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

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 services1964
• Performance contracts (grant in aid)
• Political/economic changes
• HB 2377 provider/authority separation (failed)
• 1998 NorthSTAR

3
NorthSTARcreation

• 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)

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NorthSTAR

• NorthSTAR website
• Managed care
• Uses behavioral health organization (BHO)
• (Value OptionsHMO)
• 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)

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NorthSTAR Goals

• Efficiency
• Effective
• Access
• Choice
• Access and choice create advantages to the
  consumer and problems to the system
• Benefits design

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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

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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

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Collin
Dallas
Ellis
Hunt
Kaufman
Navarro
Rockwall
Board of Directors
Executive Director

Information Team
Clinical Team
Admin Team
Lead Ombudsman
Technology and Systems
Office Manager
Clinical Forensics
Program Evaluator
Care Coordinator
Community Resources
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HHSC
COLLIN
DALLAS
ELLIS
HUNT
KAUFMAN
NorthSTAR
NAVARRO
DANSA
ROCKWALL
BHO/VO
PROVIDER NET
Community/Stakeholders
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Dallas Area NorthSTAR Authority

• Roles
• Ombudsman
• Planning
• Facilitating
• Resource development
• Coordinating
• Diversion
• Mental Health Authority
• Single Portal Authority

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Dallas Area NorthSTAR AuthorityProjects

• 340b drug pricing
• UTMB
• Telemedicine/Video Conferencing
• Electronic Health Records
• Computerized Texas Medication Algorithm Project
• Outcomes
• Drug Utilization Management Programs

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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

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Dallas Area NorthSTAR Authority Data

• Examples of service creep
• Psychiatric Rehab services
• Four year growth

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CSS Data - Summary 2/9/04
Source TDMHMR Data Warehouse
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CSS Data 2/9/04
Source TDMHMR Data Warehouse
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Dallas Area NorthSTAR Authority LBJ School of
Public Policy, UT

• Independent Assessment
• To summarize at the outset the LBJ School
  research teams 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.

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Dallas Area NorthSTAR AuthorityCurrent Issues

• Access
• One year 40 growth in persons served per month
• Drug costs
• Overall Economy
• Job lossstate dependence
• Enemies
• Change from state model to private model

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"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