January 25, 2011

Georgia Behavioral Health CaucusC

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Community CareCommunity Care

Joseph Bona, MD, MBA

Chief Medical Officer

DeKalb Community Service Board

January 25, 2011

Georgia Behavioral Health CaucusC

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OutlineOutline

• Large number of individuals in Georgia with mental illness and substance abuse who are uninsured.

• Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement.

• Service capacity and budget planning should be population based.

• Successful community providers will need to be integrated, complex organizations with specific core competencies.

• Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011

Georgia Behavioral Health CaucusC

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Segmenting Georgia’s Uninsured Population

Uninsured Georgians By Segment Percent Estimated

Number

Uninsured, Not Needing Financial Assistance 30% 510,000

Uninsured, Needing Financial Assistance 35% 595,000

Uninsured, Eligible for Gov’t Programs 20% 340,000

Uninsurable 15% 255,000

Total 100% 1,700,000

This group of uninsured Georgians represent the target population for the DBHDD under State Contracted Services (SCS).

Census estimates Georgia population growth of 10% per 5 years.

January 25, 2011

Georgia Behavioral Health CaucusC

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Serious Mental Illness (SMI) among Georgian Adults Serious Mental Illness (SMI) among Georgian Adults Aged 18 or Older, by Age and Gender: 2009Aged 18 or Older, by Age and Gender: 2009

In 2009, there were an estimated 310,000 adults aged 18 and older in Georgia with SMI in the past year (4.4 % of all adults in the state)

Percent with SMI in the Past Year

GenderAge Group

18 or Older

4.4%

18 to 25

7.4%

26 to 49

5.2%

50 or Older

2.3%

Male

3.0%

Female

5.6%

0

1

2

3

4

5

6

7

8

January 25, 2011

Georgia Behavioral Health CaucusC

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Substance Dependence or Abuse in the Past Year,Substance Dependence or Abuse in the Past Year, among Georgia Adults among Georgia Adults

767,000 Georgians with substance abuse illness767,000 Georgians with substance abuse illness 230,390 without insurance230,390 without insurance

Population in Thousands

497 493 507 513 520 527 534

130 127 130 120 127 123 130

107 103113 110 107 107 103

0

100

200

300

400

500

600

700

800

900

2003 2004 2005 2006 2007 2008 2009

22.0 21.622.5 22.6 22.3 22.222.2

Both Alcohol and Drugs

Alcohol Only

Illicit Drugs Only

767757 Total Substance Abuse Georgia

754743

January 25, 2011

Georgia Behavioral Health CaucusC

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Uninsured GeorgiansUninsured Georgians

• With SMI: 310,000• With Substance Illness: 230,390• With Dual Diagnosis: 115,000

• Total at Risk lives DBHDD: 655,390

*DOJ Settlement specifically focuses on the 9,000 most acute

January 25, 2011

Georgia Behavioral Health CaucusC

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The Unmet NeedThe Unmet Need

Substance Use Treatment Only

Mental Health Treatment Only

Dual Diagnosis Treatment

39.5%

45.2%

3.7%

11.4%

No Treatment

259,000 uninsured adults in Georgia have never accessed care

January 25, 2011

Georgia Behavioral Health CaucusC

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OutlineOutline

• Large number of individuals in Georgia with mental illness and substance abuse who are uninsured.

• Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement.

• Service capacity and budget planning should be population based.

• Successful community providers will need to be integrated, complex organizations with specific core competencies.

• Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011

Georgia Behavioral Health CaucusC

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DOJ Settlement: Service EnhancementsDOJ Settlement: Service Enhancements

• Crisis Line• Crisis Stabilization Programs• Mobile Crisis• Assertive Community Treatment• Housing Supports• Supported Employment• Peer Support Services• Targeted Case Management

January 25, 2011

Georgia Behavioral Health CaucusC

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Community Service Delivery Spectrum

January 25, 2011

Georgia Behavioral Health CaucusC

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Characteristics of a Well-Organized Characteristics of a Well-Organized Community Delivery SystemCommunity Delivery System

•Services are organized into a simple, local network of care

•Network services are available through multiple entry points

•Formal linkages exist between mental health, substance abuse and primary care

•Local networks are responsible for coordination of client services

•Case management is identified to coordinate care

•Stakeholders have direct and meaningful input

January 25, 2011

Georgia Behavioral Health CaucusC

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OutlineOutline

• Large number of individuals in Georgia with mental illness and substance abuse who are uninsured.

• Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement.

• Service capacity and budget planning should be population based.

• Successful community providers will need to be integrated, complex organizations with specific core competencies.

• Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011

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Uninsured GeorgiansUninsured Georgians

• With SMI: 310,000• With Substance Illness: 230,390• With Dual Diagnosis: 115,000

• Total at Risk lives DBHDD: 655,390

*DOJ Settlement specifically focuses on the 9,000 most acute

January 25, 2011

Georgia Behavioral Health CaucusC

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January 25, 2011

Georgia Behavioral Health CaucusC

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Focus for the Delivery SystemFocus for the Delivery System

• Coordination of Services

• Access and Availability of Services

• Effective Services and Supports

• Adequate Oversight of Service Delivery

• Sufficient Funding for Services

January 25, 2011

Georgia Behavioral Health CaucusC

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Core Competencies For Community

Behavioral Health Provider Groups

1. The full spectrum of Specialty Behavioral Health Services2. Strong and deep clinical staff3. A well defined Assessment Process and Level of Care System 4. A solid approach to Prevention, Early Intervention, and Recovery 5. The ability to Coordinate Care across the spectrum of services 6. Demonstrated use of evidence-based Clinical Guidelines 7. Measurement Systems and Tools to measure Outcomes8. A robust Electronic Health Record that includes Patient Registries9. Quality Improvement Processes and supporting Data Systems 10. Financial Systems to manage Risk and Case Rate Payments11. Ability to market services in response to increased competition

January 25, 2011

Georgia Behavioral Health CaucusC

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OutlineOutline

• Large number of individuals in Georgia with mental illness and substance abuse who are uninsured.

• Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement.

• Service capacity and budget planning should be population based.

• Successful community providers will need to be integrated, complex organizations with specific core competencies.

• Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011

Georgia Behavioral Health CaucusC

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Meaningful Community PlanningMeaningful Community Planning

• Wealth of Expertise, Experience and Local Relationships

• State and Regional Level

• Strategic and Tactical Counsel

• Assist with Resource Allocation Decisions

• Implementation Support