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"Private/public Partnerships: Financing Behavioral Health Services Through Managed Care in the NorthSTAR Model.". David E. Young, MBA Executive Director Dallas Area NorthSTAR Authority. Background: NorthSTAR Pilot. Mental health/mental retardation services in Texas

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"Private/public Partnerships: Financing Behavioral Health Services Through Managed Care in the NorthSTAR Model."

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Private

"Private/public Partnerships: Financing Behavioral Health Services Through Managed Care in the NorthSTAR Model."

David E. Young, MBA

Executive Director

Dallas Area NorthSTAR Authority


Background northstar pilot

Background: NorthSTAR Pilot

  • Mental health/mental retardation services in Texas

  • Community mental health services:1964

  • Performance contracts (grant in aid)

  • Political/economic changes

  • HB 2377 provider/authority separation (failed)

  • 1998 NorthSTAR


Northstar creation

MetroCare meltdown

How can system provide more services with fewer dollars?

Efficiencies of managed care

CMS waiver

Blending funding sources

No wrong front door

MH & SA services (no MR)

NorthSTAR:creation


Northstar

NorthSTAR

  • NorthSTAR website

  • Managed care

  • Uses behavioral health organization (BHO)

    • (Value Options–HMO)

  • Blended funding goes to premiums that are paid to VO for eligible consumers


Northstar1

NorthSTAR

  • Eligible 1,230,000

  • Enrolled 444,000

  • Competitive provider network

  • Specialty Provider Networks (SPN)


Northstar goals

NorthSTAR: Goals

  • Efficiency

  • Effective

  • Access

  • Choice

    • Access and choice create advantages to the consumer and problems to the system

  • Benefits design


Dallas area northstar authority

Dallas Area NorthSTAR Authority

  • Afterthought to public response for need for local input

  • State is ultimate mental health authority (MHA)

  • Authority delegated to LMHA

  • DANSA is LMHA and LBHA (behavioral)

  • Referenced in Texas Administrative Code and Health & Safety Code


Dallas area northstar authority1

Dallas Area NorthSTAR Authority

  • Inter-local agreement of seven counties

  • Board is appointed by county commissioners of each county

    • Dallas-4

    • Collin-2

    • Hunt, Rockwall, Kaufman, Ellis, Navarro-1

  • Board appoints executive director

  • Administrative agency of the state


Private

Collin

Dallas

Ellis

Hunt

Kaufman

Navarro

Rockwall

Board of Directors

Executive Director

Admin

Team

Information

Team

Clinical

Team

LeadOmbudsman

Technology andSystems

OfficeManager

ClinicalForensics

ProgramEvaluator

Care Coordinator

CommunityResources


Private

HHSC

COLLIN

DALLAS

ELLIS

HUNT

KAUFMAN

NorthSTAR

NAVARRO

DANSA

ROCKWALL

BHO/VO

PROVIDER NET

Community/Stakeholders


Dallas area northstar authority2

Dallas Area NorthSTAR Authority

  • Roles

    • Ombudsman

    • Planning

    • Facilitating

    • Resource development

    • Coordinating

    • Diversion

    • Mental Health Authority

    • Single Portal Authority


Dallas area northstar authority projects

Dallas Area NorthSTAR Authority:Projects

  • 340b drug pricing

    • UTMB

  • Telemedicine/Video Conferencing

  • Electronic Health Records

    • Computerized Texas Medication Algorithm Project

  • Outcomes

  • Drug Utilization Management Programs


Dallas area northstar authority data

Dallas Area NorthSTAR Authority: Data

  • Data Book

    • Eligible persons (1,227,191 persons)

    • Monthly services (14,758 {Nov 16997})

    • Recidivism (Readmit to SH within 30 days 6%)

    • BHO Financials (Providers paid within 60 days 95%)

      • (Total premiums paid out for services to date 93%)

  • NorthSTAR Presentation

    • Growth

    • Productivity


Dallas area northstar authority data1

Dallas Area NorthSTAR Authority: Data

  • Examples of service creep

  • Psychiatric Rehab services

    • Four year growth


Css data summary 2 9 04

CSS Data - Summary 2/9/04

Source: TDMHMR Data Warehouse


Css data 2 9 04

CSS Data 2/9/04

Source: TDMHMR Data Warehouse


Dallas area northstar authority lbj school of public policy ut

Dallas Area NorthSTAR Authority: LBJ School of Public Policy, UT

  • Independent Assessment

    • “To summarize at the outset the LBJ School research team’s finding: having overcome many obstacles during its initial years, NorthSTAR is by its fourth year of operation a success. It embodies a total re-conceptualization of multiple systems of care. Under this re-conceptualization more service providers are available and more clients have access to service. And this new conceptualization of multiple systems of care has been carried out at no additional budgetary costs.

    • The road to this success,however, was not without many struggles.”


Dallas area northstar authority current issues

Dallas Area NorthSTAR Authority:Current Issues

  • Access

    • One year 40% growth in persons served per month

    • Drug costs

  • Overall Economy

    • Job loss=state dependence

  • Enemies

    • Change from state model to private model


Private

"Private/public Partnerships: Financing Behavioral Health Services Through Managed Care in the NorthSTAR Model."

  • Should private/public partnerships be used to finance and manage public health systems?

  • Reasoning

  • Implications for policy makers

  • Opportunities for MPH students


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