A New System for New Mexico
New Mexico and ValueOptions use Braided Funding to transform the state's behavioral health services
by BARBARA B. HILL
In recent years, calls for mental health reform have resonated across the nation. New Mexico was one of the first states to enact sweeping changes to its public behavioral healthcare system. At the heart of this transformation lies Braided Funding, a process that maximizes the use of federal dollars.
Transforming Service Delivery
New Mexico Gov. Bill Richardson envisioned a single public behavioral healthcare network that would ensure better coordination of care and link multiple state and federal funding sources. Most importantly, the new statewide system would enhance the lives of children, adults, and families in need.
In 2004, the New Mexico legislature passed HB 271 to create the Interagency Behavioral Health Purchasing Collaborative, which brought together 15 state agencies including the following departments: Human Services; Health; Corrections; and Children, Youth and Families. The Collaborative aims to make access to services easier for consumers, enhance the quality of care, and make better use of public funding.
Via a competitive bid process, in 2005 New Mexico selected ValueOptions, a privately held managed behavioral healthcare company, to oversee public funding and the delivery of behavioral healthcare in the state. Under the direction of the Collaborative, ValueOptions New Mexico operates as the state's single managed care entity to ensure access to and delivery of behavioral healthcare. The company administers the state's Braided Funding model, manages the provider network, and works to ensure a seamless system of consumer-centered care promoting the principles of recovery and resiliency.
Under Braided Funding, ValueOptions is able to make access to services easier for consumers. The company uses different public funding streams to address the varied needs of consumers and families. For example, consider the case of a child receiving outpatient psychotherapy covered by Medicaid through the Human Services Department. At the beginning of treatment, the provider registered the child in the ValueOptions system so that an array of services could be identified, developed, and delivered to the consumer, and so the provider could receive reimbursement. In the course of care, the provider discovered that the child's parents could benefit from group and family counseling covered through the Children, Youth and Families Department, not through Medicaid. The provider also identified a need for housing assistance to keep the family in their home to provide stability for treatment. That service would be covered through Temporary Assistance for Needy Families, a separate funding source. The provider notified ValueOptions New Mexico, which issued the referrals. Each provider sent its claim to ValueOptions New Mexico for payment, and the family received the needed services: outpatient therapy, family counseling, and housing assistance.
Involving the Public
Developing strong local voices to guide behavioral health planning and services is a key element of the new public behavioral health initiative. Everyone, from consumers and families to providers and advocacy groups, participates in the process. The community is invited to make recommendations to the Collaborative and ValueOptions New Mexico at monthly public meetings and participate as members in the Behavioral Health Planning Council, the Consumer and Family Advisory Board, and Local Collaboratives. The monthly meetings provide the public an opportunity to not only review state spending reports for mental health and substance abuse services, but also propose changes and communicate any concerns or issues related to behavioral healthcare.
As part of its commitment to enhance the quality of behavioral health services, the Collaborative initiated a process to reinvest a portion of public funds into community-based programs or other noncovered services desired by the community. Managed by ValueOptions New Mexico, community reinvestment funds help consumers and providers in communities across New Mexico develop, improve, or provide programs that offer care that helps address the needs of specific at-risk populations. The funds already have advanced innovative treatment programs for children, Native Americans, homeless individuals, corrections parolees, and people living in remote areas of the state. In FY 2006, more than $5 million was reinvested in community-based programs and projects.
"When reinvestment funding is available, we're able to help providers and consumers build sustainable programs that address behavioral health concerns within their own communities and maintain those enhanced services that add demonstrated value to New Mexico's behavioral health system," explains Pamela Galbraith, CEO of ValueOptions New Mexico.
Focusing on Recovery and Resiliency
The family- and community-centered system of care builds on the Collaborative's vision for mental health reform. A coordinated network of family and community programs enhances the quality of care for individuals and families dealing with mental health and/or substance abuse concerns. ValueOptions Care Coordinators are on hand to help individuals and families receive all the services available to them depending on their needs. This system of care provides the least restrictive level of care while still ensuring that consumers' needs are being met.
The principles of recovery, resiliency, and prevention are the foundation of this structure. People who have overcome their own behavioral health issues can be effective in working with others in recovery. To this end, ValueOptions New Mexico's Department of Recovery and Resiliency (R&R) is staffed by people in recovery and maintains a strong community presence by advocating for consumers and family members, as well as providing training and workshops on recovery. The Department of R&R also assists in the development of consumer- and family-run programs and businesses (e.g., consumer-run drop-in centers).
"The Department of R&R is among the first of its kind in the nation," says Norma Faries, vice-president of recovery and resiliency at ValueOptions New Mexico. "Each of us has both personal and work experience within the behavioral health system. And when I say personal, I mean that we are all in recovery."
Simplifying Reimbursement
The Braided Funding model simplifies the reimbursement process for providers. Providers no longer have to contract with multiple managed care organizations and state agencies for behavioral health services. They now have one point of contact for billing and are reimbursed directly through ValueOptions New Mexico from the state's various funding streams. Provider credentialing and training are simplified in the same way. In essence, a single comprehensive network yields one set of standards and common service definitions.
"The Braided Funding approach is giving community mental health providers a real opportunity to think outside the box," explains Noel Clark, CEO of Carlsbad Mental Health. "No longer limited by capitated contracts with multiple managed care organizations, this new single-entity system has enabled us to respond more quickly to the unique behavioral health needs of our communities."
Conclusion
Using public funds efficiently is an integral part of New Mexico's behavioral health system transformation. ValueOptions New Mexico, in its role as the statewide entity for managing the behavioral health system, monitors and tracks each funding stream and works to ensure better coordination of care and better use of state dollars. And a movement toward evidence-based systems of care ensures that specific types of treatment for particular populations are tied to data-substantiated outcomes. Across the state, the new managed system of behavioral healthcare is building greater efficiencies and quality-driven care for consumers and families.