Michigan’s $3 billion public system just for treating individuals with severe mental health problems, intellectual disabilities and addictions is definitely heralded by advocates as being without any the financial pressures the industrial marketplace faces to squeeze away a profit.
These same advocates also acknowledge the device is sometimes inefficient, bulky and not able to meet a growing need for behavioral medical care amid escalating financial pressures for your state’s overall Medicaid insurance system for low-income residents.
The layers of oversight and administration of each dollar used on mental health are daunting: Taxpayer funding starts in Washington plus flows to Lansing through the The state of michigan Department of Health and Human Solutions, which contracts with 10 state-created prepaid inpatient health plans or even PIHPs to manage care for fewer than three hundred, 000 of Michigan’s 10 mil residents.
The particular regional PIHPs in turn contract along with one of Michigan’s 46 community psychological health authorities, an arm associated with county government. Those agencies after that contract with behavioral health care suppliers, clinics and hospitals for providers.
“It’s no easy system to navigate, inch said Marianne Huff, president plus CEO of the Mental Health Organization of Michigan.
But CMHs only serve people with severe behavioral and mental wellness disorders. Medicaid recipients who have mild-to-moderate mental health disorders stay in the device run by commercial health insurance providers, causing some individuals to bounce among two different insurers, depending on their particular physical and behavioral health requirements.
“There certainly are a lot of layers to get right down to the service level, ” Kyle Williams, director of litigation with Disability Rights Michigan, a Lansing-based federally funded nonprofit that promoters for adults and children with afflictions.
Removing a layer with this system of health care for the mind offers proved to be a daunting challenge, in part since there’s control of $3 billion within Medicaid spending at stake.
An effort by former Gov. Rick Snyder’s administration to turn more than management of the public mental wellness system to the Medicaid health programs in what’s referred to as “behavioral wellness integration” fizzled before the COVID-19 outbreak began consuming Gov. Gretchen Whitmer’s administration last year.
“Both sides of the issues have never accepted the fact that you’re not going to obtain everything you want and you shouldn’t choose everything you want, ” said previous state Rep. Joe Haveman, movie director of government relations at WISH Network, a mental health providers provider. “I think we noticed that Lansing hates big adjustments. ”
A global public health crisis has put bare long-simmering problems with access to treatment in Michigan, reviving calls to improve the way mental health services are usually delivered in a bureaucracy that requires the diagram to understand.
At MDHHS, the pandemic offers paused all activity on producing wholesale changes to the community psychological health system.
“We’re going to continue the lücke because COVID is our primary focus, ” said Allen Jansen, senior deputy director of MDHHS’ behavioral health and developmental disabilities management.
Before COVID, state and local health authorities, the health insurers and behavioral wellness advocates spent three years debating adjustments to the system under what is referred to as Section 298, the boilerplate vocabulary that called for privatization that Snyder first proposed in the $25 billion dollars MDHHS budget in 2017.
“Nobody wanted to drop power, ” said state Representative. Mary Whiteford, an Allegan Region Republican who chairs the House Appropriations subcommittee for the MDHHS budget. “I would love to see them just go returning to providing care. But it’s big bucks. ”
Much like Michigan’s no-fault auto insurance system, the community mental wellness system is seen by some being a model to the country that concentrates on keeping people in their homes plus communities — and out of psychiatric hospitals.
Plus like Michigan’s once-mandatory unlimited healthcare benefit for injured drivers, an extensive mental health system also is expensive — and those pressures have obtained worse in recent years.
In some corners of the state, the particular publicly run behavioral health program was awash in red printer ink before the pandemic.
In 2019, MDHHS yanked an agreement for the Lakeshore Regional Entity that will oversees the flow of behavior health Medicaid funding to 7 counties in West Michigan since the PIHP had run up the $16 million structural deficit.
During that same period of time, the four-county PIHP that redirects $163 million annually in Medical planning dollars to behavioral health companies in Lenawee, Livingston, Monroe plus Washtenaw counties said it racked up nearly $42 million within deficit spending in fiscal yrs 2017, 2018 and 2019, based on court records.
To obtain by, the Washtenaw County Local community Mental Health Agency covered the $10 million shortfall in 2019 with “local funds meant for some other purposes… putting other county commitments at risk, ” according to a lawsuit submitted against MDHHS last year seeking a situation bailout.
In late 2018, Macomb County Community Psychological Health had less than $200, 500 in its risk reserve fund — a dangerously low amount of cash available for a health care organization with a $250 million annual budget.
All told, nine associated with Michigan’s 10 PIHPs had structural deficits of nearly $93 mil in 2018, according to financial information compiled by the Michigan Association associated with Health Plans, the trade firm for private health insurers within the Medicaid managed-care business.
For critics of the community health system, including the private insurance providers vying for a slice of Michigan’s $20 billion Medicaid pie, the particular chronic deficits point to a system associated with care where each tax money travels through multiple layers associated with government.
Getting Medicaid patients in need of treatment to get psychosis or a controlled substance dependancy leads to a “finger pointing more than who’s responsible for paying” for behavior and physical health problems that often intersect, said Dominick Pallone, executive movie director of the Michigan Association of Wellness Plans.
“At the end of the day, we’re trying to associated with Medicaid benefit look and feel a lot more like the commercial benefit, ” said Pallone, whose organization represents 12 main health plans.
Michigan’s 10 regional PIHPs is surely an animal of the state, unlicensed open public insurance and managed care organizations created by statute in 2011.
