AHEAD AND GET STARTED WITH OUR
OUR JOINT HEARING.
WE EXPECT THAT MEMBERS WILL BE
JOINING US ON AND OFF THROUGHOUT
THE HEARING TODAY BUT WE'D LIKE
TO THE INTERESTS OF KEEPING
THINGS ON SCHEDULE BY TO GET
STARTED.
TOYS FOR SMALL SAY CONGRATS GOOD
CONGRATULATIONS.
TO RVCA CONGRADULATIONS I GUESS
FOR WHATEVER FOR WHATEVER YOU
KNOW GOOD AFTERNOON HOW LET'S
TRY THAT --
ONE AND WE'LL GO AHEAD GET
STARTED --
MENTAL HEALTH SERVICES ARE A
CORE COMPONENT OF THE PROGRAM
AND MEDI CAL IS THE MAJOR SOURCE
OF FUNDING OF OUR COVERAGE FOR
LOW INCOME CALIFORNIANS.
THE LAST WEEK'S JOINT HEARING WE
HEARD HOW THE MEDI CAL SYSTEM IS
ADMINISTERED FINANCED AND
DELIVERED TODAY'S JOINT
INFORMATIONAL HEARING IS
INTENDED TO PROVIDE AN OVERVIEW
OF HOW WELL THE MEDI CAL.
A MENTAL HEALTH BENEFITS LIBERTY
SYSTEM WORKS WHAT CAN BE
IMPROVED AND HOW HOW CARE CAN BE
BETTER INTEGRATED.
WE HAVE A FULL AGENDA SO I'D
LIKE TO GET STARTED.
ARE THERE ANY MEMBERS WOULD LIKE
HAVE ANY COMMENTS BEFORE WE
START.
OKAY SEE NO ONE WILL ASK OUR
FIRST PANEL --
CHEN JENNIFER CAN'T THE DIRECTOR
DEPARTMENT HEALTH CARE SERVICES
AND KARIN LARSSON DIRECTOR OF
HEALTH AND HUMAN SERVICES AGENCY
FOR YOLO COUNTY.
ALSO A MEMBER OF THE BOARD OF
THE COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION SO
[inaudible]
FORWARD.
JEFF ECOMMERCE BEFORE WE START.
TO QUIT THAT WE HAD DOCTOR
PASSCODE.
OKAY HEALTH THANK YOU THANK YOU
DOCTOR WORDS AND I THINK YOU AND
YOUR STAFF.
FOR PUTTING THESE HEARINGS
TOGETHER AND REALLY APPRECIATE
THAT -- THE
INFORMATION WE GOT THE LAST WEEK
IN OUR FIRST HEARING HAND
PARTICULAR ABOUT THE SERVICES.
CLEAN.
SEE WE HAVE THE FARM HEALTHCARE
SERVICES TO LEADING US OFF BUT
HOW WE CAN IMPROVE THE WAY WE
DELIVER CARE FOR SOME IS FULL
PATIENTS.
AND PARTICULARLY THIS IS TIMELY
BECAUSE WE HAVE WAIVERS THEY'RE
COMING UP --
FOR NOLAN THEM DIRECTLY
INTERESTED IN HEARING HOW FAR
HEALTHCARE SERVICES.
WELL -- AS
WE TALKED ABOUT LAST HEARING HOW
TO BE GREATER OVERSIGHT.
AND HOW WHAT KIND OF DATA WE
CANNOT PROGRESS WE'RE TOLD
TOWARD OUR MENTAL HEALTH THAT.
GOALS IN OUR OF THE PROBLEMS
THAT I THINK MANY OF US AS
LEGISLATORS.
