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From the Director's Corner

Dear Friends,

Harold Wilson, twice Prime Minister of the United Kingdom, once said, “He who rejects

change is the architect of decay. The only human institution which rejects progress is
the cemetery.” We’re certainly operating in an environment of profound change, particularly
when we look at the transformations that are underway in America’s health (sick) care
system and the critical need to produce better outcomes while simultaneously saving money.
It’s also a dangerous time to rest on tradition as those who remain rooted in business as
usual are at risk of having no business at all.
Some of the emerging strategies for redesigning health care, while controversial, seem to make perfect sense. Establishing mechanisms for rewarding people who increase their commitment to healthier lives seems like a good idea that saves money, improves health outcomes and elevates patient satisfaction. Identifying disproportionately high users of healthcare services and trying to figure out what will help them to be happier and healthier, particularly if this is done with respect and the understanding that most of us can be trusted to know what we need, is another promising avenue to pursue. For this to work it will be incumbent on insurance companies and policy makers to become more flexible in what they will fund and
how reimbursements are managed, applying metrics of cost to probable benefit without consideration for what is “typically” paid for. As an example, I was unable (and I’m pretty persuasive) to get my insurance company to pay $200 for an evidence-based Diabetes Prevention Program because it was delivered at the YMCA. Fitting round health problems into existing square services won’t result in the sweeping changes necessary to get costs in check.
Proposed changes, which are moving forward at an outrageously brisk pace, create opportunities that fit well with Direction Service’s values and strengths. At our Family Support and Service Coordination Program we’ve specialized for the last 35 years in partnering with parents to organize services and supports around families who have children with disabilities, a population that is likely to have meaningfully increased healthcare needs. There’s recognition in the healthcare reform movement that having “navigators” can help systems more capably respond to individual needs and give healthcare consumers the tools needed to be healthier. For children who often face complex health and behavioral challenges, ensuring that all the critical players are engaged in planning and service delivery results in comprehensive programs that produce better results. Funding care coordination per capita rather than per billable hour eliminates some of the current barriers that artificially constrain “the work” and add bureaucratic billing expectations that needlessly increase expense. At a recent presentation, health policy expert Dale Jarvis shared the shocking statistic that Americans with serious mental illness die on average at the age of 53 and that Americans with behavioral health needs have much higher healthcare costs. The recognition that healthcare, behavioral health and chemical dependency treatment are inextricably linked is setting the stage for a new era of coordinated services that wraps around individuals who are facing particularly challenging circumstances
and helps them lead longer, improved lives.
Direction Service is pleased to be a part of the Community Behavioral Health Consortium, a network
of behavioral health providers that is aggressively pursuing operational changes that will enhance
working relationships with physicians and hospitals, all in service of better community health. As Dale is fond of saying, “the head is being reconnected to the body.”
At Direction Service we’re eagerly participating in the unfolding changes while remaining acutely aware that in the final analysis, the true test will be how the lives of the individuals and families who count on us to do the right thing will be impacted.
We won’t disappoint.

Marshall Peter, Executive Director

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