certain amount per enrollee per month to contract providers, Maine will continue to pay providers directly while also reviewing how services are delivered. We’re looking for better outcomes and more efficiency.

We have seen this model work effectively in other states and have had some success with it here in Maine. For example, a similar system is used for in-home support services for children.

Those efforts began in July 2006 and less than a year later, we’re already seeing results. We have seen real savings, and data from independent review show that we have delivered better results.

An equally powerful example exists in the managing of the care of children placed out of state. By bringing children back to Maine and establishing and initiating appropriate plans of care, $12 million has been saved in a four-year period.

While it is too soon in the process to agree with Dr. Steele’s choices for quality indicators, there’s no argument that we will need new ways to measure success. That’s a legitimate point well worth a column without all the fiction and drama.

Too bad the column gets lost in its exaggerations. Dr. Steele built his column upon the idea of a blood feud between the state and some providers.

He said, cynically, that just a mention of the state of the Department of Health and Human Services would cause some of his friends to “froth at the mouth” or have “feral snarling replace coherent speech.”

Our experience has been a little different. We are grateful to the many providers who have worked with us to build a more sustainable mental health system, and to all of the providers in the state for the work that they do.

And we also understand that the conflicts we’ve had with some providers stem from sincere and thoughtful policy disagreements. People can disagree about policy without being liars. But there is one inescapable truth in this debate. Maine cannot sustain its current system. We spend more than we can afford, with mixed results for the people we are trying to serve.

That can’t continue.

If we have any hope of helping the people of this state who rely upon behavioral health services, then we will need cooperation and help from the frontline providers who say they are working for the public benefit.

If they retreat behind anonymous barbs and the unreasonable expectation of unlimited yearly increases in spending, then the transition to a new system will be unnecessarily difficult.

Nonetheless, the transition will still happen because sustaining a system of care for behavioral health is critical to the people we serve, their families and the taxpayers of Maine.

Brenda M. Harvey is commissioner of the Department of Health and Human Services.