WE CAN DO THAT [Behavioral Healthcare]

Retiring MHCA CEO Don Hevey (left) we comes lift CEO Dale Shreve and reflect on 43 years in the business of behavioral health

Just about 43 years ago, Don Hevey, MSW, a 1968 graduate of nearby Florida State University, was wrapping up his second year as a clinical social worker at the Leon County mental health clinic (now the Apalachee Center for Human Services) in Tallahassee. And, like any young man, he was eager to make his mark in his chosen field.

At the time, a bold new national initiative - the formation of federally-funded "community mental health centers" - was still taking shape. The new CMHCs, as they were called, were the product of the Community Mental Health Centers Act, which President Kennedy signed into law in October 1963, only weeks before his death.

So, when the state of Florida'sOffice of Mental Health began looking for individuals that could help the state develop its vision for a statewide network of CMHCs, Hevey applied for and got the job. This 3-1/2 year assignment took him around the state and brought him face to face not only with the challenges and the opportunities, but also introduced him to dozens of people and personalities who were to shape the behavioral health field in Florida - and around the country - for years to come.

The heyday of the movement

In 1975, Hevey shifted from helping develop CMHCs to leading one when he was named the CEO of Manatee Mental Health Center (now Manatee Glens), a newly opened CMHC in Bradenton, Manatee County, on Florida'sGulf Coast. The 1970s were the heyday of the CMHC movement, a time when CMHCs faced the challenges of deinstitutionalization, but did so with a secure source of funding - direct from the federal government. It was a time when "mission trumped economic concerns" and "people were really excited about the notion of accessible mental health care in the community." It was also a time of unprecedented activism that saw a record number of lawsuits filed on behalf of better services and supports for people with mental illnesses and disabilities.

The activism reached even to the White House, where President Carter and First Lady Rosalynn Carter championed the interests of people with mental illnesses. The Administration's efforts gave birth to an important new piece of mental health legislation, the Mental Health Systems Act, which passed in 1980. The Act represented a substantial upgrade to the original CM HC Act, addressing not only the original limitations of the CMHC Act, but augmenting services and further strengthening the partnership between the federal government and the CMHCs. The future of the field appeared bright.

A change in fortune

But the reforms developed in the Carter Administration were never implemented because, in November 1980, Ronald Reagan won a landslide victory over President Carter, taking office in early 1981. At the same time, Bob Graham, who had recently been elected Florida's governor, asked Hevey to step in as the Program Director of the Alcohol/Drug Mental Health Program of the State Department of Health and Rehabilitative Services, a move that brought the Hevey family back to Tallahassee.

From his new post, Hevey had a bird's eye view of a sweeping shift in the country's support for mental health programs. The Reagan Administration launched the largest non-defense budget cuts in the nation's history and, in the Omnibus Budget Reconciliation Act of 198 1 , repealed the Mental Health Systems Act. The CMHCAct funds that had been earmarked for facilities and staffing - and paid direct from the federal government - suddenly vanished.

"The shift to block grants significantly altered the way we were working. Basically, the dollars that used to go direct to CMHCs were rolled together with other funds, then reduced by 25 or 30%, then given to the states," Hevey explains. "The notion was that you'd replace those fees with community-generated funds and levies, but it was very difficult, particularly in the inner cities, because the revenue base just was not there."

The heyday of community mental health - the time when "mission trumped economic concerns" - was over.

Big challenges

By 1985, when Hevey became MHCA's first CEO, the Reagan Era was well underway, and MHCA members had come to realize that federal budget cuts were hardly their only significant concern. They had to build new relationships with local and state officials, cope with the challenges posed by diagnostic review groups (a predecessor to managed care organizations), and figure out how to develop and fund their businesses.

Although M HC As membership was relatively small compared to that of other state and national organizations, the members didn't mind, says Hevey. "Our role was to be different. The focus was on business, not policy or advocacy. We had to cultivate an entrepreneurial spirit," he continues, noting, "the feeling among members was, 'if we stand alone, we're toast. We need to attract others who can help us survive and thrive.' That was the basis of MHCA - to pull together talents and resources for the good of the whole."

Because the CM HC era of the 1960s and '70s tended to attract "mission-focused" leaders with clinical backgrounds, Hevey quickly realized that the first order of business was to teach member CEOs "a business orientation." That meant bringing in a lot of différent people and topics - marketing, leadership development, training programs, funders, change agents. "The message was that you've got to know how to run a good business, that you've got to stay profitable to stay in business."

