The NorthSTAR program provides an integrated system of care with mental health care and chemical dependency services. ValueOptions® NorthSTAR is the BHO (Behavioral Health Organization) that is responsible for the maintenance of the provider network and care management for the enrollees. At ValueOptions®, we work together as a team with the goal of creating a quality model of care for the NorthSTAR area.
We regularly maintain, manage, educate, and outreach to our provider network. Our clinical department works to coordinate care, while maintaining quality and compliance directives. In customer service, we provide assistance in claims, enrollment, medications, benefits and eligibility, and web care data entry for authorizations of uniform assessments.
» Complete List of NorthSTAR Services
NorthSTAR is a behavioral health managed care project that fundamentally altered the structure of public behavioral health services in a seven-county area around Dallas, Texas. Multiple programs and funding sources were combined into one coordinated program. ValueOptions® began operating half the NorthSTAR program in 1999, and in July 2000, assumed operation of the entire program. Accomplishments include:
Blended funding and program coordination. When NorthSTAR started, the state Medicaid, substance abuse, and mental health authorities blended their funding to create a single system of care. Historically, these systems were under-funded and operated independently with their own eligibility criteria, programs, and benefits. Consumers had to navigate three different systems. Using the same total dollars blended from 15 federal, state, and local funding streams, NorthSTAR created a single, coordinated system of care. NorthSTAR streamlined agency policies and eligibility criteria, offering consumers a comprehensive benefit package and no longer forcing them to switch providers when their Medicaid eligibility status changed.
Increased access. In the past, many consumers were denied services or placed on waiting lists. During the first full year of operation, use of behavioral health services by the uninsured population increased 46 percent, from 9,190 individuals to 13,433 individuals served. Three changes that spurred the increased access and eliminated waiting lists were: 1) removed the county of residence restriction so that there is "no wrong door" to eligibility; 2) increased choice of providers from a larger 7-county provider network; and 3) introduced ombudsman services to help consumers access services and resolve problems.
Broader provider network. Traditionally, Texas behavioral health services were limited to a small number of state-contracted local providers who received state block funding. Under NorthSTAR, ValueOptions introduced competition and negotiated contracts with a larger number of providers. As a result, six new community mental health providers emerged to offer crucial specialty services, such as rehabilitation and ACT teams, and providers now compete for customers. ValueOptions® also trained providers on billing systems, so that 95 percent of providers (up from 40 percent at start-up) submit their claims within 60 days of service, and ValueOptions® pays most claims in less than 15 days.
Increased accountability. ValueOptions® developed a data and monitoring system capable of measuring the funds expended, the sources of those funds, services purchased with the funds, and customer satisfaction with services. NorthSTAR distributes a data book, available on the Internet and shared broadly with stakeholders, that tracks program performance over time. This level of data and monitoring was unobtainable under the traditional system. ValueOptions® is working to develop the next generation of outcomes to measure and report on the impact of the NorthSTAR program using clinical and quality-of-life indicators.
Positive program evaluation by the Texas Health and Human Services Commission. This commission examined three Medicaid managed care models, STAR, STAR+PLUS, and NorthSTAR, in the areas of access, quality, integration, and cost. The study concluded, “NorthSTAR does a better job of collecting data and managing behavioral health services than STAR or STAR+PLUS. Comparative data available on several indicators such as timely provision of care after hospitalization, timely claims payment, and satisfaction also indicate that it may be performing better than the other two models.” (Behavioral Health in Managed Care: A Review of Texas Medicaid Models, Texas Health and Human Services Commission, December 2002, Executive Summary, page 6.)
Involvement of consumers and advocates: Consumers and advocates were involved from the beginning and helped shape the design and development of the NorthSTAR program. Through their involvement, they have seen the value the NorthSTAR program brings for its members. The NorthSTAR authority has a governing board made up of consumers and serves as a vehicle for holding ValueOptions accountable for resolving consumers’ complaints, concerns, and systems issues. In addition, ValueOptions® has a strong prevention, education and outreach department that employs consumer and family advocates who act as internal change agents and bring consumer and advocate perspectives to our organization.