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. 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)

4. NorthSTAR NorthSTAR website Managed care Uses behavioral health organization (BHO) –(Value Options–HMO)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)DANSA 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. CollinDallasEllisHuntKaufmanNavarroRockwall Board of Directors Executive Director Information Team Clinical Team Admin Team Office Manager Care Coordinator Technology and Systems Program Evaluator Lead Ombudsman Clinical Forensics Community Resources

10. HHSC NorthSTAR BHO/VO PROVIDER NET DANSA Community/Stakeholders COLLINDALLASELLISHUNT KAUFMAN NAVARRO ROCKWALL

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 –GrowthGrowth –ProductivityProductivity

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