BARRIERS to mental health care in NC: no standardization of Utilization Review & Massively Disorganized Authorization Process
From: Marsha V. Hammond, PhD: Clinical Licensed Psychologist in private practice, working mostly w/ indigent clients in western NC
E mail: hammondmv@netzero.com
To: Joe Morrissey, PhD, Professor of Health Policy and Management, Sociology & Psychiatry, UNC
E mail: jmorris@cnsmail.com, joe_morrissey@unc.edu
RE: computer models for mental health care in NC
September 22, 2008
Dear. Dr. Morrissey:
I listened with interest to this information associated w/ computer models pertaining to NC mental health reform problems, in which you outlined, grossly, such models: http://www.healthlimited.com/2008/09/mental-health-system-improvement/.
I went to google scholar and was curious about this article, particularly as it hints at matters associated w/ Utilization Management/ Review, which, I believe, is at the heart of problems associated w/ NC Mental Health Reform: Comparing provider perceptions of access and utilization management in full-risk and no-risk medicaid programs for adults with serious mental illness : http://www.springerlink.com/content/n184816313h8v114/
While, as per the video, which you explained is a simple model associated w/ matters such as patients coming into a psychiatric unit and those being discharged, would be helpful in terms of planning psychiatric beds at various locations, the problem w/ mental health reform is much bigger and problematic than this.
I would list these problems accordingly (and I am afraid I am not advanced enough in understanding the matter though I have followed it in detail for the past several years, in order to rank order the following):
1. Utilization Management/ Review departments within the LME’s operate without any standardization across the LME’s. This means that in central NC we have an LME that purportedly utilized a Medicaid standard in terms of mental health treatment, which is associated with 8 outpatient therapy sessions and then more as associated with an authorization request by the provider VERSUS Western Highlands Network LME in Buncombe county which allows only 8 outpatient therapy sessions/ state funded client/ year VERSUS (the other western NC LME, Smoky Mountain Center LME) which has no outpatient therapy sessions except under Community Support which is constantly being defunded.
Yes, the LME’s only, at this time, oversee state funded clients.
HOWEVER, the agenda is to have them oversee Medicaid clients and that is very problematic re: their inability to create ‘stable’ paperwork as associated with the state funded clients.
2. Value Options, the authorization agent for NC Medicaid clients, is
up to its ears in paperwork. For, you see, the paperwork that they require of us providers is then sent BACK to them and they sit on it for weeks if not months as they utilize their fewer than 300 NC employees to hack thru this mountain of useless paperwork inclusive of 20 page Person Centered Plans; ITR’s; etc. Those Community Support Services which are in appeals have to be aggressively pursued for they have, apparently, simply lost track of the paperwork. Yes, the ‘word’ is that VO will lose its contract; however, that will relegate the authorization process to the LME’s which have a very poor track record of being able to keep up with said paperwork.
The computer model is, as you mentioned on your video, for ‘fine-tuning.’
Contrarily, we are no where near fine-tuning this process but rather we, as providers, working w/ Medicaid clients, are simply trying to stay alive until a new governor gets elected----whom may, or may not, have any idea about what to do about the paperwork onslaught and the multiple Barriers to mental health care.
As a sociologist, I presume that you know about the Health Belief Model; my dissertation was associated with an investigation of Older Women’s Breast Cancer Screening Behaviors and my participants were those affiliated w/ the Women’s Health Trial at UAB.
Let me just say that the Barriers to mental health care----with Barriers being a core construct associated w/ the Health Belief Model---- in NC are MASSIVE and I have only mentioned the 2 most glaring ones from my perspective.
Marsha V. Hammond, PhD
E mail: hammondmv@netzero.com
To: Joe Morrissey, PhD, Professor of Health Policy and Management, Sociology & Psychiatry, UNC
E mail: jmorris@cnsmail.com, joe_morrissey@unc.edu
RE: computer models for mental health care in NC
September 22, 2008
Dear. Dr. Morrissey:
I listened with interest to this information associated w/ computer models pertaining to NC mental health reform problems, in which you outlined, grossly, such models: http://www.healthlimited.com/2008/09/mental-health-system-improvement/.
I went to google scholar and was curious about this article, particularly as it hints at matters associated w/ Utilization Management/ Review, which, I believe, is at the heart of problems associated w/ NC Mental Health Reform: Comparing provider perceptions of access and utilization management in full-risk and no-risk medicaid programs for adults with serious mental illness : http://www.springerlink.com/content/n184816313h8v114/
While, as per the video, which you explained is a simple model associated w/ matters such as patients coming into a psychiatric unit and those being discharged, would be helpful in terms of planning psychiatric beds at various locations, the problem w/ mental health reform is much bigger and problematic than this.
I would list these problems accordingly (and I am afraid I am not advanced enough in understanding the matter though I have followed it in detail for the past several years, in order to rank order the following):
1. Utilization Management/ Review departments within the LME’s operate without any standardization across the LME’s. This means that in central NC we have an LME that purportedly utilized a Medicaid standard in terms of mental health treatment, which is associated with 8 outpatient therapy sessions and then more as associated with an authorization request by the provider VERSUS Western Highlands Network LME in Buncombe county which allows only 8 outpatient therapy sessions/ state funded client/ year VERSUS (the other western NC LME, Smoky Mountain Center LME) which has no outpatient therapy sessions except under Community Support which is constantly being defunded.
Yes, the LME’s only, at this time, oversee state funded clients.
HOWEVER, the agenda is to have them oversee Medicaid clients and that is very problematic re: their inability to create ‘stable’ paperwork as associated with the state funded clients.
2. Value Options, the authorization agent for NC Medicaid clients, is
up to its ears in paperwork. For, you see, the paperwork that they require of us providers is then sent BACK to them and they sit on it for weeks if not months as they utilize their fewer than 300 NC employees to hack thru this mountain of useless paperwork inclusive of 20 page Person Centered Plans; ITR’s; etc. Those Community Support Services which are in appeals have to be aggressively pursued for they have, apparently, simply lost track of the paperwork. Yes, the ‘word’ is that VO will lose its contract; however, that will relegate the authorization process to the LME’s which have a very poor track record of being able to keep up with said paperwork.
The computer model is, as you mentioned on your video, for ‘fine-tuning.’
Contrarily, we are no where near fine-tuning this process but rather we, as providers, working w/ Medicaid clients, are simply trying to stay alive until a new governor gets elected----whom may, or may not, have any idea about what to do about the paperwork onslaught and the multiple Barriers to mental health care.
As a sociologist, I presume that you know about the Health Belief Model; my dissertation was associated with an investigation of Older Women’s Breast Cancer Screening Behaviors and my participants were those affiliated w/ the Women’s Health Trial at UAB.
Let me just say that the Barriers to mental health care----with Barriers being a core construct associated w/ the Health Belief Model---- in NC are MASSIVE and I have only mentioned the 2 most glaring ones from my perspective.
Marsha V. Hammond, PhD
posted by Marsha V. Hammond, PhD at 9:36 PM
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