THE DAWNING OF THE MENTAL HEALTH WALMART

THE DAWNING OF THE MENTAL HEALTH WALMART

Submitted to the New York Nonprofit News 12/6/14

Andrew Malekoff, Executive Director / CEO, North Shore Child and Family Guidance Center, Roslyn Heights, NY

New York State's scorched earth policy against mid-size and smaller community-based mental health centers and middle-class children and families has come to fruition on Long Island. Recently PSCH, a $100 million NYC-based agency led by a number former OMH officials, decided to let go of the mental health clinics of two long-standing and highly reputable Long Island-based agencies that they took-over just a few years ago with the blessing of OMH. Pederson Krag and Peninsula Counseling Center's (PCC) mental health programs are gone or on their way out, left to be scooped up by other willing suitors. My friend and colleague the late Herb Ruben, a true mental health advocate who led and built PCC during a 50-year period, must be rolling over in his grave.

OMH has been encouraging mergers (aka takeovers) for years. In this case, two deeply-rooted organizations with more than a combined 100 years on Long Island have seen their mental health services thrown to the wind to be picked up and absorbed elsewhere, never to retain what took the better part of a century to build, a strong, trusted and undeniable presence in the local community.

This is the dawning of the age of the Mental Health Walmart. We are in early stages of a sad time of proliferating Medicaid mills, where children and adolescents with mental health problems will be shuffled along a conveyer of would-be evidence-based care administered by fee-for-service workers with no time to address crisis situations or to make even adequate collateral contacts with schools and other relevant people in the children’s lives. Middle-class families are being pushed out of the so-called “system transformation” process and poorer families are seeing the quality of care erode into to a series of half hour, revenue-maximizing, individual sessions.

The transition from a gold standard to a bronze standard of care is well underway. And, this is happening at the same time that almost $6.5 billion is being thrown at the Medicaid-driven acronym-of-the-year DSRIP – Delivery System Reform Incentive Program, a hospital-conglomerate-run initiative with the admirable goal of reducing emergency room visits and hospital readmissions, for Medicaid patients, of course. Another $1.2 billion is being made available for capital projects.

The other acronyms receiving mere millions are the $7 million to CTAC – Children’s Technical Assistance Center that trains agencies how to best serve Medicaid clients and send those with private insurance packing.  And, most recently on board is the $30 million to VAP – Vital Access Provider initiative aimed at helping agencies that are on life support to find ways to become fiscally self-sustaining on a diet of Medicaid-only clients or take steps to be taken over as Pederson Krag and Peninsula before them. And, oh yes, there is another acronym I almost forgot to mention. That is OT – Overtime. According to NYS Comptroller Tom DiNapoli, the New York State Office of Mental Health spends $100 million annually on overtime expenses.

At North Shore Child and Family Guidance Center, founded in 1953, the only specialty children’s mental health agency on Long Island, we have not received an increase in our Article 31 contract funding in more than 30 years.  If not for our community supporters we would have disappeared long ago, along with our sister agencies. A very small percentage of the billions being spent could make a difference and would go a long way to sustaining needed children’s mental health services on Long Island. But all appeals continue to fall on deaf ears, from the governor to the legislators to the commissioners.

Hello, hello, anyone out there! Does anyone in Albany care?

NEW VAP FUNDING SKIRTS THE ISSUE OF UNIVERSAL ACCESS

New VAP funding skirts the issue of universal access by Andrew Malekoff in the New York Nonprofit News, November, 25, 2014 http://www.nynp.biz/index.php/points-of-view/23292-new-vap-funding-initiative-skirts-issue-of-universal-access

By Andrew Malekoff, Executive Director and CEO, North Shore Child and Family Guidance Center Recently, I participated in a New York State Office of Mental Health Clinic Vital Access Provider (VAP) webinar. The webinar is a first step towards Article 31 mental health clinics applying for funding to preserve long term critical access to community-based mental health services. A total of $60 million in funding, over a three year period, is available. The intention of the VAP funding opportunity is for community-based mental health clinics that are “fiscally challenged” to develop plans that will demonstrate fiscal viability after three years. The funds can be used for such things as incremental costs for staffing and billing software, for example. Each clinic that receives a VAP award will be assigned a “strategic planner,” who would be a financial specialist, to help them to complete their final application, to include measurable outcomes. The ongoing achievement of measurable metrics will be tied to continued payments to agencies that have been awarded funding. The ultimate goal of the project, whether through mergers, improved efficiencies such as centralized scheduling, or agency sharing of back office functions, will be to ensure long term fiscal viability. I thought that the webinar was very informative. Webinar participants were given an opportunity to ask questions by typing them into a chat box function during the presentation. At the end of the almost two hour webinar, the moderator thanked the participants and concluded the session by stating that all questions had been addressed. Not so! Here are three questions that I typed in that the moderator did not acknowledge or respond to: Is the VAP funding initiative biased against middle class and working poor non-Medicaid children and their families who have no other viable access to labor-intensive community-based mental health care? Our specialty children's mental health agency [North Shore Child and Family Guidance Center] works with approximately 68% non-Medicaid and 32% Medicaid and Medicaid Managed Care families? Would a viable VAP proposal look to severely restrict access to care for children in Nassau County who need our outpatient care? It appears that you are supporting mergers. Is there any concern about what has come of the New York City-based PSCH takeovers in Nassau and Suffolk Counties? I felt that I had to ask these questions since, in my attending one webinar after another sponsored by OMH’s Children’s Technical Assistance Center (CTAC), the issue of universal access to children’s outpatient mental health care is routinely skirted. The sole focus of OMH webinars, regarding children in need of mental health care, are Medicaid-eligible children. North Shore Child and Family Guidance Center is a proponent of universal access for children and their families. New York State is not. On the issue of access to care, earlier in the year I asked Governor Cuomo about this and he directed my letter to OMH Commissioner Dr. Ann Marie T. Sullivan, who responded by stating that there is a work group looking into the issue of the non-Medicaid population. One outcome would be to get commercial insurers to increase their rates which, on average, are significantly lower than Medicaid rates. However, the State Department of Financial Services, within which the State Insurance Department is subsumed, does not have the authority to regulate commercial rates. Statute change, which is unlikely, would be required for this to happen. Presently, commercial insurance network adequacy, including for behavioral health care, is monitored every three years by the Department of Financial Services. However, I think it is unlikely that this will lead to significant penalties that would bring about change for entities that do not provide adequate networks of care. After all, the health insurance lobby is well-healed and well-connected in Albany. On the issue of mergers, a few years ago New York City-based PSCH took over Pederson Krag in Suffolk County and Peninsula Counseling Center in Nassau County, both well-established and well-respected community-based mental health agencies on Long Island. When a larger entity takes over a smaller one, the smaller one’s board of directors is dissolved and, at best, becomes an advisory committee, with a few select board members joining the larger entity’s board of directors. This is a step toward diluting the local community’s investment in the organization and its mission. It appears that PSCH has given up on Pederson Krag and its clinics are being dispersed and made available to other interested parties. Will this also be the fate of Peninsula Counseling Center? What are the consequences of decades of dedicated professional and lay leaders building a community-based culture, and then having it demolished by a takeover by a $100 million dollar organization that did not take. And, so, I thought it was a reasonable question to ask the VAP moderator whose agenda would appear to promote mergers and takeovers. What do you think?