THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, August 4, 1995 TAG: 9508040457
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: Long : 186 lines
An Allen administration plan to take some mental health services out of the hands of Hampton Roads officials and give them to a for-profit corporation is rankling mental health advocates across the state.
The plan would add mental health services to a pilot program that will require Medicaid recipients to join health maintenance organizations, or HMOs. That program is scheduled to begin Jan. 1.
Under the Allen plan, the state would contract with a managed-care organization to oversee outpatient mental health services for Medicaid recipients in Norfolk, Portsmouth, Chesapeake, Virginia Beach, Newport News, Hampton and Poquoson. Eventually, the program could be expanded to the rest of the state and to non-Medicaid clients.
A managed care organization, or MCO, differs from an HMO in that it doesn't directly provide the services, but manages the system through contracts with providers.
The goal of the Allen plan is to save money by improving the mental-health system's efficiency.
But some advocates for the mentally ill complain that the Allen plan would jeopardize services and might destroy a 25-year-old system of locally run mental health programs.
Currently, state mental health services are provided and managed by 40 community-services boards, which are appointed by local city councils. They provide a wide range of services to the mentally ill and mentally retarded, and to substance abusers, including day-treatment programs, job-training programs and counseling.
Under the Allen plan, the MCO would contract with local mental health providers to deliver services. For at least the first year, the main providers would be the community-services boards and the change would be ``invisible'' to consumers, said Timothy A. Kelly, commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse Services.
But in succeeding years, he acknowledged, the MCO could contract with private mental health providers.
The plan is in line with Allen's stated goals of privatizing elements of state government.
In Hampton Roads, 14,873 people receive mental health services through the community-service boards; 4,150 of them are on Medicaid and would be directly affected by the pilot program.
One is Thynesis Ricks of Norfolk.
Ricks, 43, was diagnosed with bipolar disorder, formerly called manic depression, 26 years ago. Since then, she has been in and out of psychiatric hospitals, sometimes staying for months at a time. But seven years ago, when she began attending a psychosocial rehabilitation program called Hospitality Center, run by the Norfolk Community Services Board, her life changed.
Six days a week, a van picks her up and drops her at the center on Tidewater Drive, where she answers phones, interacts with other mentally ill clients and finds a peace and sense of belonging missing in the rest of her life.
``It keeps me from getting depressed,'' she said. ``When I come to this center, it's like hope. And I'm not sitting at home looking at the four walls where it's dark.''
But Ricks has heard about the Allen administration plan. She worries that it might affect her time at the center or, even worse, that the center could close to save money.
She is not alone.
Longtime mental health advocate Douglas Bevelacqua of Newport News, a Republican appointed to the state Mental Health, Mental Retardation and Substance Abuse Services Board last year, quit the board in May after learning about the Allen plan.
``These people need services,'' said Bevelacqua. ``When someone has a psychotic break, what do you not do for them in order to save money?''
But Kelly said the change wouldn't cut services. It would, he said, improve accountability, efficiency and quality of care. It would also enable the state to provide care to the more than 10,000 people on mental health, mental retardation and substance-abuse waiting lists.
When Kelly began floating the Allen plan in May, it took mental health advocates, and even some lawmakers, by surprise. When the General Assembly adjourned in March, it was with the understanding that the Medicaid HMO would include only physical health care - not mental health, said Franklin P. Hall, D-Richmond, chairman of the Health and Human Resources Subcommittee, which helped design the pilot Medicaid program.
``Our concerns are that we want to make sure that (the Allen plan) is truly more efficient and that it is not merely a curtailment of services to our most vulnerable citizens,'' he said. ``It's easy to cut costs if you don't care about who is going to be hurt.''
Del. George H. Heilig Jr., D-Norfolk, said the Allen administration is going too far too fast. ``I think it needs to be put on hold. . . . It's a completely different proposal than what we've been operating with.''
The existing system, he said, has room for improvement. ``But it's the most efficient and cheapest delivery of these services now because we've got local people involved providing the services for local residents.''
Under the Allen plan, the MCO would receive at least 5 percent less than the $7.5 million the state spent last year on outpatient community mental health, Kelly said. The state would also pay the MCO a negotiated administrative fee.
