LOOKING AHEAD: SHARING PERSPECTIVES ON THE FUTURE OF PUBLIC MENTAL HEALTH IN BALTIMORE CITY

PEOPLE ENCOURAGING PEOPLE’S PERSPECTIVEBY DALE EILEEN MEYER, CEOOCTOBER 4, 2011

External Factors

FederalHealth Care Reform

SAMSHA’s Reorganization and Strategic Initiatives HEARTH ACT Opening Doors: 10 Year Plan to End Homelessness HMIS Integration

StateImprobable Change in LeadershipMHA/ADAA IntegrationRisk to Carve-Out

CityImprobable Change in LeadershipBRAC?

In A Word (or two) ……

Strategic Risk Management

Downside vs. Upside Risk

Risk can be defined as unforeseen changes.

Downside risk is when the changes have a negative impact on your organization or business.

Upside risk is when the changes have a positive impact on your organization or business.

Population Targets

Individuals with Co-occurring Mental Health and Substance Abuse Disorders

Individuals with Forensic and Criminal Histories People with History of Sex Offenses Families Slipping from Middle Income to Lower

Income Children, Adolescents and Transitional Age Youth Immigrant Groups Veterans Dually Diagnosed: Mentally Ill and

Developmentally Disabled; Mentally Ill and TBI Aging Population

Risk re: New Populations

Downside: Increased clinical risk; risk to employees Increased stigma Potential financial risk associated with piloting new

models Requires re-tooling of models and re-training of staff Lack of clearly defined mandates

Upside: New models of service Evidence based/best practices Diversification of funding Niche markets Ability to help define models and policy

Economic

Recession appearing to continue for some time

Downturn in markets High unemployment Restricted lending by banks Constricted giving by

foundations

Risk re: Economics

Downside: Credit difficult to secure; heightened

emphasis on proactive cash management Significant increases in operating costs;

increased need for operating efficiencies Upside:

Buyer’s market Employer’s market Availability of unique, one-time only money

to help build infrastructure and pilot new models

Social Determinants of Health Increased need for affordable housing High cost of nutritious foods and food

oasis Lack of social capital and community

support Lack of individual support networks Unclear future of educational system Globalization’s affect on labor market

and education system

Risk re: Social Determinants

Downside: Increase in homelessness, especially homeless families Increase in head of households who are disabled Increased pool of entry level employees Increase in hunger and poorer health outcomes Lack of infrastructure and capital to address social

determinants Upside:

Opportunities for housing development Opportunities for unique feeding and other food related

programs Unique community building program models and

opportunities

Technology

Unclear mandates about electronic health records

Younger vs older employees’ relationships with and expectations of technology

Increased demand for data of all sorts Need to re-tool to assure compliance in

technology dependent environment

Risk re: Technology

Downside: Balancing up front spending against actual EHR roll out Affordability of tech savvy staff throughout the

organization Risk of “de-humanizing” human services Cost of capital goods

Upside: Automation of certain operating functions frees staff

up for more face-to-face time with clients New models of tech dependent services can be piloted Increased accountability and efficiency Theoretically, improved care management and cost

effectiveness

Focus on Peer to Peer Supports and Services Employment of Peers into Existing

Services Models Peer Run Services and Programs Person Centered Planning Wellness and Recovery Plans Consumer Led Quality Teams

Risk re: Peer to Peer Supports and Services Downside:

Unchartered territory re: employment law Duplication of efforts

Upside: Improved engagement and quality of services Improved satisfaction with services Reduction of stigma within community of

consumers Increased employment opportunities for

consumers Identified employee pool

Integrated Care

Integration of Mental Health and Substance Abuse into Behavioral Health

Integration of Behavioral Health and Somatic Health

Integration of Healthcare and Determinants of Health

Integration at the clinical, programmatic and systemic levels

Risk re: Integration

Downside: Increased clinical risk and liability Risk to cash flow due to billing system changes and “new”

rate structures Risk to carve-out and risk of new relationships with MCOs Risk of changes in target population Affordability of integration vis a vis staffing disciplines Risk of Imploding (Being all things to a few people) Lack of scale

Upside: Improved health outcomes and opportunities for research New, replicable models of service Availability of start up funding which helps to build infra-

struture Strengthens/deepens existing relationships with funders and

purchasers of services