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The Coalition to Preserve Behavioral Health Choices

The Coalition to Preserve Behavioral Health Choices. A Brief History of the Program. Prior to 1997. Behavioral health services were provided in a variety of un-coordinated ways County government was responsible for overseeing the provision of many non-medical services

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The Coalition to Preserve Behavioral Health Choices

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  1. The Coalition to Preserve Behavioral Health Choices A Brief History of the Program

  2. Prior to 1997 • Behavioral health services were provided in a variety of un-coordinated ways • County government was responsible for overseeing the provision of many non-medical services • The Medicaid (Medical Assistance) fee-for-service program, in certain counties, paid for inpatient and outpatient psychiatric services, partial hospitalization and other services • Medicaid physical health managed care organizations, in other counties, also paid for these Medicaid behavioral health services

  3. “A Unified Behavioral Health System” • The Ridge Administration, under the leadership of Secretary Feather Houstoun and Deputy Secretary Charles Curie, decided to implement a unique behavioral health delivery system • They gave county government the “right of first opportunity” to manage the entire behavioral health program on a risk basis • Went on to become a model nationally

  4. Goals and Advantages of the Program • The goals of the program are to: • Assure greater access • Improve quality • Manage costs • Advantages include: • Service development and financial decisions at the local level • The opportunity to better coordinate and manage care • Flexibility to make decisions to meet the needs of each county • The reinvestment of savings in programs and supports that meet the needs of consumers

  5. Implementation • Implementation began in 1997 in Southeastern Pennsylvania • The program, begun under Governor Ridge, continued under Governor Rendell • The implementation process was completed statewide in 2007, by Secretary Estelle Richman and Deputy Secretary Joan Erney

  6. Status in 2011 • All counties are covered by Behavioral Health Choices • Well over 2 million Pennsylvanians are eligible to receive behavioral health services • Most counties subcontracted with behavioral health managed care organizations (BH-MCOs) to assist in operating the program • Each county has one BH-MCO • Only 23, mostly rural counties, did not take advantage of the “right of first opportunity” • In these 23 counties, the state contracted directly with a BH-MCO to manage Behavioral Health Choices

  7. Status in 2011(continued) • Broad base of services provided, including mental health, drug and alcohol, autism, and others • Special populations include children and youth and persons with intellectual disabilities • Five BH-MCOs provide services throughout the state • A national model for BH delivery systems, being considered in several states

  8. Outcomes - Access • Increased number of people served • Access exceeds national benchmarks for persons with serious mental illness • Drug and alcohol network increased by 500 providers; increased access to non-hospital detoxification, rehabilitation, and halfway house services • Less restrictive alternative services increased by 400%

  9. Outcomes - Quality • All behavioral health services are now coordinated and managed at the county level of government • Three state hospitals have closed since 1997 • Consumers and families serve on evaluation committees that select BH-MCOs • Counties and BH-MCOs must establish Consumer/Family Satisfaction Teams (C/FSTs) • Published reports present results of C/FST interviews and 29 quality indicators • BH-MCOs must develop performance improvement plans

  10. Outcomes - Savings • An estimated $4 billion was saved between 1997 and 2008, as compared to the fee-for-service program • A wider array of services in less restrictive settings continues to grow • About $446 million has been reinvested in the expansion of service options in the community • In 1996, in the Southeast Zone, 38.0% of fee-for-service dollars went to inpatient care and 4.4% went to Community Support Services (CSS); In 2008, 16.2% was for hospitalization and 9.5% on CSS • Administrative fees have been reduced

  11. Physical Health/Behavioral HealthCoordination • People with behavioral health conditions are at higher risk for physical illness and are costly • Medicaid patients are more likely to have diabetes, hypertension, and other chronic diseases • Good health outcomes can be achieved through the existing Behavioral Health Choices Program • Projects supporting BH/PH integration are going on throughout the Commonwealth – at BHMCOs, PHMCOs, providers and counties

  12. Physical Health/Behavioral HealthCoordination (continued) • Examples include co-location, shared staff, shared medical records, and others • Two large pilots, supported by the Center for Health Care Strategies, have started, one in the Southeast and one in the Southwest

  13. Questions?

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