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External Factors

Looking Ahead: Sharing Perspectives on the Future of Public Mental Health in Baltimore City People Encouraging People’s Perspective by Dale Eileen Meyer, CEO October 4, 2011. External Factors. Federal Health Care Reform SAMSHA’s Reorganization and Strategic Initiatives HEARTH ACT

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External Factors

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  1. Looking Ahead: Sharing Perspectives on the Future of Public Mental Health in Baltimore CityPeople Encouraging People’s Perspectiveby Dale Eileen Meyer, CEOOctober 4, 2011

  2. External Factors Federal Health Care Reform • SAMSHA’s Reorganization and Strategic Initiatives • HEARTH ACT • Opening Doors: 10 Year Plan to End Homelessness • HMIS Integration • State • Improbable Change in Leadership • MHA/ADAA Integration • Risk to Carve-Out • City • Improbable Change in Leadership • BRAC?

  3. In A Word (or two) …… Strategic Risk Management

  4. Downside vs. Upside Risk Risk can be defined as unforeseen changes. Downside risk is when the changes have a negative impact on your organization or business. Upside risk is when the changes have a positive impact on your organization or business.

  5. Population Targets • Individuals with Co-occurring Mental Health and Substance Abuse Disorders • Individuals with Forensic and Criminal Histories • People with History of Sex Offenses • Families Slipping from Middle Income to Lower Income • Children, Adolescents and Transitional Age Youth • Immigrant Groups • Veterans • Dually Diagnosed: Mentally Ill and Developmentally Disabled; Mentally Ill and TBI • Aging Population

  6. Risk re: New Populations • Downside: • Increased clinical risk; risk to employees • Increased stigma • Potential financial risk associated with piloting new models • Requires re-tooling of models and re-training of staff • Lack of clearly defined mandates • Upside: • New models of service • Evidence based/best practices • Diversification of funding • Niche markets • Ability to help define models and policy

  7. Economic • Recession appearing to continue for some time • Downturn in markets • High unemployment • Restricted lending by banks • Constricted giving by foundations

  8. Risk re: Economics • Downside: • Credit difficult to secure; heightened emphasis on proactive cash management • Significant increases in operating costs; increased need for operating efficiencies • Upside: • Buyer’s market • Employer’s market • Availability of unique, one-time only money to help build infrastructure and pilot new models

  9. Social Determinants of Health • Increased need for affordable housing • High cost of nutritious foods and food oasis • Lack of social capital and community support • Lack of individual support networks • Unclear future of educational system • Globalization’s affect on labor market and education system

  10. Risk re: Social Determinants • Downside: • Increase in homelessness, especially homeless families • Increase in head of households who are disabled • Increased pool of entry level employees • Increase in hunger and poorer health outcomes • Lack of infrastructure and capital to address social determinants • Upside: • Opportunities for housing development • Opportunities for unique feeding and other food related programs • Unique community building program models and opportunities

  11. Technology • Unclear mandates about electronic health records • Younger vs older employees’ relationships with and expectations of technology • Increased demand for data of all sorts • Need to re-tool to assure compliance in technology dependent environment

  12. Risk re: Technology • Downside: • Balancing up front spending against actual EHR roll out • Affordability of tech savvy staff throughout the organization • Risk of “de-humanizing” human services • Cost of capital goods • Upside: • Automation of certain operating functions frees staff up for more face-to-face time with clients • New models of tech dependent services can be piloted • Increased accountability and efficiency • Theoretically, improved care management and cost effectiveness

  13. Focus on Peer to Peer Supports and Services • Employment of Peers into Existing Services Models • Peer Run Services and Programs • Person Centered Planning • Wellness and Recovery Plans • Consumer Led Quality Teams

  14. Risk re: Peer to Peer Supports and Services • Downside: • Unchartered territory re: employment law • Duplication of efforts • Upside: • Improved engagement and quality of services • Improved satisfaction with services • Reduction of stigma within community of consumers • Increased employment opportunities for consumers • Identified employee pool

  15. Integrated Care • Integration of Mental Health and Substance Abuse into Behavioral Health • Integration of Behavioral Health and Somatic Health • Integration of Healthcare and Determinants of Health • Integration at the clinical, programmatic and systemic levels

  16. Risk re: Integration • Downside: • Increased clinical risk and liability • Risk to cash flow due to billing system changes and “new” rate structures • Risk to carve-out and risk of new relationships with MCOs • Risk of changes in target population • Affordability of integration vis a vis staffing disciplines • Risk of Imploding (Being all things to a few people) • Lack of scale • Upside: • Improved health outcomes and opportunities for research • New, replicable models of service • Availability of start up funding which helps to build infra-struture • Strengthens/deepens existing relationships with funders and purchasers of services

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