"Private/public Partnerships: Financing Behavioral Health Services

Through Managed Care in the NorthSTAR Model."

David E. Young, MBA

Executive Director

Dallas Area NorthSTAR Authority

Background: NorthSTAR Pilot

• Mental health/mental retardation services in Texas

• Community mental health services:1964

• Performance contracts (grant in aid)

• Political/economic changes

• HB 2377 provider/authority separation (failed)

• 1998 NorthSTAR

NorthSTAR:creation

• MetroCare meltdown• How can system provide more services

with fewer dollars?• Efficiencies of managed care• CMS waiver• Blending funding sources• No wrong front door• MH & SA services (no MR)

NorthSTAR

• NorthSTAR website

• Managed care

• Uses behavioral health organization (BHO)– (Value Options–HMO)

• Blended funding goes to premiums that are paid to VO for eligible consumers

NorthSTAR

• Eligible 1,230,000

• Enrolled 444,000

• Competitive provider network

• Specialty Provider Networks (SPN)

NorthSTAR: Goals

• Efficiency

• Effective

• Access

• Choice– Access and choice create advantages to the

consumer and problems to the system

• Benefits design

Dallas Area NorthSTAR Authority

• Afterthought to public response for need for local input

• State is ultimate mental health authority (MHA)

• Authority delegated to LMHA

• DANSA is LMHA and LBHA (behavioral)

• Referenced in Texas Administrative Code and Health & Safety Code

Dallas Area NorthSTAR Authority

• Inter-local agreement of seven counties

• Board is appointed by county commissioners of each county– Dallas-4– Collin-2– Hunt, Rockwall, Kaufman, Ellis, Navarro-1

• Board appoints executive director

• Administrative agency of the state

Collin Dallas Ellis Hunt Kaufman Navarro Rockwall

Board of Directors

Executive Director

InformationTeam

Clinical Team

AdminTeam

Office Manager

Care Coordinator

Technology and Systems

Program Evaluator

Lead Ombudsman

Clinical Forensics

Community Resources

HHSC

NorthSTAR

BHO/VO

PROVIDER NET

DANSA

Community/Stakeholders

COLLIN DALLAS ELLIS HUNT

KAUFMAN

NAVARRO

ROCKWALL

Dallas Area NorthSTAR Authority

• Roles– Ombudsman– Planning– Facilitating– Resource development– Coordinating– Diversion– Mental Health Authority– Single Portal Authority

Dallas Area NorthSTAR Authority:Projects

• 340b drug pricing– UTMB

• Telemedicine/Video Conferencing

• Electronic Health Records– Computerized Texas Medication Algorithm

Project

• Outcomes

• Drug Utilization Management Programs

Dallas Area NorthSTAR Authority: Data

• Data Book– Eligible persons (1,227,191 persons)– Monthly services (14,758 {Nov 16997})– Recidivism (Readmit to SH within 30 days 6%)– BHO Financials (Providers paid within 60 days 95%)

• (Total premiums paid out for services to date 93%)

• NorthSTAR Presentation– Growth– Productivity

Dallas Area NorthSTAR Authority: Data

• Examples of service creep

• Psychiatric Rehab services– Four year growth

CSS Data - Summary 2/9/04

-5000

20000

45000

70000

95000

120000

145000

FY 2000Q1

FY 2000Q2

FY 2000Q3

FY 2000Q4

FY 2001Q1

FY 2001Q2

FY 2001Q3

FY 2001Q4

FY 2002Q1

FY 2002Q2

FY 2002Q3

FY 2002Q4

FY 2003Q1

FY 2003Q2

FY 2003Q3

FY 2003Q4

$0.00

$1,000,000.00

$2,000,000.00

$3,000,000.00

$4,000,000.00

$5,000,000.00

$6,000,000.00

Sum of Un-Duplicated Count of Claimants Sum of Allowed Units Sum of Allowed Amount

Source: TDMHMR Data Warehouse

CSS Data 2/9/04

0

20000

40000

60000

80000

100000

120000

140000

160000

FY 2000Q1

FY 2000Q2

FY 2000Q3

FY 2000Q4

FY 2001Q1

FY 2001Q2

FY 2001Q3

FY 2001Q4

FY 2002Q1

FY 2002Q2

FY 2002Q3

FY 2002Q4

FY 2003Q1

FY 2003Q2

FY 2003Q3

FY 2003Q4

$0.00

$1,000,000.00

$2,000,000.00

$3,000,000.00

$4,000,000.00

$5,000,000.00

$6,000,000.00

Sum of Un-Duplicated Count of Claimants Sum of Allowed Units Average Number of Units per Claimant

Sum of Allowed Amount Average Amount per Claimant

Source: TDMHMR Data Warehouse

Dallas Area NorthSTAR Authority: LBJ School of Public Policy, UT

• Independent Assessment

– “To summarize at the outset the LBJ School research team’s finding: having overcome many obstacles during its initial years, NorthSTAR is by its fourth year of operation a success. It embodies a total re-conceptualization of multiple systems of care. Under this re-conceptualization more service providers are available and more clients have access to service. And this new conceptualization of multiple systems of care has been carried out at no additional budgetary costs.

– The road to this success,however, was not without many

struggles.”

Dallas Area NorthSTAR Authority:Current Issues

• Access– One year 40% growth in persons served per

month– Drug costs

• Overall Economy– Job loss=state dependence

• Enemies– Change from state model to private model

"Private/public Partnerships: Financing Behavioral Health Services Through

Managed Care in the NorthSTAR Model."

• Should private/public partnerships be used to finance and manage public health systems?

• Reasoning• Implications for policy makers• Opportunities for MPH students