A plan for NC Mental Health Reform to entertain an OUTCOMES BASED rather than FEE FOR SERVICE model re: mental health care

Marsha V. Hammond, PhD Clinical Licensed Psychologist, NC e mail:

hammondmv@netzero.com cell: 404 964 5338

April 21, 2008

Dear Senator Garrou:

Thank you for creating a forum this evening, Monday, April 21, 2008 , re: mental health reform concerns. I am sorry I will not be able to attend.

I would like to make a comment as a clinical psychologist in the trenches, treating medicaid/ medicare and state funded mental health clients.

First of all, it is a terrible mess. And it is mostly a mess as there are, as a (unnamed: "I would lose my job") administrator of Western Highlands Network told me on Friday, there are "too many cooks in the kitchen and no one taking responsibility."

While Dempsey Benton may be a nice man, he has no experience managing mental health.

The Democratic party gubernatorial candidates are avoiding the subject and though I am a determined Dem, I'm telling you...the Republicans are looking pretty good as re: their candor while the Dems whistle past the mess.

I'd hate to see a Republican governor in NC as I know what happened in GA when that happened but the Dem party is squandering its chance to make things right. Many Dems feel exactly as I do.

Along those lines, and as re: conversation with that WHN administrator, I am in complete agreement that DHHS (where many are to retire quite soon, I'm told: Wainwright; Lancaster, the co-directors of mental health, bearing in mind that Moseley, the director, just retired) has completely mucked the thing up while the LME's are the messengers, with some doing a better job than others in protecting 'their' providers.

I am informed by that administrator that NC DHHS 'appears to be seeing the light somewhat' as re: an Outcomes-based platform associated with services.'

We cannot go backwards and we cannot stay in this no man's land of fee for service and so we must evolve to this outcomes based place.

The entire matter needs to move away from piecemeal fee-for-service and towards OUTCOMES BASED reimbursement.

What would this mean?

1. Emergency and critical mental health services would not be held up at the bottleneck of 'how am I going to get paid' re: services for quite ill citizens coming out of the hospital or urgently needing services.

There is not a lack of providers; there is a lack of providers willing to work w/ the LME's and thus NC DHHS given the authorization/ billing/ payment structure.

You have no idea how much paperwork is associated with a state funded client and how much paperwork is associated with Community Support Services for Medicaid clients as associated w/ post-payment reviews mandated by NC DHHS.

This it not to say that Endorsed Provider companies should not be overviewed. We all are very clear now as re: the country's mortgage / banking fiasco re: just what happens when capitalism is given free reign.

2. Providers would be able to compete with each other but not at the level of fee for service. As it is, every little piece of service has to be authorized, billed, paid for.

The LME's miraculously return money to the state legislature while the citizens go un-served. Why? Because the providers cannot make a living given the structure of mental health reform as envisioned by NC DHHS.

Basically I have given up having more than one or two state funded clients. I cannot afford to take the time to create the paperwork.

If there was an Outcomes based model being utilized, Endorsed Provider companies, now in place, and as associated with this pretty painful rather unnecessary evolution of Mental Health Care Reform in NC, then companies would contract w/ the LME's to provide services for blocks of clients.

The companies would function as capitated HMO's wherein the company would most benefit----financially----by keeping its patients/ clients WELL rather than doing a piece by piece care plan which has to be OK'd at every step.

This will not work, what is in place. And it is very evident that it is not working.

Will some Dem please step up to the plate and create another model which is in the wings?

I thank you for any attention you can give to this matter.

Sincerely, Marsha V. Hammond, PhD: NC Licensed Psychologist cc: Madame Defarge NC Mental Health Reform blogspot

************************************************** associated article: http://www2.journalnow.com/content/2008/apr/21/mental-health-forum-tonight-with-garrou/Mental health Form tonight w/ GarrouBy Wesley YoungJOURNAL REPORTERPublished: April 21, 2008People with concerns about the delivery of mental-health services in Forsyth County will have two hours tonight to discuss them with state Sen. Linda Garrou.The community meeting will be from 6 to 8 p.m. in the auditorium at the Behavioral Health Plaza, 725 N. Highland Ave. CenterPoint Human Services, the Mental Health Association of Forsyth County and the Forsyth County affiliate of the National Alliance on Mental Illness are sponsoring the meeting.Garrou, D-Forsyth, said it is important for her as a legislator to know what residents are thinking as the state tries to fix what is widely considered a broken system of delivering mental-health services."There is a lot to be done, and a good place to start is to assess where you are and start from there," Garrou said. Garrou is a co-chairwoman of the N.C. Senate appropriations base budget committee. State Rep. Verla Insko, D-Orange, the chairwoman of the mental-health reform committee, will also be at the meeting.Mental-health services were changed in 2001 and the system of locally run public mental-health agencies was dismantled. In its place, the state created a system with regional agencies overseeing the delivery of services through private companies. CenterPoint Human Services is the agency that manages mental-health services in Forsyth, Stokes and Davie counties.Those changes have come under fire. In 2005, the Winston-Salem Journal published a series of articles that outlined evidence that the state's post-reform system of care was worse than ever.In February, the Raleigh News & Observer reported that the state had wasted at least $400 million in an effort to treat mentally ill people in their communities rather than in the state's mental hospitals. Now state officials are talking about reforming the reform.Here, some local mental-health advocates have complained about a variety of issues surrounding CenterPoint's governance, operations and interaction with the mentally ill and their advocates."People who need and who are entitled to services are not able to obtain the services," said Laurie Coker, a local mental-health advocate who serves on a state advisory commission. "That is one of the biggest concerns. The second thing we hear from all over is that services aren't coordinated well enough to prevent people from needing to go back to the hospital more frequently."Local advocates have also complained that they have trouble making their concerns known to CenterPoint. CenterPoint had a roundtable discussion in March, but some local advocates were upset that the number of them allowed to attend was limited.A recent survey of the state's mental-health agencies rated CenterPoint among the top agencies in financial and business management, and in clinical operations and governance. CenterPoint was among the bottom performers in information technology and claims maintenance.CenterPoint officials said they hope that tonight's forum will help the agency better identify problems and solutions."We are looking for themes as we have these community meetings and solicit input," said Ronda Outlaw, the assistant area director for operations at CenterPoint. "I think the issue is that reform facilitated consumer choice, (but) the other side of that is that it created fragmentation of the system." A fragmented system can be harder to navigate for those in the greatest need, she said.¦ Wesley Young can be reached at 727-7369 or at wyoung@wsjournal.com.