1 / 19

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

"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

omer
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. "Private/public Partnerships: Financing Behavioral Health Services Through Managed Care in the NorthSTAR Model." David E. Young, MBA Executive Director Dallas Area NorthSTAR Authority

  2. 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

  3. 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

  4. 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

  5. NorthSTAR • Eligible 1,230,000 • Enrolled 444,000 • Competitive provider network • Specialty Provider Networks (SPN)

  6. NorthSTAR: Goals • Efficiency • Effective • Access • Choice • Access and choice create advantages to the consumer and problems to the system • Benefits design

  7. 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

  8. 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

  9. 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

  10. HHSC COLLIN DALLAS ELLIS HUNT KAUFMAN NorthSTAR NAVARRO DANSA ROCKWALL BHO/VO PROVIDER NET Community/Stakeholders

  11. Dallas Area NorthSTAR Authority • Roles • Ombudsman • Planning • Facilitating • Resource development • Coordinating • Diversion • Mental Health Authority • Single Portal Authority

  12. 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

  13. 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

  14. Dallas Area NorthSTAR Authority: Data • Examples of service creep • Psychiatric Rehab services • Four year growth

  15. CSS Data - Summary 2/9/04 Source: TDMHMR Data Warehouse

  16. CSS Data 2/9/04 Source: TDMHMR Data Warehouse

  17. 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.”

  18. 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

  19. "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

More Related