xxAACP Newsletter, Volume 12,
Number 2, Spring 1998
Regional Reports
Alabama
Public psychiatry is thriving in Alabama, as we seek to improve our ability to respond to the challenges that confront us (e.g., managed care, dual diagnosis, primary care networking, mentally ill and substance abusing inmates, and accountability). The following briefly describe a few of the innovations presently occurring in Alabama:
- Planning by all stakehohlders (consumers, family members, DMH [Department of Mental Health] providers) regarding the shape/standards/funding of Medicaid managed mental health care. There is presently minimal public sector managed care penetration in Alabama, and we aspire to avoid the pitfalls experienced by colleagues.
- Bed reduction efforts (closing state institution beds) remains a successful process; due to CMHC efforts, over 500 state hospital beds have closed in the last four years this resulted in the annual transfer of over 10 million dollars to the CMHCs. A portion of these monies have wisely been designated to pay for the use of newer medications.
- Substance abuse programs in the local jails are using a Justice Department grant to access the effectiveness of offering alternatives to jail for those identified as substance abusers. Intensive outpatient programs focusing on abstinence, stabilization of housing, and development of employment opportunities are offered to preindicted inmates. In addition, outreach from the University of Alabama (at Birmingham) Mental Health Center (UAB MHC) provides on-site psychiatric services in the local city/county jail system for those with serious mental illness.
- Development of a "partnership" between the UAB Department of Psychiatry and primary care medicine has occurred, involving placement of on-site psychiatry attendings in primary care clinics, as well as rotation of internal medicine and family practice residents at the UAB MHC.
- The Alabama Department of Corrections has initiated more intense, sophisticated substance abuse programs for those incarcerated (including a splendid program designed for those who are HIV-positive). These include rigorously structured patient education programming, GED preparation, vocational skills development, and preparation for applying for citizenship rights. Although it is early in the program, already remarkable results have been noted in terms of recidivism and maintenance of health, mental health and sobriety.
- Two years ago, DMH started a program to provide PGY-I through PGY-IV psychiatry residents (one class per year for four years) with a substantial extra stipend. Designated recipients are those who are willing to declare their committment to public sector psychiatry. They participate in a specially designed curriculum, allowing for additional development of knowledge base and systems understandings pertaining to the public sector. DMH also provides these residents membership in the AACP, computer hardware and software, funding of attendance at AACP meetings, and sponsorship of a soon-to-be-annual CEU event.
- Outcomes measurement is now included in the contract between mental health centers and the DMH. Not only is each center required to demonstrate the functional presence of a quality improvement program, but each center's "successful outcomes" are measured on four core parameters, includling: assessment of access, consumer satisfaction, family satisfaction, and quality of life surveys.
REMEMBER: Next year's AACP Winter (1999) Meeting will be in Birmingham, Alabama!
Kentucky
After four years of negotiations with state government, a unique system for mental health Medicaid managed care is being implemented in Kentucky. The state has been divided into eight Medicaid regions. Each region will be dealt with separately and in a phased approach. The first region's program to come "on line" is in the Louisville metropolitan area. This area has approximately 100,000 Medicaid recipients, nearly 20% of the total recipients in the state. The plan being implemented involves a contract between the state Cabinet for Human Resources and a non-profit entity which has been established. This non-profit entity is a partnership between the Department of Psychiatry at the University of Louisville Schoolof Medicine, University Health Care Inc. (the Medical School's non-profit HMO for physical health), and the two regional community mental health centers in our region, Seven Counties Services and Communicare. An operating board made up of representatives of the partners has been meeting for nearly two years to prepare for beginning enrollment, planned to begin during the second half of 1998.
The Medicaid partnership is unique in several regards. First, it is a non-profit entity. Therefore, the maximal resources possible will be devoted to patient care, with nothing going to repay stockholders in the form of dividends. Second, any qualified mental health practitioner, defined by state criteria, is eligible to be a provider within the system. This approach parallels that of University Health Care, which began enrolling patients for physical health coverage in November of 1997. The "any willing provider" philosophy will allow for maximum clinical flexibility and patient choice within a managed environment.
Several other aspects of the agreement with the state are notable. First, this is a multi-year contract, taking into account the need to assume that some period of time will be devoted to startup. Second, the terms of the contract provide for a perservation of prior levels of funding. Third, although the system is one in which mental health dollars are "carved out," there will be a single patient registration system, and an integrated medical information system with University Health Care to provide all the benefits of a unitary system of care.
For more information on any of the details of this program, please contact Allan TAsman, MD, Chairman, Department of Psychiatry and Behavioral Sciences, University of Louisville, KY 40202 or Howard Bracco, Ph.D., Chief Executive Officer, Seven Counties Services, Inc., 101 W. Muhammad Ali Blvd, Louisville, KY 40202.
Web Editor's Note, June 9, 2002 -- Here is a link to the Department for Medicaid Services of the Kentucky Cabinet for Health Services
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