RALEIGH -- Thousands of people in the Triangle with mental health, developmental delay and substance abuse problems will get help from a managed-care agency that's a joint project of Wake and Durham counties, if everything goes as planned.
Wake County commissioners unanimously agreed Monday to merge with Durham County to form an independent agency that also will serve clients in Johnston and Columbus counties. Wake's initial request to become its own agency was sharply rejected by the state Department of Health and Human Services last week.
Officials of both counties hope the arrangement will provide better care at lower cost by supplying a set amount of money per client, per month.
"We are excited about the possibility of this merger," said Ellen Holliman, area director of the Durham Center and leader of the proposed merged systems. "We think it will be a win-win for Wake County and Durham County."
The agreement still requires approval by Durham County's Board of Commissioners and the state Department of Health and Human Services.
If the merger receives those approvals, the new agency would become the state's largest managed-care organization for mental health and disability services, serving an area with more than 1.7 million people, Wake County officials said.
Carlyle Johnson, head of Wake's current mental health agency, said the joint agency will ensure continuity and high-quality care for consumers.
Representatives of both service providers and people with mental illness told commissioners the move has their blessing.
"At each point, we insisted that we become more and more part of the formula," said Raleigh resident Marc Jacques, who has advocated for people with mental illness at the state and local levels.
Some clients will receive additional care under this approach, but others could see services reduced if the care is deemed unnecessary, said Denise Foreman, assistant to Wake's county manager.
"What the state is hoping is that the management of the money is so much better that they'll be able to serve more people," Foreman said.
Treatment eyes savings
The change in the way mental health clients are treated is part of a state mandate to save money in Medicaid, the massive federal-state health care program for low-income people. One of the hallmarks of the ongoing efforts to reform mental health care in the state has been to put care in the hands of independent agencies that can contract for the best providers of services.
Paul Coble, chairman of the Wake County commission, said although set amounts of money will be funneled to the agency, more of the decision-making will be in local hands.
Typically, care for Medicaid clients is paid out on a fee-for-service basis.
"It gives us a lot more flexibility in meeting our clients' needs," Johnson said.
Durham has received approval from the state to begin operating as a managed-care organization beginning in early 2013. Officials of both counties said the agreement would let them pool resources to combat common problems such as homelessness, crime and school dropout numbers.
Original plan criticized
Wake's initial attempt to become its own mental health agency was met with pages of criticism by the state.
A letter from consultant Steve Day found fault with seven areas of Wake's application, beginning with a lack of clarity about the agency's independence from the county.
"The implementation plan states that the board will be appointed by Wake County Commissioners," Day wrote. "If the board is appointed by the commissioners, is it truly independent of the county?"
Wake County's behavioral health care has been mixed with public health and physical health service under the Human Services department, making it difficult to operate within the guidelines of managed care, Day said.
County employees who work for the current mental health agency in Wake will compete for jobs in the new agency, Coble said.
In addition, employees could be given opportunities to work elsewhere in Wake, he said.
