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