A Brief History of the Program

 Behavioral health services were provided in a variety of un-coordinated ways ◦ County government was responsible for overseeing the provision of many non-medical services ◦ The Medicaid (Medical Assistance) fee-for-service program, in certain counties, paid for inpatient and outpatient psychiatric services, partial hospitalization and other services ◦ Medicaid physical health managed care organizations, in other counties, also paid for these Medicaid behavioral health services

 The Ridge Administration, under the leadership of Secretary Feather Houstoun and Deputy Secretary Charles Curie, decided to implement a unique behavioral health delivery system  They gave county government the “right of first opportunity” to manage the entire behavioral health program on a risk basis  Went on to become a model nationally

 The goals of the program are to: ◦ Assure greater access ◦ Improve quality ◦ Manage costs  Advantages include: ◦ Service development and financial decisions at the local level ◦ The opportunity to better coordinate and manage care ◦ Flexibility to make decisions to meet the needs of each county ◦ The reinvestment of savings in programs and supports that meet the needs of consumers

 Implementation began in 1997 in Southeastern Pennsylvania  The program, begun under Governor Ridge, continued under Governor Rendell  The implementation process was completed statewide in 2007, by Secretary Estelle Richman and Deputy Secretary Joan Erney

 All counties are covered by Behavioral Health Choices  Well over 2 million Pennsylvanians are eligible to receive behavioral health services  Most counties subcontracted with behavioral health managed care organizations (BH-MCOs) to assist in operating the program  Each county has one BH-MCO  Only 23, mostly rural counties, did not take advantage of the “right of first opportunity”  In these 23 counties, the state contracted directly with a BH-MCO to manage Behavioral Health Choices

 Broad base of services provided, including mental health, drug and alcohol, autism, and others  Special populations include children and youth and persons with intellectual disabilities  Five BH-MCOs provide services throughout the state  A national model for BH delivery systems, being considered in several states

 Increased number of people served  Access exceeds national benchmarks for persons with serious mental illness  Drug and alcohol network increased by 500 providers; increased access to non-hospital detoxification, rehabilitation, and halfway house services  Less restrictive alternative services increased by 400%

 All behavioral health services are now coordinated and managed at the county level of government  Three state hospitals have closed since 1997  Consumers and families serve on evaluation committees that select BH-MCOs  Counties and BH-MCOs must establish Consumer/Family Satisfaction Teams (C/FSTs)  Published reports present results of C/FST interviews and 29 quality indicators  BH-MCOs must develop performance improvement plans

 An estimated $4 billion was saved between 1997 and 2008, as compared to the fee-for-service program  A wider array of services in less restrictive settings continues to grow  About $446 million has been reinvested in the expansion of service options in the community  In 1996, in the Southeast Zone, 38.0% of fee-for- service dollars went to inpatient care and 4.4% went to Community Support Services (CSS); In 2008, 16.2% was for hospitalization and 9.5% on CSS  Administrative fees have been reduced

 People with behavioral health conditions are at higher risk for physical illness and are costly  Medicaid patients are more likely to have diabetes, hypertension, and other chronic diseases  Good health outcomes can be achieved through the existing Behavioral Health Choices Program  Projects supporting BH/PH integration are going on throughout the Commonwealth – at BHMCOs, PHMCOs, providers and counties

 Examples include co-location, shared staff, shared medical records, and others  Two large pilots, supported by the Center for Health Care Strategies, have started, one in the Southeast and one in the Southwest