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CROSS SYSTEM FINANCING – NEW MEXICO’S STORY

CROSS SYSTEM FINANCING – NEW MEXICO’S STORY. Pamela S. Hyde, J.D. Secretary New Mexico Human Services Department June 14, 2006. New Mexico. Rural, frontier state – 1.8 million people; ABQ only city > 100,000 people

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CROSS SYSTEM FINANCING – NEW MEXICO’S STORY

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  1. CROSS SYSTEM FINANCING – NEW MEXICO’S STORY Pamela S. Hyde, J.D. Secretary New Mexico Human Services Department June 14, 2006

  2. New Mexico . . . • Rural, frontier state – 1.8 million people; ABQ only city > 100,000 people • Fifth largest state (10 hours diagonal drive); sixth lowest density (15 people per square mile) • 10 times more American Indians compared to nation (10%) – some without written language • 3 times more people of Hispanic and Mexican origin (45%) – many native Spanish-speaking • Largest number of households without phones

  3. Highest number of children uninsured; second highest total uninsured (21% in 2004) Second highest Medicaid FMAP in country (72%), meaning among the poorest Majority of counties are health professions shortage areas for core MH professionals 50 percent of counties have no psychiatrist; some have no MH professional at all; 80 percent of licensed psychiatrists and almost as high a percentage of psychologists live and work in Albuquerque (largest city) and Santa Fe (state capitol) New Mexico . . .

  4. NEW MEXICO’S BEHAVIORAL HEALTH CROSS SYSTEM FINANCINGAPPROACH

  5. Often insufficient & inappropriate services; lack of attention to evidence-based practices Insufficient or duplicative oversight of providers & services – little attention to quality Lack of common agreement about goals and outcomes Why Is New Mexico Changing?

  6. Not maximizing resources across funding streams, especially Medicaid • Multiple disconnected advisory groups & processes • Duplication of effort & infrastructures at state & local levels (8 different overlapping local administrative infrastructures)

  7. Fragmentation, i.e., different departments, funding streams, service definitions, data systems, and oversight mechanisms for Medicaid, non-Medicaid adults, children, people coming out of prisons, and individuals charged with DWI • Higher administrative costs for providers (multiple contracts for similar services and populations)

  8. How Did This Change Come to Be? • September 2003 – Governor Richardson announces behavioral health changes to achieve: • Better access • Better services • Better use of taxpayers’ dollars • Fall 2003 – Stakeholder meetings and concept paper

  9. February 2004 – HB 271 passed and signed, creating Interagency BH Purchasing Collaborative and Behavioral Health Planning Council, effective May 19, 2004 • Spring & Summer 2004 – Stakeholder meetings and concept paper; multiple topic papers • Fall 2004 – RFP Released • February 2005 – Guidelines for Local Collaboratives Released • Winter 2005 – ValueOptions Selected as Statewide Entity • Spring 2005 – 30 days, contract negotiated; 90 days transition from 5 regional care coordination entities and 3 statewide MCOs

  10. July 1, 2005 – VO begins managing Medicaid behavioral health (including pharmacy); MH and SA Block Grants; State GF for children, non-Medicaid adults, and community corrections • July 1, 2006 – VO will begin managing prevention funds, additional funds for children and substance abuse, and state operated program funds with shadow claims • NOTE: The Collaborative is MORE than just common purchasing through a statewide entity

  11. Vision: Quality Behavioral Health Care Promotes Recovery & Resiliency • Support of recovery & resiliency is expected • Mental health is promoted • Adverse effects of substance abuse & mental illness are prevented or reduced • Customers are assisted in participating fully in the life of their communities • Available funds are managed effectively & efficiently The State of New Mexico is designing a single BH delivery system in which:

  12. TheCollaborative Members • Finance & Administration • Division of Vocational Rehabilitation • Admin. Office of the Courts • Mortgage Finance Authority • Health Policy Commission • Developmental Disabilities Planning Council • Governor’s Commission on Disability • Governor’s Health Policy Advisor • Human Services • Health • Children, Youth & Families • Corrections • Aging & Long Term Services • Public Education • Transportation • Labor • Indian Affairs