Profits or deficits would be split between the state and the MCO. Kelly said the state's share of any profits, plus the 5 percent-plus initial savings, would be reinvested into community mental health programs not under the MCO's control.
Critics, however, say that the MCO's primary objective would be to cut costs so that it could turn a profit.
``One has to question a system where those charged with making decisions about access to care . . . would be rewarded directly for denying care,'' Candace Waller, executive director of the Chesapeake Community Services Board, wrote in a May memo to Kelly.
``The first loyalty of the HMO is to the stockholder,'' said Freda Stanley, co-chair of the Coalition for the Mentally Disabled in South Hampton Roads.
Kelly said safeguards written into the MCO contract, such as a grievance system and specific criteria the MCO must follow to ensure it meets consumer needs, would protect patients.
``The top priority is continuity of care and high-quality care,'' he said. ``I'm convinced, based on other states' experiences, that real savings will be generated.''
In Massachusetts, for instance, costs under a Medicaid managed-care program, instituted in 1990, dropped 22 percent the first year.
But the number of reported deaths in the system soared by 79 percent since the state switched to managed care, the Boston Globe reported, and injuries and suicides nearly doubled. Massachusetts officials said the increase was statistical, the result of better record-keeping.
Much of Massachusetts' savings resulted from reducing or eliminating hospital stays. But the Allen plan for mental health includes only outpatient services.
Virginia mental health advocates question where, in a system already pinched for money, there is room for savings without reducing services. They note that Virginia ranks 41st among states in spending on mental health services.
The savings can be found, said Rick Krupnick, vice president for Medicaid development for Norfolk-based FHC Choice, which runs similar programs in other states. In Nebraska, for instance, FHC is trying to improve efficiency through better training for service providers. It also emphasizes outreach and wellness programs to try and keep people healthy.
``You can save money and still provide the care,'' he said.
Mental health advocates and community-services board directors in Hampton Roads have submitted their own proposal.
Their plan calls for a partnership with an MCO, enabling the boards to take advantage of the detailed data analysis and actuarial information that MCOs can provide. This information would help ensure programs were operating efficiently - a point Kelly makes in his advocacy of the MCO system.
Unlike the Allen plan, the local-alternative proposal would not give control of the system to a private corporation.
``We want to bring technology into our system as a partner, instead of simply giving up our public responsibility and accountability,'' said Dennis I. Wool, executive director of the Virginia Beach Community Services Board.
Kelly questions whether a partnership could work.
``You can't ask the providers of care to manage the care as effectively as a managed-care organization does,'' he said.
Regardless of how the system changes, Thynesis Ricks, who, after 21 years in Virginia's mental-health system has seen many programs come and go, has a message for the bureaucrats and politicians trying to tinker with it again: ``Just let them take my six days (in the rehab center) away without me putting up a fight.'' MEMO: IMPORTANT DATES
The Allen pilot plan is tentatively scheduled to begin Jan. 1. Before
proceeding, officials must receive a Medicaid waiver from the federal
government.
State officials will present a detailed outline to two General
Assembly subcommittees Aug. 28, and more specific details of the program
at another meeting with those same groups Oct. 2. For more information
from the state about the proposal, contact Commissioner Kelly's office
at 804-786-3921.
Mental health advocates are planning their own informational meeting
from 7 to 9 p.m. Wednesday at the Airport Hilton in Norfolk. For more
information, call the Virginia Beach Alliance for the Mentally Ill,
499-2041.
ILLUSTRATION: THE PLAN
Gov. George F. Allen wants the state to contract with a
managed-care organization to oversee outpatient mental-health
services for Medicaid recipients in Norfolk, Portsmouth, Chesapeake,
Virginia Beach, Newport News, Hampton and Poquoson. Eventually, the
program could be expanded to the rest of the state and to
non-Medicaid clients.
PRO
Allen seeks to save money by improving the mental-health system's
efficiency.
CON
Some advocates for the mentally ill complain that the Allen plan
would jeopardize services and might destroy a 25-year-old system of
locally run mental-health programs.
KEYWORDS: HMO MCO MENTAL HEALTH MEDICAID by CNB