They receive a set quantity of dollars from the Michigan Department associated with Health and Human Services to agreement with 46 community mental wellness authorities that encompass single areas in populous southern Michigan plus multiple counties Up North.
The bureaucracy associated with Michigan’s public mental health program comes with a contract that’s some seven hundred pages long.
“When the money comes to us, additionally, it comes with a lot of requirements — and lots of those requirements just cost money, inch said Dave Pankotai, CEO associated with Macomb County Community Mental Wellness.
MAHP has argued for a long time that integrating care will not simply lead to cost savings, it will create much better outcomes. The association representing Wellness Alliance Plan, McLaren Health Strategy, Molina Health Plan and other insurance companies contend they can better manage someone’s care than having them move into the general public system when they require hospitalization or even intensive outpatient therapy.
Advocates for the public psychological health system are skeptical the plans understand the intricacies of medical case management for individuals whose needs go beyond medical treatment.
“We don’t look for cost savings in terms of question care, ” said Dana Lasenby, CEO of the Oakland County Local community Health Network. “I don’t think (the health plans) truly have an concept of all the things that we do. I think these types of looking at bottom lines and our own budget… (and) thinking they can get it done cheaper and have cost savings. It’s not a good apples-to-apples system that you can just take more than. ”
Local community mental health agencies are involved in putting individuals in housing and making sure they’re stabilized to remain there — cost-intensive case management work, said Huff.
“That’s some thing I don’t think the health plans as well as the traditional insurance companies have a knowledge plus understanding of, ” said Huff, who have ran the Allegan County Neighborhood Mental Health agency from the year 2010 to 2017.
Huff contends what ails the particular multitiered community mental health strategy is a policy change in 2014 that will shifted money out of Medicaid psychological health and into the expanded Medicaid actual physical health insurance benefit for low-income grown ups.
Allegan Region alone sustained a 65 % reduction in funding that year. “The carnage that caused is still occurring today, ” Huff said.
MDHHS has just 3 full-time workers whose sole work is to enforce contracts with the ten PIHPs and 46 community psychological health authorities.
“A lot of the problems legislators yet others hear about in community mental wellness would go away if people might be held accountable in the contracts, inch Huff said.
Whiteford acknowledged the 14, 000-employee state health department is “very shorthanded” in this area. “There’s probably ten times more staff overseeing the particular Medicaid contracts than the CMH agreements, ” she said.
Allen, the MDHHS established, said he needs eight workers to oversee the contracts which hiring for those positions is a concern.
Whiteford mentioned she wants to see the 10 PIHPs consolidated into one entity.
But such a move didn’t obliterate an entire bureaucracy, Huff mentioned.
“That might still mean administrative costs due to the fact you’d have to have the ability to hold fouthy-six CMHs accountable, ” she stated.
Kevin Fischer, executive director of Michigan’s section of the National Alliance on Psychological Illness, said the public mental wellness system “isn’t perfect” and has to become more efficient.
But Fischer is not convinced privatizing the public mental health system can help matters.
“Those cost savings can be achieved without turning it over towards the health plans, ” Fischer mentioned. “The health plans don’t notice or truly appreciate all of the interpersonal supports that the public system offers the person. ”
There have been pregressive changes in recent years to integrate treatment without turning the payment design on its head. Some private hospitals have established specialized crisis units to help keep people with mental health crises away from emergency rooms.
The federal government is now funding the organization of Certified Community Behavioral Wellness Clinics that are designed to integrate primary treatment with mental health. There are eighteen such clinics across the state, although none has been established in the north Lower Peninsula and Upper Peninsula, according to the Center for Health and Analysis Transformation in Ann Arbor.
“I think all of us are trying to figure out what that integration will probably look like, ” said Dr . Amy McKenzie, associate chief medical official for Blue Cross Blue Protect of Michigan.
In recent years, the particular Detroit Wayne Integrated Health System axed a vendor contract for incoming phone calls from Wayne County inhabitants seeking mental health services plus eliminated an entire layer of its paperwork that created sub-networks of suppliers within the county. Both of those features were brought in-house, DWIHN Mouthpiece CEO Eric Doeh said.
“Now we arrive at control our front door making those people critical decisions about who will get in, where they receive providers, ” Doeh said.
Since the statewide behavioral wellness integration project failed to get off the earth, DWIHN has been working on developing a smaller-scale project integrating physical and behavior health.
DWIHN has partnered with two wellness plans that serve 14, 500 common Medicaid clients to organize care and get medical doctors talking along with behavioral health clinicians to work jointly on each patient’s needs, DWIHN Deputy CEO Eric Doeh stated.
Doeh mentioned he could not disclose the names from the two Medicaid health plans focusing on the behavioral health integration task with DWIHN.
The three entities are working on an intend to demonstrate to MDHHS how they will generate savings for both the private insurers as well as the public mental health entities, Doeh said.
“We want to be able to duplicate this throughout Eight Mile, Up North, all around the state of Michigan, ” he or she said.
Conscious of the political pressures to produce cost savings within the overall Medicaid budget, DWIHN is trying to be proactive about behavior health integration before lawmakers create another run at privatizing the machine, Doeh said.
“And believe me, we avoid want legislators deciding this issue for all of us, ” Doeh told Crain’s. “Legislators, as much as they have great knowledge, with regards to this piece right here, the folks that are knowledgeable are the folks who experience this every day. ”
This tale first appeared in our sister publication, Crain’s Detroit Business