ARE HEARING FROM MY CONSTITUENTS
AND ALSO --
WHAT WE'RE GONNA DO TO TRY --
TO TO BASICALLY ADDRESS BOTH
MENTAL HEALTH SUBSTANCE USE A
REDUCTION IN THE STATE OF
CALIFORNIA SO --
VERY EXCITED TO HEAR CAN --
PURSUE THOSE AND ALSO BE SURE
THAT WE CAN DEMONSTRATE TO THE
PEOPLE OF CALIFORNIA THAT WE'RE
MAKING PROGRESS ON THE MANY
MENTAL HEALTH AND SUBSTANCE --
USE --
ISSUES THAT THEY SEE AND AND
THEIR COMMUNITIES AND OF COURSE --
AND EFFECT EFFECT PERHAPS
AFFECTING THEIR OWN NEIGHBORS
AND FAMILY SO THANKS VERY MUCH
[inaudible]
WHICH GREAT SO THANK YOU VERY
MUCH JENNIFER CAN --
DIRECTOR FOR THE DEPARTMENT OF
HEALTH CARE SERVICES --
SO I WOULD LIKE TO KIND OF START
OFF BY A SETTING --
A LITTLE BIT OF PERSPECTIVE FROM
THE STANDPOINT THAT WE AT THE
DEPARTMENT OF HEALTH CARE
SERVICES --
OPERATE AN OVERSEAS SIX DELIVERY
SYSTEM SO WHEN YOU THINK ABOUT
REALLY BIG CONSEQUENTIAL
PROGRAMS --
IN THE STATE WE ESSENTIALLY HAVE
SIX DELIVERY SYSTEMS THAT WERE
OPERATING AND AS WE TALKED A
LITTLE BIT --
LAST --
HEARING --
THERE'S A FROM SERVICE AND
PEOPLE THINK THAT MEDI CAL
BASICALLY BREAKS DOWN INTO THOSE
TWO DELIVERY SYSTEMS BUT I LIKE
TO REMIND PEOPLE.
THAT BAY ON FEE FOR SERVICE IN
MANAGED CARE WE HAVE THE MENTAL
HEALTH DELIVERY SYSTEM WHICH IS
COMPOSED OF FIFTY SIX COUNTY
MENTAL HEALTH PLANS.
ON EACH OF THOSE COUNTY MENTAL
HEALTH PLANS ARE RESPONSIBLE FOR
SUBSTANCE USE DISORDER SERVICES.
THEY CAN TAKE THE SHAPE OF BEING
A COUNTY THAT'S PARTICIPATING IN
OUR ELEVEN FIFTEEN WAIVER
THROUGH THE ORGANIZED DELIVERY
SYSTEM WHICH IS A SEPARATE
MANAGED CARE DELIVERY SYSTEM.
AS OPPOSED TO BEING A COUNTY
THAT IS DOING IN ON WHAT WE CALL
STATE PLAN DRUG MEDICAL SERVICES
WHICH ARE FIVE STATE PLAN
SERVICES.
THEN WE ALSO HAVE THE DENTAL ADD
DELIVERY SYSTEM WE HAVE
CALIFORNIA CHILDREN'S SERVICES
AND SO WHEN YOU START TO LOOK
ACROSS THE SPECTRUM.
OF WHO ARE BENEFICIARIES ARE OF
WHICH WE ARE THE LARGEST
PUBLICLY FINANCED PROGRAM IN THE
NATION BEHIND MEDICARE SERVING
OVER THIRTEEN MILLION
CALIFORNIANS.
IT GETS REALLY COMPLICATED
REALLY QUICKLY I THINK THAT
THERE'S A LOT OF INTEREST AND
THERE HAS BEEN A LOT OF INTEREST
IN INDIVIDUALS WHO SUFFER FROM --
MENTAL ILLNESS ESPECIALLY
SERIOUS MENTAL ILLNESS BECAUSE
OF THE CONSEQUENCE AND THE
IMPACT TO OTHER --
BOTH PROGRAMS AND SERVICES IN
THE STATE AS WELL AS TO THE
INDIVIDUAL SUFFERING FROM THE
ILLNESS.
SO WHEN YOU STOP TO OUR MENTAL
HEALTH DELIVERY SYSTEM --
THERE AND YOUR AGENDA DOES A
REALLY NICE JOB AS NOTING IT --
THERE ARE SEVERAL CONSEQUENTIAL
FINANCING SOURCES THAT HELP.
UNDER GIRD THAT ENTIRE DELIVERY
REALIGNMENT FUNDING SOURCES
THERE'S THE MENTAL HEALTH
SERVICES ACT THERE'S SOME STATE
GENERAL FUND THERE'S MENTAL
HEALTH BLOCK GRANT AND THEN
OBVIOUSLY THE MOST IMPORTANT
COMPONENT --
FOR WHICH WE WOULD BE AS
COMPLETELY REMISS TO NOT MENTION
AS THE FEDERAL FUNDS AND WHEN
YOU DO THINGS WITH MEDICAID
FEDERAL FUNDS.
AS YOU WILL QUICKLY ALSO
APPRECIATE IS THE RULES AND THE
COMPLEXITY AROUND HOW THOSE
FUNDS ARE USED IN THE
DOCUMENTATION THAT IS REQUIRED
IN ORDER FOR THOSE FUNDS TO BE
DRAWN DOWN.
IS SOME OF THE REASONS WHY WE
HAVE THE SYSTEM THAT WE HAVE.
