Jason Helgerson has been hired by several states by now to lead major transformations in how states have utilized Medicaid. His most recent stint was in New York where articulate mental health leaders/advocates for improved health and “behavioral” health outcomes have been very engaged in ensuring user-informed and practical system changes that would result in better outcomes in people’s lives. Helgerson has announced his resignation after doing great work in New York and we want to share with you the letter he sent out to stakeholders across the state. It is shared with us by Mr. Harvey Rosenthal, a person whose mental health history has informed his own excellent work for many years. (Harvey is the Director of the New York Association of Psychiatric Rehabilitation Services.) Mr. Helgerson, whose letter follows, has been the state’s Medicaid Director for several years now.
Dear Stakeholder Community:
Happy Friday. As you may have heard, I have decided to resign from my position effective April 6th. It has been a tremendous honor to help lead New York’s effort to fundamentally transform Medicaid and health care. Together we have made the world a better place through innovation and hard work. While much has been accomplished there is still much left to do! I want to make clear that my departure will have NO impact on this important mission. The Department of Health and its leadership remains 100% committed to the causes of MRT, DSRIP and VBP.
While I am sad to go, I am so bullish about our state’s collective future. Delivery systems across our state are changing and health outcomes are measurably improved. Organizations are working together as never before and as a result the system is really starting to work like a seamless, patient-centered delivery system focused on results. I can’t wait to see what the future has in store for your collective work. Know that I will be cheering you on as you show the world that collaborative, accountable care that meaningfully addresses the social determinants of health, improves health care outcomes as well as community health.
I wish you all the very best.
NYS Medicaid Director
Fellow advocate, let us not expect any less here in our state than what New York has accomplished through its inclusive and collaborative effort!
Complaints alone are not advocacy. To be effective, we need to identify some potential solutions that can be offered to decision-makers. In advocating for Ideas to strengthen inclusion of consumers and families in system development, oversight, and quality improvement, here are three ideas that perhaps our State Consumer and Family Advisory Committee and other advocates can consider as part of our advocacy strategy:
- Recommend that actions are taken to ensure that the Consumer Policy Advisory is empowered to undertake functions as defined in the position posting from February 12, 2015:
- “The selected candidate will work with LME-MCOs, applicable DHHS Divisions, county agencies, citizen groups, consumers, and consumer family members to guarantee that disability populations are adequately represented at all levels and in all phases of Department and Division efforts. The selected candidate will initiate and participate in system improvement and citizen involvement and ensure that the community-based system remains compliant with legal rights protections for recipients of supports and services.”
If the functions described were supported to be done with optimal result, the Consumer Policy Advisor would definitely strengthen the position of the consumer and family voice at the Division of Mental Health.
- Recommend that consumer and family inclusion are leveraged through MCO Contracts: Create language for the contract between MCOs and DHHS that ensures that consumers and families are engaged in an integral (integrated) way in advising MCO process, practices, culture. Tie funding incentives to meaningful and measurable consumer engagement as is done in public health systems.
- Recommend that the development of independent statewide consumer advocacy organizations be supported to 1) empower citizens toward recovery or personal goal advancement, 2) facilitate collaboration with area and state CFACS to ensure more stakeholder engagement with these advisor bodies, and 3) foster shared visioning for system and service innovation and quality improvement. Commitment to the effectiveness of these organizations should be shared between leadership of these organizations and Division leadership and liaisons. The aim is to collaboratively shift system culture toward participatory change/participant driven progress and family support.
- Funds from community mental health and substance use block grants can be accessed for this. Funds should be identified for individuals with intellectual and developmental disabilities.
WHAT other recommendations do YOU have in mind? Please share them with us!
This week, the Strategic Plan for Improvement of Behavioral Health Services was released to the General Assembly. It offers some clear data defining areas of system need and it focuses on bringing more accountability to system management. But it does not go far enough to ensure that public dollars are purchasing value in the lives of those served through citizen tax dollars. The following explains what is missing in this plan.
In order to effectively serve an identified group of citizens (“intended beneficiaries”) using public dollars, the use of these dollars and the assurance of quality results from their expenditure MUST be guided substantially by the beneficiaries and those who are their closest personal allies. Simply put, if the development of a citizen-serving system of supports and services is not adequately informed by its users—its customers—then it will neither be efficient or effective. Indeed, such a system can actually worsen of the health status of those who were actually intended to benefit by the system.
This has happened in North Carolina. We have in the past fifteen years worked hard at seeming without being, turning our state motto on its head! In spite of multiple system reforms and constant instability, we are still hurting. Readers can see excellent data in the recent Strategic Plan and in the report, The State of Mental Health in America , a state-by-state analysis of mental health and substance use care and access which shows North Carolina being in the bottom quarter across most reporting fields. But data aside, our communities live this systemic ineffectiveness and inefficiency daily. Citizens know this. Leaders probably know this. But it takes a bit of courage to reframe an overall objective and to share the mission and the effort with others—including those whom leaders may feel don’t really matter.
