1. My Original Presentation Reconnecting the Head to the Body: The Role of Behavioral Health in the New Healthcare Ecosystem Dale Jarvis, CPA dale@djconsult.net

2. But then I was listening to Dr. Shelp and thinking about… > Not being from around here, I didn’t know if my perception that a bomb had been set off in the room was accurate > But I decided to change my slides, just in case 2

3. Change is Coming… And How Not to End Up at the Bottom of the Food Chain in Georgia Dale Jarvis, CPA dale@djconsult.net 3

4. For the last year, I’ve been predicting… > Healthcare Reform will trigger dramatic changes that transform the current sick care system to a true health care system > These changes will create a tipping point for Americans with MH/SUD and those that serve them > The head is being reconnected to the body in order to address the whole health needs of all Americans 4 4

5. Will we address the cost and quality problems in the US healthcare system? 110 Preventable Deaths per 100,000 $7,285 Per Capita Health Expenditure 5 5 5

6. For Georgia’s Boards, its about incorporating a 3 rd, related problem Half of the 5/50 population has a mental health, substance use, or co-occurring disorder 6

7. Dale’s 20-State Adventure... 7 7

8. For many, the key question is, how well are you addressing… > The 1% of the population that use 20% of the healthcare resources? > The 5% that use 50%? (the 5/50 population) > The half of the 5/50 population with a MH/SUD 8

9. Different States are Taking Different Approaches > Door 1: Some states with managed mental healthcare carve-outs are blowing up those carve-outs and giving all of the money to the health plans > Door 2: Other states are strengthening the carve-out and increasing expectations > It sounds like Georgia’s plan might be: Let’s try Door 2 with the CSBs (and/or others) through a competitive bidding process If that doesn’t work, stick with Door 2, but contract it out to one or more national managed behavioral healthcare companies, or try Door 1 9

10. Exhibit A: FY2009 Per Capital Public Mental Health Expenses 10

11. Exhibit B: FY2009 Per Capital Public Mental Health Expenses 11

12. BUT…Exhibit C: People (especially legislators and taxpayers) like Winners, not Whiners… > 1) Whiners Focus on the Past, Winners Focus on the Present and Future > 2) Whiners Cast Blame, Winners Take Responsibility > 3) Whiners React, Winners Think > 4) Whiners Freeze, Winners Take Action > 5) Whiners Look for Validation, Winners Lead by Example > 6) Whiners Waffle, Winners Decide 12

13. Today I’d Like to Suggest… > The Objective? Achieve the Triple Aim in order to bend the cost curve > Healthcare providers that don’t get with the program will be disrupted by those that do > The implications for BH Providers? Addressing only the BH needs of those you serve will no longer cut it You need to figure out how to become woven into the larger healthcare system in order to… bend the cost curve 13

14. Connecting Exhibits A, B, and C: You might need a new plan > The Objective: Help Georgia addressing the sucking sound related to state and local health and health-related costs > Your Role: Helping your target population achieve the Triple Aim in order to bend the cost curve > The Plan: A Rapid Cycle Change Plan accompanied by a Business Case document 14

15. First the Business Case 15

16. There are two unfolding roles for the nation’s Community Mental Health Centers > Participation in Health Homes > Demonstrating that you are a high performing specialty MH/SUD provider organization 16

17. Role 1: Bi-Directional Primary Care/ Behavioral Health Integration Bi-Directional Care: Mental Health and Substance Use (MH/SU) Treatment in Primary Care and Primary Care in MH/SU Clinics 17

18. Connecting Exhibits A, B, and C: Key Change Plan Questions > What is the size of the region’s target population? > How many youth, adults and older adults, should receive service? > How much of what type of service, through which programs, ought to be provided? > What is the cost of providing these services? > Are there more cost effective ways to achieve similar or better clinical outcomes? > Are there changes that can be made in how the system is administered to reduce costs? 18

19. Effective Planning Models Exist 19

20. 6 Key Clinical Design Features & Interventions Crisis System that Serves as a Hospital and Jail/Juvenile Justice Prevention Service Hot Spotting - Case Management System for High Risk Clients that Serves as a Hospital/Jail Prevention Service Housing First Models, leveraging the funds and expertise of Housing Specialists Open Access combined with Initiation and Engagement Standards Clinical Flowthrough Model that Includes Front and Back Porches Addressing Consumers Holistically – Managing Total Healthcare Expenditures 20

21. Folks across the country are already figuring this out: Camden’s Hot Spotting 21

22. Police Hot Spotting: Jeffrey Brenner turned the idea towards the analysis of patient flow and healthcare expenditure patterns. Two most expensive city blocks, 900 people, accounted for 4000 hospital visits, 200 hundred million in healthcare costs over a 5 year period. 1% of 100,000 people used 30% of costs Implemented the equivalent of mental health PACT Teams Camden’s Hot Spotting 22

23. Role 2: High-Performing Mental Health/Substance Use Provider > Are you viewed as the Mayo Clinic of Behavioral Health in your community? 23

24. Missouri is Helping Lead the Way into the Brave New World… 24

25. For Georgia’s Community Service Boards: What Cost Curve Bending Triples and Home Runs can you build into your plan, within the constraints of your funding environment? 25