CURRENT SYSTEM OF CARE Structural Challenges with the Existing System The existing system of care in this and other regions suffers from profound structural challenges. Additional funding is certainly needed, but it will not fix the conflicting incentives and lack of coordination that perpetuate the siloed delivery of services. For example, because of poor communication among providers and payers, patients experience long delays in getting appropriate crisis, inpatient and outpatient services. The system also lacks a rational funding structure. Temporary funding of promising behavioral health initiatives runs out because providers and payers who may benefit are not incentivized to invest in them. It is beyond dispute that addressing social determinants, such as housing and employment, contribute directly to improved patient outcomes, while reducing repeated and expensive hospital emergency department (ED) visits and inpatient care. And yet, there is no framework to incentivize savings by guaranteeing that at least a portion of the savings will be re-invested locally in social determinants, such as respite and supportive housing, to improve health care outcomes for more patients. The gaps in the care continuum discussed below will demonstrate that a new source of revenue would plug some the important gaps, but not come close to sustaining existing, successful programs, and certainly would not fund the increased capacity to meet the needs of the second largest county in the state. We turn to a summary of available services in the region, gaps in those services, important improvements following the 2016 HSRI report, and then the presentation of a new model based on the successful Medicare ACO architecture that has the potential to transform the region’s system of care to be “accountable, organized, control costs, and improve quality [while being] accessible, equitable, and effective.” 4
Evaluating the Regional Behavioral Health System In 2016, the Pierce County Council engaged the Human Services Research Institute (HSRI) to help identify the essential elements of a “good and modern” behavioral health system and identify the then existing gaps. Our discussion of the region’s services, and service gaps, is organized according to those elements: Community Education; Prevention and Early Intervention; Outpatient Treatment; Communitybased Services; Crisis and Inpatient Services; Services for Justiceinvolved Populations.