  13. New Departments/Entities since 2004 • Public Defender • Public Education Department • Office of Workforce Training and Development • Children’s Cabinet

  14. The Collaborative’s Statutory Duties • Identify BH needs statewide • Give special attention to regional differences: cultural, rural, frontier, urban, & border issues • Seek/consider suggestions of Native Americans • Inventory all MH and SA expenditures • Plan, design and direct A statewide BH system • Contract for operation of one or more BH entities to ensure availability of services (Collaborative decided to do one) • Develop a comprehensive statewide BH plan

  15. The Collaborative Structure (see Handout) • Collaborative as Public Policy-Making Board • Co-Chairs • HSD + Rotating CYFD & DOH every other year • Collaborative Coordinator (CEO) • Cross Agency Steering Group • 8 Cross Agency Teams

  16. What’s Happened So Far? – 1 • Collaborative and BH Planning Council established – per HB 271 • Cross-agency staff workgroups activated (a “virtual department” across agencies, not a reorganization) • 15 Local Collaboratives developed and recognized within five common geographical regions (13 judicial districts) and a sixth common “region” for 2 Native American populations (see Handout – Maps, Roles Chart, etc.) • RFP issued, proposals reviewed, vendor selected, contract negotiated with ValueOptions

  17. What’s Happened So Far? – 2 • Common service definitions developed • First revision of rates toward commonality • Transformation Grant obtained from SAMHSA • Comprehensive planning efforts commenced (see Handout Use of Planning) • Evaluation efforts and resources obtained (2 reports) • Executive Order to address licensing and credentialing of professional workforce (psychologists, social workers and counseling professions); three pieces of legislation to make reciprocity easier

  18. What’s Happened So Far? – 3 • Intervention in specific trouble spots locally and regionally • Creation of 34 additional school-based health centers with BH components • Additional suicide prevention activities • Additional drug abuse (esp. methamphetamine) funding • Medicaid state plan changes – ACT; MST, IOP, CCSS, etc. • Residential treatment services study • Provider capacity survey and training • Multiple grants sought and supported

  19. What’s Happened So Far? – 4 • Consortium for BH Training and Research (CBHTR) kicked off with new Department of Higher Education to address workforce/evidence-based practices • Data from first six to nine months started to come in • 21 performance measures identified for Phase Two and Three (see Handout) • More cohesive contract for Phase Two developed • Over 120 pieces of BH legislation introduced (we’ve got their attention!) • Creating coordinated legislative process • Legislative Finance Council auditing contract

  20. Phase One Goals – FY 2006 • People Get Served • Providers Get Paid • Data Gets Collected • Lose No Ground on Performance

  21. Beyond Phase One • Phase Two = FY 2007 & FY have to RFP for FY 2010 in Fall 2008) • Inclusion of new funding streams/services ($50-$100 million additional state and federal funds) • Increase in evidence-based practices (and practice-based evidence) • Increased workforce development activities • Improved system performance/efficiency • Streamlined and user-friendly systems for providers, customers • Real outcomes for real people, focused on recovery and resiliency

  22. What Have We Learned? – 1 • Social capital & culture shifts – creating the expectation of change and excellence; need for constant reminders • Time & resource requirements – collaboration is hard and time-consuming • Importance of action – rather than build the bridge; leap then learn to fly • Details and data vs. the “Big Picture” (eye on the longer-term vision while attending to current details)

  23. What Have We Learned? – 2 • Communications – the importance of “the elevator story” • Change management challenges – memory loss requires keeping the vision alive; keep explaining how the details matter • Transparency & participation – consumers, families, stakeholders, local communities, legislators, policy-makers, etc. • Rising expectations; rising resistance

  24. What Have We Learned? – 3 • Impact/critical role of strong leadership (at Secretary, Gov, legislative, staff and stakeholder levels) • Real meaning of “partnership” (give and take; need to sustain the engagement and interest) • Critical nature of private sector partner – flexibility & agility, risk-taking, keeping the faith, willingness to take the heat (ValueOptions has been a critical player)

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