Political structures and the sequestering of decision making power to few top officials, elected and unelected, has created a very inefficient and ineffective superstructure for serving people with intellectual and developmental disabilities, with mental health challenges, and with substance use problems. In fact, I know that many fine people who work for our Division of Mental Heatlh, Developmental Disabilities, and Substance Abuse Services wish for more community informed change but are not themselves empowered enough to help lead. And I know many direct service providers who also are frustrated by the culture of service provision in our state—yet they feel they cannot act or speak to foster change or they risk losing their jobs. We suffer from an outdated state-funded operational culture and we need to bring it to currency!
Consider that if the changes we make in our system are not motivated by the desire for good outcomes, then the things that motivate—profits, preservation of status quo, mere compliance, etc.–are actually toxic to having an efficient publicly funded system! This is why the changes put forth in the State Strategic Plan for Improving Behavioral Health Services may indeed manifest as structural changes and may call for more fiscal accountability, but we may still miss the mark as far as human service results are concerned.
Effective people-serving is best accomplished when the systemic driver is optimal outcomes and these outcomes are defined by the folks intended to benefit by these services. In order to insure such outcomes, we would need for service system development, service delivery, and service quality improvement to be done with significant and continuous involvement of the people who use them, their families, and those who have first-hand experience with life improvement because they truly have learned what works! (We pay for a lot of things that do not work! And we are not paying for some that we know are working out in our communities. Yet there are dollars existing through federal grants that could be used this way if our state administration would only allocate them to do so. So will such innovations be sustainable?) What we need is true, transformational change where we do not just “put new wine in old wineskins,” so to speak. And we cannot have such change without the Voices of service users, ex-users, family members, well-motivated providers, and others at the local community level who would focus on real solutions!
The world is changing. Internationally a strong and informed community of individuals–many having lived with mental ill-being, substance use history, or other disabilities–has shifted the paradigm on improving health and mental health of their fellows. These changes started in other countries and have taken hold in several states in our country. They are based in the belief that individuals with challenges have important understanding to offer that will enhance the systems created to help them. Their agency is respected and their families are valued as important system informers, as well. The deliberate, valued engagement of system users and allies to inform those systems has reduced hospital and other facility utilization, has greatly increased numbers of individual recovery and integration into community life, and has reduced the misunderstanding about the value of citizens with mental health and substance use challenges and developmental disabilities. We should aim for no less than this, and we should insist upon a plan for real engagement of system users, families, and local community voices as an adjunct to the Strategic Plan for Improving Behavioral Health Services.
(Posted on FB, NC CANSO EMPOWERS page)
While the public mental health system isn’t the only source of help and support for people with mental health challenges, they are to ensure that citizens with no private means–and that is so many of us!–are given the help they need when they may need it. Are the outputs of your MCO reflected by people living higher quality lives and personal growth or is your area still having growing numbers of citizens appearing in EDs when in personal crises or because they simply do not know where to go?
If you are on a CFAC (consumer and family advisory committee), please ask about the numbers of individuals utilizing Emergency Departments and psychiatric emergency centers, where they exist. Because these numbers are the best indicators of 2) how well people are accessing services before they reach the point of crisis, 2) the service culture and quality with which they are met, and 3) the coordination of the local mental health system, including relationships with community assets that may be best able to help and individual, depending on need.
If you are an advocate serving on a CFAC or not, this is such important information for us to have! We can hardly ask for specific changes to ensure progress in our communities with out such data.
Is no one keeping this data? Then we as caring citizens must ask the legislature and the Department of Health and Human Services to put a focus on these aspects of service. Because we may be spending way too much money on too few good or lasting results if such things are not regularly considered!
- One of the VERY important aims of this subcommittee is to address the development of a comprehensive plan that would include outcome based measures, clear definitions of the roles and responsibilities of DMA, DMH, and the LME/MCOs.
- It would also address how to ensure that our public service systems become TRULY informed by community stakeholders, including CONSUMERS and FAMILY MEMBERS!
- Further, this committee could be the legislative forum that introduces lasting recovery-promoting policies in North Carolina’s public mental health and substance use services system!
The article below linked was published in Raleigh yesterday, January 19. This is at least the second time the federal government has expressed concern about our insufficient effort re: the initiative. For mental health consumers, this is a social justice and civil rights issue. People in area homes have been placed here from all over the state while the legislature let us develop one of the largest “assisted living” industries in the country. It takes guts to live in these and more guts to leave after one has become accustomed to custodial care.
From the Raleigh News And Observer:
Federal government says NC is shirking its agreement to help mentally ill people with housing and jobs
“The state agreed in August 2012 to provide housing for 3,000 mentally ill people by 2020, and supported employment for 2,500 by 2019. The state entered into the legal agreement with the U.S. Department of Justice to avoid getting sued for violations of federal laws that require states to provide services to disabled people in the least restrictive settings. A federal investigation found that the state was segregating people with serious mental illnesses in adult care homes when they were capable of living independently with mental health services and help finding and keeping jobs.
“The federal Justice Department filed the motion on Jan. 9 in U.S. District Court, asking the court to enforce the agreement.”