At times, it was a lot to swallow. "We didn't want our CEOs to lose their vision or passion for working in their communities," Hevey remarks, "but there was a realization. Our CEOs saw that they were stewards of a system that received investments of dollars and hopes from the greater community."

It didn't take long for a culture to develop - a culture that emphasized CEOto-CEO communication. "They learned so much from each other, so we decided to meet quarterly and have stayed small," says Hevey. "We have brought in new members slowly, with an emphasis on trust. [MHCA membership is by invitation only] We found that this makes for very free sharing about people, resources, programs, and problems."

"We can do that"

From the beginning, there was always one unwritten rule at MHCA meetings, says Hevey: "Don't whine about a problem - think of ideas to solve it." The talent of M HC A and its members to see and respond to industry challenges - starting with the Reagan era funding cuts - has enabled the group to make a series of significant contributions to the behavioral health field.

One of MHCA's most notable accomplishments - the formation of the Mental Health Risk Retention Group (MHRRG) - happened not long after M HCA's founding. At that time - the midto-late '80s, Hevey states, "the commercial insurance companies said they were going to phase out of social service operations. Our members were faced with the prospect of 'going bare' - without liability coverage - or closing. So, we decided to develop our own captive insurance company."

The idea was timely, since Congress had only recently passed domestic insurance reforms that made the creation of such an entity possible. "We hired an ex-insurance commissioner, an underwriting manager with malpractice and liability experience, executives and officers, and all the rest," says Hevey. To the relief of MHCA members - and the leadership of many other behavioral health providers - MHRRG continues to serve the field today - as a for-profit subsidiary of MHCA.

Along with many in the field, MHCA members blanched when they learned about the plans of new "managed care" organizations (MCOs), which sprang up in the 1980s. "In the beginning, our CEOs felt their backs were against the wall. The message from the MCOs, at first, was 'we're going to take over your populations,'" Hevey recalls, noting that for a while, the MCOs were successful in "cherry-picking" specific groups. Yet, over time, he says that providers noted the MCOs "couldn't offer much to SPMI populations. The feeling among our members was, 'We know how to treat them better than anyone. If we can just survive the worst of this, we'll make it.'" In time, they were proven right.

Through the years, MHCA has, through the collaboration of members and the support of staff, also developed a series of products, services, and trainings for the benefit of members and organizations nationwide, including:

* Technical help for members in developing the products needed to become "preferred providers" to insurers and MCOs.

* Research into key measures of performance, productivity, and quality.

* Development of national client, referral source, and staff satisfaction surveys, administered through a national data center, complemented by a program of consultation offering access to top practitioners, as well as best-practices trainings for member staff.

* Peer-to-peer consultation groups focused on both industry/strategic and dav'today business and operational concerns.

* Practices for building and sustaining effective boards and business relationships.

* Practices for building effective business and working relationships with healthcare, social services, and governmental entities.

According to MHCA's new CEO, Dale Shreve, Hevey 's knack for leading big efforts led members to associate their retiring CEO with one of his favorite sayings: "We can do that." Shreve, a long-time MHCA member, served as CEO ofHarbor (Toledo, Ohio) before moving into the CEO post at MHCA on February 1.

With a list of accomplishments like these - and a membership that has swelled to 129 organizations - there was only one more question to ask retiring MHCA CEO Don Hevey. "So," I ventured, "were there any things that MHCA tried that didn't work?"

He laughed. "You know, the very first thing we tried was to pool our purchases - equipment, supplies, food services, and the rest." The result was a total flop, for reasons that seem obvious today but weren't 25 years ago: "Our members realized that they were community-based businesses with locally based board members and that having local business partners was important." The lesson: "Do business locally."

Understanding the MHCA organization

MHCA

(Mental Health Corporations of America)

A 501 (c) (3) organization

Mental Healthcare America (MHA)

MHA operates as a for-profit subsidiary of MHCA. with a separate board of directors. MHA offers products, tools, technical assistance, and other resources to support MHCA member organizations in achieving their missions. These include:

* Mental Health Risk Retention Group (MHRRG): MHRRG is a domestic, captive insurance company that provides general, professional, and D&O insurance. MHA oversees MHRRG's loss control/risk management program. Negley Associates is the underwriting manager. MHCA remains the founder and major shareholder; it appoints six of MHRRG's board members.

* Customer Satisfaction Management System: Provides measurement tools for client, referral source, and staff satisfaction through MHCA's National Data Center.

* Peer Consultation: Utilizes resources of both active and retired MHCA CEOs to benefit MHA and MHCA member CEOs and their organizations.

