Cooperation Now Required in Transformation for Community Mental Health
Mental health advocates say there are other options
May 12, 2011--County mental health administrators are relieved that the newest version of the healthcare transformation bill (House Bill 3650) requires written agreements between counties and coordinated care organizations (CCOs) that will stipulate how the two entities will coordinate mental health services and funding for Medicaid and non-Medicaid clients.
The new language is verbatim language as suggested by Claudia Black, Multnomah County’s lobbyist and Cindy Becker, with Clackamas County, and reflects what other proponents of county mental health systems wanted to see.
“They clearly wanted this exact language,” said Rep. Tim Freeman (R-Roseburg). “We spent a ton of time on this section.”
“We think we have it right,” said Rep. Mitch Greenlick (D-Portland), the committee’s co-chair.
“We’re really pleased with how it turned out,” Becker said. “It brings the counties into being an active participant with the CCOs around mental health and addictions.”
The written agreement between the counties and the coordinated care organizations—which would be responsible for integrating physical, oral and mental healthcare for OHP members and the dually eligible (those receiving both Medicaid and Medicare services)—would outline mutually agreed upon outcomes and funding to “maintain the mental health safety net system.”
The language specifically mentions a number of services provided by the counties, which are local mental health authorities, that need to be funded in order for there to be “effective management” of those services.
They include managing services related to people transitioning to or from the Oregon State Hospital to residential treatment facilities, residential care and related supports, crisis services and supportive services.
“It’s our vision that those written agreements will help the CCOs and the counties coordinate those services,” said Mark Nystrom, policy director with the Association of Oregon Counties.
The bill now makes it possible for coordinated care organizations to contract with counties and receive Medicaid funding. Previously, as The Lund Report reported, county mental health administrators were extremely worried that taking those dollars away from the counties would destroy the community mental health system.
“There was going to be a lack of coordination between Medicaid and non-Medicaid clients,” Nystrom said.
But mental health advocates are critical of allowing counties to continue being the local mental health authority, and said there are other options that should be considered by the Transformation Committee..
Chris Bouneff, the executive director of Oregon’s chapter of the National Alliance of Mental Illness (NAMI), said that counties have not necessarily proven themselves capable of providing adequate mental healthcare, and that the current transformation legislation may result in the perpetuation of a broken system.
“People aren’t getting good, quality care,” he said. “The care is uneven. It’s not as if counties are doing a ton of services, and frankly, they’re not meeting all the needs of the [non-Medicaid] population right now.”
One month ago, the City Club of Portland released a scathingly critical report on Multnomah County’s mental health system, calling for the system to be “completely restructured.”
NAMI is continuing to work with legislators on a proposal that would create a "brokerage" type system allowing counties to purchase services, using their general fund dollars, from the CCO. Those services would involve crisis and safety net services.
However, Greenlick announced last week that it's no longer possible for organizations to submit amendments to the Transformation Committee. Any amendments must come from a legislator. The committee intends to take a vote on the transformation bill on May 19.
Bouneff said if the current version of the transformation bill goes through, the written agreements need to clearly spell out a county’s responsibilities and the outcomes they are expected to deliver.
“Those counties that do a good job should continue to receive preference in contracting," he said. "[But] if outcomes aren't being met, then CCOs should be responsible for finding service providers that can meet the needs of Oregonians living with mental illness."
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Although I completely understand the pain and frustration of advocates of the mentally ill, my own family has been deeply touched by Bi-Polar Disorder, I can't help but feel that the criticisms I read in the press and particularly the Portland City Club report display a basic lack of information around the current system and a misdirected anger at public employees that are hamstrung by our society's morally bankrupt priorities. I work everyday with people at every level of the system and I have found the vast majority to be dedicated, caring, competent people doing the best they can with resource allocations that are shameful, innovating where they are able and open to new ideas as long as they can meet the numerous regulations that must be met when tax dollars are in use.
Significant portions of the state have already moved to a system of outsourced outpatient, residential and crisis/outreach services, leveraging the amazing non-profit community in Oregon. Washington, Multnomah, Clackamas, Marion, Polk, Lane, and Deschutes have embraced the model advocated by NAMI, representing a large proportion of Oregon's care system for the mentally ill. If the model isn't as fully used in areas outside of these urban settings this is largely due to a limited provider network in rural areas where the county mental health departments represent the only economical method of sustaining mental health and addiction care. Efforts should be focused on supporting county health departments, especially in rural areas, as they modernize practice management systems, implement electronic medical records and transform their internal culture.
If our society would put its money where its mouth is (do you hear me Portland City Club) and get behind the many progressive projects already in place and provide the resources to do all the many wonderful things we would all like to see from our public health system, then we might see real incremental, but steady year over year improvements. Blowing up the underfunded system every decade because it doesn't create the results we expect doesn't seem like a very successful strategy.
I am very happy to see the changes in language to the CCO legislation to include the counties as partners, as I believe the counties and, where possible, their non-profit subcontractors are already the most cost effective delivery system. I look forward to seeing the amazing work they can do when they are included by the physician and hospital community as an essential part of the solution to our struggling public health care system. As in the first part of this century, they will have the opportunity to light the way to transformation of our entire care system.
Please note that this story has been changed from its original version to give a clearer reflection of Chris Bouneff and NAMI Oregon's thoughts concerning the relationship between Community Care Organization's and the Oregon counties that provide mental health care. The original story did not make the concept of a "brokerage system" clear.
Also note that the Joint Committee on Healthcare Transformation has changed the date that it will vote on the transformation bill. The meeting is now scheduled for Monday, May 16.
Thanks for reading,
Amanda Waldroupe
The Lund Report
Same old, same old. Counties need to provide quality assurance as third parties - and should not continue to provide direct services. $$ are diluted this way. There are non-profits out there who can actually provide the services. But, it is critical to have a LOCAL authority that reviews their work. The state, in that regard, is fairly non-functional. Get it right or don't do it at all.