Anita Toney: Getting it right

Regarding the Sept. 22 news article “NC budget cuts $110 million from regional mental health”: With its cuts to mental health services, our legislature has realized our current Managed Care Organization design for regional mental health services has failed to adequately fund, improve and expand community mental health services while it also created large fund balances, excessive salaries, accountable immunity, favoritism in delegation of services and variable and discriminatory reimbursement rates for the same services among providers. The system lauded highly regarded best practice services often available only in small geographical pockets of catchment areas and built out opulent office space.

The legislature’s conclusion is to create more of the same by turning over Medicaid to managed care by private-profit driven MCOs. But what clear-thinking MCO will sign up after witnessing the legislature requiring them to give it back? The design of the managed care model allows MCOs to keep what they save, creating a basic conflict of interest in authorizing or denying services, which has resulted in the past decade in inconsistent and ineffective care of our most fragile population.

The current premise appears to be that community-led services didn’t work and closure of Dorothea Dix was a big mistake – so we will take back some money and build more psychiatric beds. The theory of community-based mental health services, funded and supported as initially envisioned (which included local psychiatric emergency beds), can work if afforded appropriate funding, management and leadership by providers of health care. There is adequate money appropriated to do it correctly.

Provider-led management has dedicated and proven interest in designing state of the art health care for our Medicaid clients over and above making money on the backs of these fragile individuals we are charged with helping. CCNC has proven it can be done within the physical arena of Medicaid care, and the proposed Accountable Care Organizations allow “integrated whole person” provider-driven care for both primary and mental health/ developmental disability/ substance abuse care while contained within a capitated payment to these organizations.

We have just a few months to get it right. Approval and scrutiny from Centers for Medicare and Medicaid Services will be more challenging and directive this time around – and it has little to do with North Carolina not signing up for the Affordable Care Act initiative and much to do with the fact that we have created an administratively bloated, often inaccessible and poorly responsive mental health service for our NC residents for the past 15 years.

The length limit was waived.

This story was originally published September 26, 2015 at 2:00 PM with the headline "Anita Toney: Getting it right."