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