KeepHealthCare.ORG – Detroit Wayne Mental Health Authority moves to bring services in-house
Since 1998, Michigan has operated under a federal waiver that carved out serious mental health patients and those intellectually or developmentally disabled or those with substance abuse problems from Medicaid HMOs, which manages mild behavioral health issues.
Medicaid moderate and severe behavioral health services are managed by 10 regional prepaid inpatient health plans; DWMHA is the state’s largest. DWMHA takes care of about 80,000, or 25 percent of the approximately 300,000 behavioral health Medicaid population.
But in early 2016, Gov. Rick Snyder proposed in the budget boilerplate Section 298 to turn over the state’s $2.6 billion Medicaid behavioral health system to the Medicaid health plans. After some discussion, the state Legislature agreed to study integration with three pilot projects, which were supposed to begin Oct. 1. However, because of various planning and policy issues, the state and the selected pilot organizations agreed to delay the start of projects a year until Oct. 1, 2019.
This delay ended up allowing DWMHA time to restructure its organization to prepare for expected changes in the state’s behavioral health delivery and financing system. Brooks said he expects the authority’s behavioral and physical health pilot project to begin alongside the state’s three approved projects.
“What happened was in order to prepare for integration, we actually have to manage the care ourselves, so we can partner with health plans,” Brooks said. “When I came here, one of the issues I realized is that we are not managing care, just funding it and allowing other people to manage the care.”
Simply overseeing Medicaid behavioral health funding “is not always in the best interest of people served,” Brooks said. “It did not give us the opportunity to be responsible to affect change. We had to rely on others to serve people.”
Last fall, the DWMHA board approved a plan to study contracting with one or several Medicaid health plans to provide another experiment for the state to review as part of its integration of behavioral health and physical health services.
Brooks, who was hired by DWMHA in January, said he was especially happy the board supported his reorganization proposals as the authority had a slightly different plan last year. The authority initially wanted to begin contract negotiations with health plans to integrate physical and behavioral health as a slightly different way than the state’s Section 298 effort.
“The board was very cooperative in this process,” he said. “When I came in (earlier this year from Oakland Community Health Network), they were going in one direction. I asked them to hold off on plans they had and they unanimously gave us support for this plan.”
By Oct. 1, 2019, Brooks said the authority will have completed its reform plan and expects to have a contract signed with a Medicaid health plan for integration. He said the authority would like to sign another two contracts with Medicaid health plans in 2020.
“This is the first step toward holistic care. Our plan is to not just provide behavioral and physical health, but also social, economic and spiritual” services, Brooks said. Because jobs and housing play a major role in healing, he said DWMHA and contracting health plans will focus on all five areas affecting patients.
“We are revamping ourselves. We are not just a behavioral health provider,” he said.
Brooks said he hopes the integration model DWMHA is seeking will be eventually adopted by the state for all of Michigan because it will retain the best elements of the behavioral and physical health managed care systems.
“We want to integration at the service level. We will manage risk when it comes mental health and then partner will health plans for the physical health,” Brooks said. “The shortcomings of the state’s pilots now is it allows the HMOs to manage the funding. HMOs are risk avoiders. We are risk seekers. We try and find people to help.”
Brooks said by continuing to allow funding to follow patients, the state can save administrative money and provide better care for patients. He said behavioral health organizations and Medicaid HMOs can share information to improve care coordination.
By phasing down the four MCPNs and eliminating bureaucracy, Brooks estimated the authority will save about $7 million in administrative costs. The authority spends each year about $17 million to administer the MCPNs.
“We will be able to put back that in services to the community,” he said. “We don’t have a good crisis continuum in Wayne county. We hope to put in two or three crisis (agencies) to reduce inpatient hospital costs and provide better emergency (mental health intervention) services.”
Brooks said the authority issued a request for proposal last week and hopes to have a crisis agency in place by October.