A New Paradigm...
Horizon Healthcare Partners, was formed by four of Rhode Island’s seven Community Mental Health Centers to preserve and share administrative and clinical capacity, and efficiently provide community services that reduce state costs and improve the quality of life for our clients.
We have rapidly evolved into a multi-agency network that horizontally links behavioral healthcare services with agencies and social enterprises that provide medical services, client-run services, supported housing, supported employment, alternative education and family services. We are focused on using the best community-based practices available to prevent more institutional and costly services.
We welcome state leadership that collaboratively develops a new Medicaid approach that contains costs and improves services for our most at risk neighbors. It is critical to recognize the role that mental health policy and practice plays in reducing costs, particularly the increased costs associated with acute care hospitalizations and emergency room visits.
We have the diverse boards, diverse workforces and diverse community services needed to achieve success in controlling these costs and improving care. We focus not only on the mental health needs of our high-risk clients, but also their housing, employment, peer support and healthcare needs that effect how they use services.
Cost containment and efficiency are second only to the quality of care we provide. Our network has succeeded in bundling staff capacity in new ways to reduce costs for those in need of the highest levels of care. We have re-engineered administrative and clinical practices to address costly co-occurring trauma, substance use and medical conditions among some of Medicaid’s most at-risk enrollees. We believe that Rhode Island must take greater advantage of opportunities that exist in a horizontal network to reduce inefficiency in its use of Medicaid providers.
Acute Care: A Diversity of Programs
We provide around the clock emergency mental health services as well as open access for walk-in urgent care. We are a safety net for all Rhode Islanders, not just those on Medicaid, yet Rhode Island has eliminated all state mental health funding except for Medicaid.
We successfully collaborate with police, hospitals, health centers, schools and other non-profits to provide services wherever and whenever needed and to prevent our clients from requiring out-of-home placement or acute inpatient care.
There are many areas where we can have an even greater impact with high-risk groups, such as the homeless, ex-offenders, and families in the child welfare system. With necessary financial support for our mental health emergency services restored, we can collaborate with other community-based organizations to divert Medicaid clients and others from emergency rooms and higher cost facilities.
Community Based Care: Our Priority
We have achieved dramatic results in preventing children going into DCYF care and in reducing the use of inpatient services for children and adults. Further, we have substantially reduced the use of the state hospital for adults with severe and persistent mental illness. We have made great strides in integrating primary and behavioral healthcare for better outcomes for our long-term clients. Our health homes demonstration is nationally recognized.
As our state experiences an increased use of hospitals and increased costs to Medicaid – a result of mental health funding cuts – we can look at new and simpler reimbursement models. We are ready to be measured by our client outcomes. We cannot sustain more cuts and continue to be a resource for all severely mentally ill adults, without regard to their insurance status or to safely maintain children in families where they will have better long term outcomes.
Cooperative Planning for the Future: Behavioral Health Workgroup Needed
The impact of Medicaid expansion on mental health and substance abuse services is unique and requires thoughtful planning. No changes to the system can be successful if made without hearing the many voices that speak for the needs of those recovering from behavioral health problems and mental illness. We request that DBH sponsor “listening sessions” to hear the voices of our consumers, family members, local advocates and providers regarding what is working and what needs to be improved. We request the formation of a Mental Health Workgroup that is diverse enough to advise DBH and EOHHS regarding anticipated or unintended consequences of change. We also ask for dialogue on the federal resources available for “systems improvement” and “excellence” so that we can accommodate regional and special population differences.
We are absolutely not satisfied with the status quo. We are not advocating for one model as the sole solution nor for a return to unaffordable past practices. We strongly believe that managed care approaches need to incorporate the capacity and flexibility found in CMHOs. We support a far greater role for low income residents, consumers and those with “lived experience” in our governance structures. With the greater communication and collaboration that is possible through a horizontally integrated network, Horizon Healthcare Partners can help expedite improvements in efficiency, effectiveness and customer satisfaction.
Economic Impact and Growth Through Improved Mental Health
We don’t just help eligible people qualify for and use Medicaid appropriately; we help residents deal with all aspects of their life that effect their mental health. We resolve personal problems and help people find and keep jobs. Our supported employment and supported housing services are invaluable resources for reducing Medicaid utilization for disabled adults.
Every day we see the importance of employment for individuals and the communities we serve. We are training CNAs and peer advocates and placing them in jobs. With more flexibility on credentials and degrees we can have an even greater impact on job creation for those just entering the workforce.
The majority of jobs in behavioral health, homecare and assisted living are affected by Medicaid priorities. Without these job opportunities, workers in these fields may not otherwise enter or re-enter Rhode Island’s workforce. Where the state reduces Medicaid spending will have considerably different impacts on job satisfaction and retention, unemployment rates and employee spending in local economies.
Money spent on mental health is money spent on strengthening individuals, families and communities. Mental health services improve the economy, create jobs and help people live better and more productive lives.
Horizon Healthcare Partners is the hub organization for a unique collaboration of some of Rhode Island’s leading regional community mental health organizations, including The Kent Center, Newport County Community Mental Health Center, Community Care Alliance and Riverwood Mental Health Services. We have other affiliated organizations and are developing new social enterprises to make our work as effective as possible.