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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."

David E. Young, MBA

Executive Director

Dallas Area NorthSTAR Authority


Background northstar pilot
Background: Services Through Managed Care in the NorthSTAR Model." 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 Services Through Managed Care in the NorthSTAR Model."

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 Services Through Managed Care in the NorthSTAR Model."

  • 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 Services Through Managed Care in the NorthSTAR Model."

  • Eligible 1,230,000

  • Enrolled 444,000

  • Competitive provider network

  • Specialty Provider Networks (SPN)


Northstar goals
NorthSTAR: Goals Services Through Managed Care in the NorthSTAR Model."

  • 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 Services Through Managed Care in the NorthSTAR Model."

  • 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 Services Through Managed Care in the NorthSTAR Model."

  • 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


Collin Services Through Managed Care in the NorthSTAR Model."

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


HHSC Services Through Managed Care in the NorthSTAR Model."

COLLIN

DALLAS

ELLIS

HUNT

KAUFMAN

NorthSTAR

NAVARRO

DANSA

ROCKWALL

BHO/VO

PROVIDER NET

Community/Stakeholders


Dallas area northstar authority2
Dallas Area NorthSTAR Authority Services Through Managed Care in the NorthSTAR Model."

  • Roles

    • Ombudsman

    • Planning

    • Facilitating

    • Resource development

    • Coordinating

    • Diversion

    • Mental Health Authority

    • Single Portal Authority


Dallas area northstar authority projects
Dallas Area NorthSTAR Authority: Services Through Managed Care in the NorthSTAR Model."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 Services Through Managed Care in the NorthSTAR Model."

  • 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 Services Through Managed Care in the NorthSTAR Model."

  • Examples of service creep

  • Psychiatric Rehab services

    • Four year growth


Css data summary 2 9 04
CSS Data - Summary Services Through Managed Care in the NorthSTAR Model."2/9/04

Source: TDMHMR Data Warehouse


Css data 2 9 04
CSS Data Services Through Managed Care in the NorthSTAR Model."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: Policy, UTCurrent 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/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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