Drug crisis, push for parity boosting behavioral health?
Edd Cote
Michael Krupa, CEO of Health Partners New England, is overseeing construction of a new inpatient psychiatric facility in Devens.
On a seven-acre plot of land in Devens, a Winchester-based behavioral health consulting company is in midst of building a 104-bed inpatient facility for people with mental and behavioral health disorders.
Attracted by Devens’ streamlined permitting process and a friendly set of neighbors who don’t mind seeing such a facility built nearby, Health Partners New England (CQ) CEO Michael Krupa (CQ) said the new Devens location will be an apt extension of the for-profit company’s services.
For people living in Central Massachusetts who need inpatient treatment and have to sometimes wait for days before a bed opens up, often far from home, it could offer a sorely needed option close to home.
“By opening these beds up, it will both be closer (to Worcester and Lowell) and by adding all this capacity, it should hugely reduce these wait times,” Krupa said.
Krupa hopes the building will be enclosed in time for crews to begin working inside the building this winter and he anticipates an opening in September 2016. And while a for-profit , standalone behavioral health facility is unique in the region, Krupa doesn’t expect that Health Partners New England will be the only newcomer offering services in Central Massachusetts.
An improved environment for behavioral health?
Massachusetts has what Krupa described as a “pro-behavioral health” governor, plus insurance coverage policies that have been improved in recent years for behavioral health services. A movement toward parity for insurance coverage of behavioral health services, bringing them in line with medical-surgical coverage, has also been about three or four years in the works, and the opioid addiction crisis that’s rampant in New England further elevated the importance of behavioral health.
“We’re really seeing more positive embracing of behavioral health services,” Krupa said.
Whether Health Partners New England will be joined by another for-profit provider in the region remains to be seen, but planning for community hospital-based behavioral health projects in other parts of Worcester County is well underway.
Petersham, Webster projects on deck
Like Health Partners New England, new facilities planned for Petersham and Webster are designed to treat “dual-diagnoses” patients, who suffer from mental illness as well as addiction.
These projects back up Krupa’s assertion that the environment is improving somewhat for behavioral health services as a business.
Such services are not particularly lucrative for health care providers, which has led to a system that falls short of meeting the needs of people with mental health and substance abuse disorders, or both. But there have been some important developments that are driving new investment in behavioral health services in Massachusetts. Among them is opioid epidemic that state officials have vowed to address in midst of a huge spike in opioid-related deaths.
Rebecca Bialecki (CQ), vice president of Community Health at Gardner-based Heywood Healthcare (CQ), believes the crisis helped boost the fight for parity in the behavioral health arena.
“It’s sad to see that it took a crisis to get there,” Bialecki said.
Commercial insurers are becoming more adept at authorizing coverage, according to Bialecki. Meanwhile, provisions under the state health care reform law, Chapter 224, require commercial payers to treat those with behavioral health disorders the same way they would treat medical-surgical patients.
For this reason, Bialecki is hopeful that a new inpatient facility that Heywood is planning to build in Petersham will at least break even, which is about as much as the system can hope for, she said. Serving as the executive director of the Quabbin Retreat, Bialecki is spearheading the project. It’s moving ahead despite news that a $1.3 million grant to help fund the project was cut from the state budget. Renovation of the facility, formerly occupied by the Sisters of Assumption, is slated to begin next year. The facility probably won’t be a profit center for Heywood, said Bialecki, who said the system is hoping it will run in the black from insurance payments and rent generated by tenants that will lease some of the space for other purposes.
“We want to have it be sustainable,” Bialecki said.
Cost concerns aside, Bialecki said the need for more behavioral health beds in the North Central Massachusetts area is profound. She said it’s rare to find people who don’t have a mental illness occurring in conjunction with addiction, and dual-diagnoses beds are even harder to come by in the state than beds reserved for patients with mental illness only. Meanwhile, the area is plagued by a suicide rate that’s “several times the state average,” particularly among young- to middle-aged men. Economic conditions and geographic isolation are likely drivers, Bialecki said.
Public payer challenges persist
Despite some legislative changes that have improved coverage for mental health patients, public insurers, like MassHealth (CQ), don’t reimburse providers nearly enough to break even on services offered. Commercial insurers reimburse at a higher rate, but it’s tough for hospital systems serving a large number of publicly-insured patients to cover expenses, said Greg Mirhej (CQ), assistant vice president of Behavioral Health at Southbridge-based Harrington HealthCare (CQ). Mirhej said the payment delta varies depending on the service, but behavioral health services generate “significantly less money” than those delivered in, say, a hospital medical-surgical unit.
And the divide between public and commercial payers is also significant. One form of toxicology drug testing that Harrington offers to patients mandated to receive outpatient treatment through the court system is highly accurate compared with standard drug testing, but MassHealth pays significantly less than what it costs to perform the test, Mirhej said, and that discourages the system from using it.
Still, Harrington HealthCare is investing in its own behavioral health expansion. Armed with $1.4 million, a portion of a grant from the state Health Policy Commission (CQ), Harrington plans to build a 16-bed inpatient unit for dual-diagnoses patients at is Webster campus, the former Hubbard Hospital that is now the site of a new Emergency Department. A step-down unit that will house outpatient services is also in the works.
Mirhej said the unit, which requires Harrington to raise at least a couple million more dollars, is expected to break ground next year. It will provide beds in an area of the state that has historically had no local inpatient behavioral health resources, and is geographically isolated from areas that offer them. Patients in South Worcester County typically end up in Worcester or Boston when they eventually are placed in a bed. And, like Bialecki, Mirhej said dual-diagnoses beds are virtually impossible to come by. Patients often end up in a facility that treats mental illness or addiction; not both.
When asked if South Worcester County will feel a difference when Harrington opens its Webster inpatient unit, Mirhej was unsure.
“I think so and I hope so. But we are a little late to the game,” Mirhej said.
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