Governor Snyder’s proposed 2017 budget caused quite a stir in the pub- lic community mental system. It was reported Snyder’s fiscal 2017 budget called for privatizing the $2.4 billion public mental health system by turning over state funding to the private insurance companies/Medicaid Health Plans.
The budget bill, specifically Section 298, calls for carving in behavioral health benefits to the health plans by the end of fiscal 2017, which ends Sept. 30, 2017. Rightly or wrongly, a “carve in” is feared to mean by parents and advocates that the valued and progressive Michigan public mental health safety net will be ripped to shreds. Family members and consumers worry about change, losing long-term relationships with trusted providers and new rules that limit service. Given the struggles to get what they have, their worries are not without merit.
The language and its interpretations sent shivers down the spines of parents and advocates of persons with serious mental illness, substance uses disorders and intellectual and developmental disabilities. The Michigan Association of Community Mental Health Boards are working with the Snyder administration and the Michigan Health Plan Association in an attempt to have this “scary” boilerplate language removed from the budget bill or significantly modified.
In the meantime, they have provided “talking points” for Community Mental Health Boards, providers, consumers and advocates to uses in conveying the systems concerns to the Snyder Administration, legislators, and the media.
Lt. Gov. Calley to the Rescue
Lt. Gov. Brian Calley, hearing the pushback from parents, advocates and consumers, pulled a cross section of the health and mental health stakeholder community together and asked that they work together to enhance, improve and better integrate our systems of care, with the needs of consumer of service being the focal point. The first charge from Calley was to develop a philosophical/vision/ values foundation and a set of “facts” the group can use as framework upon which to build. This framework will help define a road map on where we need to go. The old saying, “If you don’t know where you are going, any path will take you there,” comes to mind.
It is reported that Calley told Crain’s Detroit Business that he “agreed to replace Section 298” budget language with a “consensus proposal from the work-group.” This is music to the ears of parents, consumers and advocates. They want and deserve a seat at the table that impacts their love ones. There is now a pathway to find ways to reimagine and reinvent our system of care that brings about change, leading to progress for the people we are all charged with serving.
Let’s move forward, getting past the politics and turf protection considerations and truly place our collective focus on the citizens of Michigan, our family members and neighbors in need of quality mental health and substance use services. Mental health issues skips no zip code and impacts one in four people in our communities.
Reimagine and Reinvent
We need to approach this opportunity as if we just discovered this place called Michigan and we had 300,000 people with disabilities that needed care and support, and each year $2.4 billion washed up on our shores to serve these individuals. Now, we have been asked to help redesign a system around our shared values to help meet their needs.
Clearly, we cannot continue to behave as though nothing has changed in health care when everything is changing around us. This is an opportunity to put into action “people over programs and politics”. I have come to respect and trust Lt. Gov. Calley when it comes to meeting the needs of persons served by the mental health system. He is accessible and willing to listen and learn and bend public policy in ways that serve people, specifically meeting the needs of persons with mental illness, substance use disorders and intellectual and developmental disabilities. He knows advocates, parents and consumers can and will hold him accountable.
Doing Good, Well
Detroit and Wayne County are well represented on the steering committee taking the lead in this review. The Detroit Wayne Mental Health Authority (www.dwmha.com), since becoming an Authority in 2013 has made a number of value based decisions which has allowed for efficiencies and cost savings to be redirected towards service.
As examples we are very proud we have:
• through better data management generated $30 million in new Medicaid re- sources for Detroit/Wayne County
• eliminated nearly $30 million in legacy pension and health care costs
• redirected over $20 million to provide a $1/hour increase to direct care staff who make slightly over minimum wage caring for extremely vulnerable persons
• consolidated 2 substance use organizations into our existing organization reducing administrative cost and redirecting over $3 million to service
• Produced with the Flinn Foundation two powerful anti stigma documentaries: Opening Minds-Ending Stigma.
At DWMHA we have strengthened care, flattened administrative costs and redirected dollars to service. We expect we will have a prominent seat at the ta- ble with the Snyder administration and the legislature as they move forward on a system redesign. There are ways, which we have demonstrated to improve service delivery that don’t place profits over people.
Moving forward, the dialog around this issue needs to be open, transparent and inclusive with the state, community mental health organizations, health plans, hospitals, consumers and advocacy groups. An open and collaborative approach with all stakeholders will produce better results. Let’s work together to enhance the care, support and opportunities for our family members with an illness or disability. Everything we do should create opportunities and a life of dignity and self-determination for our fellow citizens.
We ought to proceed as though our actions will impact someone’s mother, father, sister, brother, son or daughter because ultimately it will. An opportunity has been created to redesign a system of care in response to the expressed needs and desires of con- sumers of behavioral health services. As the old saying goes, “the proof is in the pudding.” Stay tuned.
Tom Watkins is president and CEO of the state’s largest PIHP, the Detroit Wayne Mental Health Authority.