Transcript The Coalition to Preserve Behavioral Health Choices

A Brief History of the Program
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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
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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
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The goals of the program are to:
◦ Assure greater access
◦ Improve quality
◦ Manage costs
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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
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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
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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
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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
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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%
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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
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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-forservice 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
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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
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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