2. How do we manage outpatient clinics to meet the needs of people we serve while remaining financially viable?

3.  Providers value outpatient services  Similar to a “clinical home”  Services are accessible, person- centered, person-directed, evidenced based, continuous, culturally appropriate & coordinated

4.  Community based treatment is increasing  As options increase, so does fragmented care  Managed care is the largest payer of services  Workforce shortage

5.  Deinstitutionalization of state hospital  Recovery, resiliency & evidenced based approaches  Integrating primary health, behavioral health & substance abuse treatment

6.  Focus on treating co-occurring disorders  Developing & utilizing performance improvement activities  Large demand for BHRS and services in natural environments

7.  Alternatives to incarceration  More uninsured individuals seeking treatment  Mental health parity

8.  High “No Show” rates  Reimbursement for psychiatrists does not cover costs  Psychiatrists have become “Medication Managers”

9.  Full-time staff replaced by independent contractors  Required services that are unbillable  Large deficits

10.  Sources to offset deficits have shrunk  Clinics downsizing and closing

11.  In depth evaluation by the state into the feasibility and viability of outpatient psychiatric clinics  Make changes to develop a new system for delivering outpatient services in the public sector

12.  Allow service to be delivered in the community  Establish flexible staffing patterns  Change the role of the psychiatrist

13.  Promote flexible treatment planning  Move away from annual licensing visits  Eliminate time limited waivers

14.  Increase rates, especially for psychiatric services  Reimburse for nonbillable services  Support Full-time staff  Alternative payment or mixed payment options

15. A new approach is needed to meet the needs of consumers without compromising services.