A vision, a meeting, an organization

A young Don Hevey (center, with Doug Starr at left and Morris Eaddy, right) remembers a day in 1985 when "a couple of guys came to talk with me, to get my thoughts as a state director about a new organization."

The idea, presented by Morris Eaddy, Ph.D. from the Lakeview Center (Pensacola, Fla.), was to form leaders of respected community mental health centers into a professional organization that would work for the benefit of all. "I was really supportive," says Hevey.

He must have been, because the next day, he was contacted by Eaddy, Chairman of the Board of Mental Health Corporations of America (MHCA), who asked Hevey to join the new organization as its first CEO.

In a 1985 letter to membership, Eaddy introduced MHCA and its new CEO, Don Hevey. Eaddy said that MHCA was to be a "business league of not-for-profit mental health centers organized for the purpose of strengthening the competitive position of member centers." MHCA's emphasis would be "on improving productivity and performance, increasing market share of community services, and providing revenue and capital resources needed to provide continued delivery of essential services." He predicted that "the organization will consist of approximately 150 members ... [who will] focus on the business aspects of mental health services ... and complement each other in strengthening the healthcare network."

MHCA Facts:

Today, MHCA includes 129 member organizations in 31 states. An organization's "primary" representative to MHCA is the CEO.

MHCA membership is by invitation, explains Tara Boyter, communications director, who explains, "MHCA seeks as members those provider organizations that support its mission, that demonstrate a commitment to innovation and entrepreneurial endeavors in their day-to-day operations, and that express a willingness to contribute their expertise to the development of both MHCA and the entire behavioral health industry." Member organizations must be tax-exempt 501(c)(3) organizations.

Although only one female CEO was among its 19 founding members, MHCA membership today reflects the diversity of behavioral health leaders nationwide: Nearly a third of 129 MHCA member CEOs are women (39 in all) while nine member CEOs are black.

MHCA's new leader sees issues ahead

Right out of school. Dale Shreve (at left, with Don Hevey) represented the type of business-focused leader that MHCA sought to develop among its earliest members. Though he holds an MSW (University of Michigan). Shreve's studies focused on administration and management. In 1979. Shreve says that he was hired by Chuck Thayer, the clinicallyfocused head of Lucas County's West Center (the predecessor to Harbor of Toledo. Ohio), "to do the administrative pieces that Chuck didn't enjoy."

"My appointment there was a realization that the organizations coming out of the CMHC movement needed administrative expertise to ensure long-term viability." he maintains. Given its location in a prosperous segment of an urban county. Shreve says that the center "never had any direct federal funding." And. while this was a disadvantage at the time, he believes it ultimately "may have put us ahead of the game."

Minus federal support, the center came to rely on a mix of funding from its local mental health board. Medicaid, and from commercial insurance claims. This already diverse funding stream minimized the impact of Reagan-era budget cuts, while enabling the center to exercise some entrepreneurship. One effort involved creation of an EAP program whose revenues subsidized the center's hardpressed indigent care programs in the mid- to late '80s.

When Thayer retired in 1999. Shreve becameCEOof Harbor, which has grown into a multi-disciplinary behavioral health services provider with a$22 million annual budget and a staff of 360. In his 14 years as an MHCA member, he served as an MHCA board director, as Chairman of MHCA's for-profit subsidiary company. Mental Healthcare America, and as a board director for the Mental Health Risk Retention Group, the professional liability insurance company founded by MHCA in 1987.

Shreve, who moved with his family to Tallahassee in early 2013, shares his predecessor's belief in MHCA's value, calling his new post "a dream job." But, he warns, the field must confront many very real challenges. One is health reform: "All of our members are struggling with health reform. How does the ACA get implemented? What role do a CEO and an organization have in ensuring that behavioral health services are delivered in local market?" The process- and the answers, he says, have been "anything but clear."

Another challenge, for many members, involves the service/funding mix: "Some members are more or exclusively 'public-focused' in their business and revenues. The challenge for them is- without ignoring the traditional market adults who need chronic care- how do you address the needs of a general population with physical health issues? How do you integrate behavioral health in health and medical homes? How do you expand and balance services so you can be more available to youth, serve the subset of those with autism, and other needs?"

And finally, there is the original challenge- the one that helped to launch MHCA. yet continues to vex it and every other national organization within the field: Shreve describes it as "working with a national group of providers, coming to grips with how best to implement programs locally, though each state and local implementation is totally different."

BY DENNIS GRANTHAM, EDITOR-IN-CHIEF