Multicounty agency to direct mental health care in Cumberland County [The Fayetteville Observer, N.C.]

June 22--On Jan. 1, the Cumberland County Mental Health Center will stop providing direct services to the mentally ill.

Instead, the stripped-down center will operate essentially as an insurance company, managing the accounts of the mentally ill to ensure that they get appropriate treatment at a justifiable cost.

The new Managed Care Organization, or MCO, will lump Cumberland County with Durham, Wake and Johnston counties and be called Alliance Behavioral Healthcare. It will be based in Durham and have satellite offices in each county.

Once in business, Alliance will be responsible for more than 195,000 Medicaid-eligible residents, the most of any of the 11 Managed Care Organizations in the state. All MCOs are scheduled to be operating by Jan. 1, but some could get a six-month extension if needed.

Cumberland County Mental Health will continue to have a local presence thanks to an interlocal agreement between Alliance and Cumberland County.

Psychiatrists and psychologists who were employed by the mental health center will now fall under the Cumberland County Health Department. The psychiatrists and psychologists will continue to see patients and accept walk-ins at the mental health center at 109 Bradford Ave.

"The reason we did the interlocal agreement (instead of a merger) is because we wanted to make sure we keep a local presence here in Cumberland County," said Hank Debnam, director of the Cumberland County Mental Health Center.

Debnam and Rob Robinson, who will be the deputy director of Alliance, are optimistic that the restructuring will move the state's mental health system in the right direction.

"Managing the system will benefit the consumer," Robinson said. "We'll have control over the network, and that means we can keep the best of the best providers and we can weed out those that aren't up to par."

Now, any health providers can take on Medicaid patients and receive reimbursements if they are registered with Medicaid.

Those providers will be grandfathered into the new system for the first year, provided they fill out extensive paperwork and file it with the MCO.

After the first year, the number and type of providers will be determined by the market. The MCO will seek out and authorize more providers if there is a demand, fewer if there isn't.

Each provider will be evaluated and rated under a star system. Poorly rated providers are expected to disappear as demand for them falls.

The MCO can control reimbursement rates, meaning reimbursements can be increased to attract a certain type of provider to an area. MCOs can also reward providers that achieve the best outcomes.

The MCO's main task, however, will be to manage the pot of money it will be given at the start of each year.

That amount will be based on several factors, including the number of Medicaid-eligible residents in member counties. MCOs, not county governments, are responsible for any cost overruns. Any savings can be used to provide additional services.

"The truth be known, there will never be enough money to meet all of the public mental health care needs," said Debra Dihoff, executive director of the National Alliance on Mental Illness, North Carolina. "Managing it is a good idea because it will make sure that a limited amount of money will be spent well."

The state's move to a managed-care system for mental health began seven years ago with a pilot program in a five-county area of western North Carolina. Piedmont Behavioral Health, now called PBH, initially covered Union, Cabarrus, Stanly, Rowan and Davidson counties. That number will balloon to 15 counties as part of the new consolidated system.

"I think (PBH has) reduced costs and improved care," said Dr. John Gilmore, a professor in the department of psychiatry at the University of North Carolina at Chapel Hill. "There are bits and pieces of things they've done that people haven't been happy with, but overall, they've done a reasonably good job."

The latest attempt at reform will cause a reorganization at the offices of Cumberland County Mental Health. The MCO will employ 47 people, some of whom could transfer from positions at mental health.

The Cumberland County Board of Commissioners allocated $2.8 million to mental health for fiscal 2013, down from more than $4.1 million this year. Sixteen mental health employees will be laid off as of June 29, and another 67 will be let go as of Dec. 31.

After some debate, the commissioners decided to fund the Roxie Avenue Center, a 16-bed detoxification clinic, and Cumberland County District Court's sobriety court. A clinic that administers the potent anti-psychotic drug Clozaril to schizophrenics also will remain open.

Staff writer Todd Leskanic can be reached at leskanict@fayobserver.com or 486-3511.

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