Transcript 'Private/Public Partnerships: Financing Behavioral Health

"Private/public Partnerships:
Financing Behavioral Health Services
Through Managed Care in the
NorthSTAR Model."
David E. Young, MBA
Executive Director
Dallas Area NorthSTAR Authority
Background:
NorthSTAR Pilot
• Mental health/mental retardation services
in Texas
• Community mental health services:1964
• Performance contracts (grant in aid)
• Political/economic changes
• HB 2377 provider/authority separation
(failed)
• 1998 NorthSTAR
NorthSTAR:creation
• MetroCare meltdown
• How can system provide more services
with fewer dollars?
• Efficiencies of managed care
• CMS waiver
• Blending funding sources
• No wrong front door
• MH & SA services (no MR)
NorthSTAR
• NorthSTAR website
• Managed care
• Uses behavioral health organization
(BHO)
– (Value Options–HMO)
• Blended funding goes to premiums that
are paid to VO for eligible consumers
NorthSTAR
•
•
•
•
Eligible 1,230,000
Enrolled 444,000
Competitive provider network
Specialty Provider Networks (SPN)
NorthSTAR: Goals
•
•
•
•
Efficiency
Effective
Access
Choice
– Access and choice create advantages to the
consumer and problems to the system
• Benefits design
Dallas Area NorthSTAR Authority
• Afterthought to public response for need
for local input
• State is ultimate mental health authority
(MHA)
• Authority delegated to LMHA
• DANSA is LMHA and LBHA (behavioral)
• Referenced in Texas Administrative Code
and Health & Safety Code
Dallas Area NorthSTAR Authority
• Inter-local agreement of seven counties
• Board is appointed by county
commissioners of each county
– Dallas-4
– Collin-2
– Hunt, Rockwall, Kaufman, Ellis, Navarro-1
• Board appoints executive director
• Administrative agency of the state
Collin
Dallas
Ellis
Hunt
Kaufman Navarro Rockwall
Board of Directors
Executive Director
Admin
Team
Office Manager
Information
Team
Technology and Systems
Clinical
Team
Lead Ombudsman
Clinical Forensics
Care Coordinator
Program Evaluator
Community Resources
HHSC
COLLIN
DALLAS
ELLIS
HUNT
KAUFMAN
NorthSTAR
NAVARRO
DANSA
BHO/VO
PROVIDER NET
ROCKWALL
Community/Stakeholders
Dallas Area NorthSTAR Authority
• Roles
– Ombudsman
– Planning
– Facilitating
– Resource development
– Coordinating
– Diversion
– Mental Health Authority
– Single Portal Authority
Dallas Area NorthSTAR Authority:
Projects
• 340b drug pricing
– UTMB
• Telemedicine/Video Conferencing
• Electronic Health Records
– Computerized Texas Medication Algorithm
Project
• Outcomes
• Drug Utilization Management Programs
Dallas Area NorthSTAR Authority:
Data
• Data Book
–
–
–
–
Eligible persons (1,227,191 persons)
Monthly services (14,758 {Nov 16997})
Recidivism (Readmit to SH within 30 days 6%)
BHO Financials (Providers paid within 60 days 95%)
• (Total premiums paid out for services to date 93%)
• NorthSTAR Presentation
– Growth
– Productivity
Dallas Area NorthSTAR Authority:
Data
• Examples of service creep
• Psychiatric Rehab services
– Four year growth
CSS Data - Summary
2/9/04
145000
$6,000,000.00
120000
$5,000,000.00
95000
$4,000,000.00
70000
$3,000,000.00
45000
$2,000,000.00
20000
$1,000,000.00
-5000
FY 2000FY 2000FY 2000FY 2000FY 2001FY 2001FY 2001FY 2001FY 2002FY 2002FY 2002FY 2002FY 2003FY 2003FY 2003FY 2003
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Sum of Un-Duplicated Count of Claimants
Source: TDMHMR Data Warehouse
Sum of Allowed Units
$0.00
Sum of Allowed Amount
CSS Data
2/9/04
160000
$6,000,000.00
140000
$5,000,000.00
120000
$4,000,000.00
100000
80000
$3,000,000.00
60000
$2,000,000.00
40000
$1,000,000.00
20000
0
$0.00
FY 2000FY 2000FY 2000FY 2000FY 2001FY 2001FY 2001FY 2001FY 2002FY 2002FY 2002FY 2002FY 2003FY 2003FY 2003FY 2003
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Sum of Un-Duplicated Count of Claimants
Sum of Allowed Units
Sum of Allowed Amount
Average Amount per Claimant
Source: TDMHMR Data Warehouse
Average Number of Units per Claimant
Dallas Area NorthSTAR Authority:
LBJ School of Public Policy, UT
• Independent Assessment
– “To summarize at the outset the LBJ School research team’s
finding: having overcome many obstacles during its initial years,
NorthSTAR is by its fourth year of operation a success. It
embodies a total re-conceptualization of multiple systems of
care. Under this re-conceptualization more service providers are
available and more clients have access to service. And this new
conceptualization of multiple systems of care has been carried
out at no additional budgetary costs.
– The road to this success,however, was not without many
struggles.”
Dallas Area NorthSTAR Authority:
Current Issues
• Access
– One year 40% growth in persons served per
month
– Drug costs
• Overall Economy
– Job loss=state dependence
• Enemies
– Change from state model to private model
"Private/public Partnerships: Financing
Behavioral Health Services Through
Managed Care in the NorthSTAR
Model."
• Should private/public partnerships be used to
finance and manage public health systems?
• Reasoning
• Implications for policy makers
• Opportunities for MPH students