The inevitability of outcomes.

A hundred thousand Americans lose their health insurance every month. The cost of health care consumes a huge portion of the gross national product and slows down the economy. We attempt to lower behavioral healthcare costs by reducing eligibility, inpatient treatment, length of service, and access to specific treatments, without measuring the impacts of those reductions on the clinical effectiveness of our treatment - a procedure akin to performing neurosurgery blindfolded. In view of all this, healthcare reform has taken on the aura of inevitability.

What role will outcome measurement have in the healthcare reform plan proposed by the Clinton Administration? It is a plan that changes from news release to news release, almost on a daily basis. Nevertheless, no matter what ideas are finally implemented, there is an acknowledgement of the interdependence of outcome measurement, reimbursement, and treatment organization. This will have a profound impact on the future of behavioral healthcare.

The Clinton Administration healthcare plan, as currently understood, proposes an aggressive public-private system in which providers will be organized in a continuum of care model, be paid on a capitated basis, and compete on the basis of quality. This model would revolutionize the way chemical dependency and mental health treatment is delivered in the United States. As in other revolutionary movements, it will be both the best of times and the worst of times. It will be the best of times for those who will benefit from change - patients and families who gain access to treatment, and providers who understand the nature of what is called for in the new order and are given the opportunity to provide treatment services to larger populations. It will be the worst of times for those who stand to lose by change - providers who are slow to respond to challenges and new opportunities and subsequently find themselves disenfranchised from third-party reimbursement opportunities.

From the perspective of Americans who do not have access to healthcare, universal access is the most revolutionary aspect of the proposed Clinton healthcare plan. From a provider's perspective, however, the advent of universal access is more of a quantitative than revolutionary change. Universal access creates a larger potential market of patients who will receive third-party reimbursement. The revolutionary implications of the plan from a provider's perspective are the consequences flowing from the plan architecture. Many institutions, professional disciplines, and individuals who have been providing treatment may find their roles more radically altered within the next twenty-four months than in the past ten years.

The Clinton healthcare plan, as it stands at this writing, will organize payers into Health Alliances and providers into Accountable Health Plans. There will be several Health Alliances in each geographic area, and they will compete with each other for customers. To be eligible to be a Health Alliance, an organization will have to offer a uniform, full range of treatment services to everyone. Health Alliances will have to provide public information about the clinical effectiveness of services, and about how satisfied customers are with those services. Large employers may act as Health Alliances for their employees.

Health Alliances will offer people a number of alternative health plans from which to choose. Consumers will sign up for a plan …