North Sound Mental Health Administration

Improving the mental health and well being of individuals and families in our communities
A Regional Support Network for Island, San Juan, Skagit, Snohomish & Whatcom Counties.
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Joe's Corner

Joe Valentine, Executive Director

Houses are built from the ground up [you could try building one from the top down, but might have trouble getting insurance!]. So to, changes to systems also need to be made from the ground up if they are to be successful and sustaining [you can try imposing systems change from the top down but it will end up looking like a house that was built from the top down]. As the federal and state governments pursue some of the most ambitious changes to health care and social service systems attempted in our lifetime, it's important to keep this basic principle in mind.

In last month's Around the Sound, I provided a broad overview of how NSMHA is participating in state efforts to implement Health Care Reform initiatives. As of July 1, persons receiving managed care medical benefits through the state's "Healthy Options" program were enrolled with one of 5 Managed Care Organizations [MCOs]. These MCOs signed contracts with the state that required among other things, a defined level of benefits for behavioral health services. Foster children and persons enrolled in the state's "Basic Health Plan" were added to this group and on September 1, blind and disabled persons receiving Supplemental Security Income [SSI] will also be required to be enrolled in a managed care plan.

The Managed Care Organizations are required by the state to work cooperatively with RSNs to coordinate mental health services to persons who may need more intensive levels of mental health support. To date, we have signed general operating agreements with all 5 of the MCOs Joe's Corner but have had serious and more detailed conversations on how care will actually be coordinated with only two of them.

The next chapter in the state's roll out of Health Care Reform will be the implementation of new strategies for coordinating care to high risk persons who receive both Medicare and Medicaid [the "dual eligibles"]. The first strategy, which will be implemented in most counties, is to contract with organizations that are willing to act as the "Health Home" for dually eligible persons living within a defined geographic area. Health Home organizations will be responsible for ensuring close coordination between primary health care and behavioral health and Long Term Care services. The state has solicited "Letters of Intent" from organizations who are interested in either being a "lead" Health Home entity or actively participating in a Health Home Network. NSMHA has submitted a Letter of Intent signaling our interest in participating in a Health Home network. I have personally talked with most of our provider partners who have also indicated a strong interest in working collaboratively with us in supporting a Health Home Network that includes close coordination with our existing system of high quality mental health services.

The 2nd strategy, which is scheduled to be implemented in 2014, would be to provide an even more intense level of coordination to high risk dually eligible persons by agreeing to provide all health, behavioral health, and long term care services based on a capitated payment for each person enrolled in the health plan. Three of the counties in the state have indicated an interest in considering participation in this capitated payment model: King, Snohomish, and Whatcom. Since some of the funding for the capitated payments to the MCO would come from NSMHA's existing capitated payments, we have been included in the discussions on how this would work and how care would be coordinated between the RSN and the MCO administered system.

In addition to Health Care Reform, the state has also undertaken a major re-design of the Children's Mental Health System that will improve the integration of services to children and families and will incorporate the principles from the national "System of Care" movement. Earlier this month, NSMHA co-hosted the 3rd regional "Systems of Care Institute" along with the Northwest Educational Services District and the regional office of DSHS Children's Administration [see article below]. As with Health Care Reform, local networks of collaboration will be the critical ingredient to making such systems change work. Especially exciting was the active participation of both educators and families and youth. As Eric Chambers, the Institute co-chair, indicated in kicking off the conference, "We can't hope to improve the system until everyone is seated at the table."

And, I might add, until all stakeholders are involved in building the foundation together, one collaborative brick at a time.




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North Sound Mental Health Administration