Bringing behavioral-health help closer to home
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7/3/2009 - 7/4/09
For rural patients with diseases like schizophrenia, bipolar disorder or alcoholism, managing symptoms and getting care can be a difficult task, and when you add long-distance travel into that equation, finding help becomes close to impossible.OptumHealth New Mexico, which took over the state's behavioral health services contract on Wednesday, wants to provide more services where patients need them — close to home in their own communities, said Sandy Forquer, the company's CEO.
"Our approach was to really support the vision of the (state Behavioral Health Purchasing) Collaborative to transform the system," Forquer said. "That vision is to provide recovery — and resiliency-oriented services in local communities. To do that, we had to push services downward, out of a central office and into a regional setting."
OptumHealth New Mexico now manages the combined funds for 15 state agencies focused on mental health and substance abuse, with a goal of streamlining services and providing improved care.
No exact figures are available for the total value of the contract, but last year it was worth somewhere between $300 million and $350 million. Most of those funds come through Medicaid, said Betina Gonzales McCracken, a spokeswoman for the collaborative.
OptumHealth has been planning for the transition over the past six months, since it won the contract in January. The company has been working with regional offices and talking to patients about services they need, Forquer said.
One of the biggest issues that came up in the process, and during the bidding before it, was a need for more decentralized services, said Linda Roebuck Homer, director of the collaborative.
"A lot of things can be handled in regional offices," Roebuck Homer said. "We had some of that before, but the prior contractor, ValueOptions, was a bit more centralized with mixed services regionally."
ValueOptions New Mexico ran the program for its first four years, after the collaborative was created during the 2004 Legislature. OptumHealth will run the program through June 20, 2013.
The new contractor's plan is to spread more services into its regional offices in Santa Fe, Farmington, Roswell, Las Cruces, Albuquerque and in a regional team that works with the state's Native American communities.
"We've spent a considerable amount of time and energy visiting provider sites and talking about our regional strategies," Forquer said.
One change will be that now, each regional office will have two provider relations specialists, one claim funding specialist and one information technology liaison, all dedicated to helping regional providers to support care in their areas, she said.
Another thing the company found was that Native American groups wanted more support in the Albuquerque area, Forquer said.
"One piece of feedback we received from the tribes was that Albuquerque was a very central spot, and they were hoping we wouldn't put the Native American office in Santa Fe," Forquer said.
The company had to put some services in Santa Fe, but also added support staff in Albuquerque to meet the demand, she said.
As part of its statewide assessment, the company also hired a group of workers it called "peer messengers," who held 396 meetings with consumer groups and 2,672 meetings with consumers and family members as of June 30th.
Those meetings will continue over the next several weeks, and the peer messengers will also help set up several new "mutual support groups" for patients across the state, Forquer said.
The company also plans to invite between five and 10 agencies every six months to go through what it calls a "recovery and resiliency assessment," Forquer said.
"A hallmark of those is that consumers basically set their own goals for what they want and what would be considered meaningful services in their lives," Forquer said.
In the past, many behavioral-health service providers were focused on medications, but the "recovery and resiliency" tactic, which is sort of a national trend, focuses more on quality of life, Roebuck Homer said.
"The thing in the past was that people were supposed to get better so they could get on with their lives," Roebuck Homer said. "But these are diseases. I don't have to get better to deal with something like asthma before I get on with my life. These patients don't have to get better to lead meaningful lives either. It's a health issue."
In that vein, the focus of care is more aimed at helping patients integrate with their community and work, while also providing support and medication, Forquer said.
"Even people with severe mental and addictive disorders can achieve meaningful lives," Forquer said. "It doesn't mean symptoms are gone — it just means they're managed well."
Consumers and their families have been calling the company's support line at 866-660-7185 at a rate of about 50 calls a day. That line will be open 24 hours a day, seven days a week into the foreseeable future, Forquer said.
"Most of the questions we're getting are things like 'can we get the same medications?' 'can we see the same provider?' and the answers to all those questions is yes," Forquer said.
The company also launched an improved Web site with details about services at www.optumhealthnewmexico.com, which includes a consumer portal and manuals for service providers.
"We have done a tremendous amount of work to ease the transition," Forquer said. "In the next few months we're going to focus on things like making sure nobody falls through the cracks, making sure our providers get paid, and making sure everything continues to run smoothly."
Contact Sue Vorenberg at svorenberg@sfnewmexican.com.