SO WHEN YOU TALK ABOUT --
WITHIN THE DEPARTMENT OF HEALTH
CARE SERVICES.
OVERSEEN FIFTY SIX CAN MENTAL
HEALTH PLANS THE FIRST ISSUE IS
IS THAT THERE'S FIFTY SIX OF
THEM -- AND
THERE'S A LOT OF THEM AND ONE
COUNTIES MENTAL HEALTH --
PROGRAM IS ONE COUNTIES MENTAL
HEALTH PROGRAM EACH COUNTY BASED
IN THIS LOCALITY BASED IN ITS --
CHOICES AROUND AT THE PROVIDERS
THAT THEY CONTRACT WITH --
THE WAY THAT THEY WANT TO
DELIVER SERVICES HOW THEY
ADMINISTER THE PLAN FOR YOU KNOW
APPEALS AND GRIEVANCES AND ALL
OF THOSE THINGS ARE AT THE
COUNTIES DISCRETION SO WE LIKE
TO SAY THAT WE HAVE GIVEN.
THE RESPONSIBILITY AND THE
FUNDING TO THE COUNTIES AND IT'S
UP TO THEM TO DECIDE ON A LOCAL
BASIS HOW THEY OPERATIONALIZE
THAT OBVIOUSLY WE MAINTAIN
OVERSIGHT --
THE PROGRAM BRADLEY READ BUT
EACH COUNTY HAS A LOT OF
FLEXIBILITY IN HOW THEY DELIVER
SERVICES TO BOTH PEDIATRIC AND
ADULT POPULATIONS --
WHAT WORKS WELL AND WHAT HAS
WORKED WELL --
OR WHAT IS A BENEFIT TO
CALIFORNIA'S --
DELIVERY SYSTEM IS THE FACT THAT.
COUNTIES HAVE OVER THE YEARS --
REALLY BUILT UP AN AREA OF
EXPERTISE AND SERVING --
SERIOUSLY MENTALLY ILL SERIOUSLY
MENTALLY ILL POPULATIONS IN A
WAY THAT I DON'T KNOW THE OTHER --
ENTITIES VENDORS ARE PROVIDERS
CAN STEP IN AND DO IN SUCH A
CAPABLE WAY --
THAT POPULATIONS THAT THE COUNTY
SERVE AND WORK WITH --
OFTENTIMES THE COUNTIES ARE
WORKING CLOSELY WITH THEIR LOCAL
JAILS ON THE PUBLIC SAFETY
OFFICERS THE FOSTER CARE SYSTEM
JUVENILE JUSTICE.
THESE ARE INDIVIDUALS THAT WILL
PROBABLY BE INVOLVED IN NUMEROUS --
PARTS OF THOSE COUNTY BASED
SYSTEMS AND I THINK THAT THE
EXPERTISE IN TERMS OF THE
CLINICAL BACKGROUND AND THE
FAMILIAR WITH OUR POPULATIONS
THE COUNTY MENTAL HEALTH PROGRAM
CERTAINLY HAVE.
A LOT OF STRENGTH IN THAT AREA
WHICH WE WOULD BOTH ACKNOWLEDGE
AND WANT TO CONTINUE TO PROTECT.
I THINK THE THINGS THAT HAVE
BEEN MOST CHALLENGING FOR US AS
A STATE IS AS THE FEDERAL
GOVERNMENT HAS CHANGED --
IT'S OVERSIGHT AND REQUIREMENTS
AROUND HOW BENEFITS ARE
DELIVERED --
SO THINK BACK A COUPLE OF YEARS --
TO TWENTY MANAGE CARE RULE WAS
PASSED.
THE FOR THE FIRST TIME THE
COUNTY MENTAL HEALTH PLANS WERE
HAVING TO MEET THE STANDARDS BY
WHICH OUR MEDICAL MANAGED CARE
PLANS WERE HAVING TO IN TERMS OF
NETWORK FILENE'S.
APPEALS AND GRIEVANCES PRE
AUTHORIZATION OF SERVICES AND
THERE IS A REALLY SIGNIFICANT
CHANGE IN THE COMPLIANCE ASPECT
OF DELIVERING CARE THAT THE
COUNTY MENTAL HEALTH PLANS HAD
NOT DONE BEFORE.
THIS COMPLIANCE --
TENDS TO I THINK THE ONE OF THE
LARGEST AREAS OF CONCERN TO US
AS A DEPARTMENT AND THAT THERE
ARE A LOT OF VERY SMALL COUNTIES.
I AM I'M JOINED BY A FAIRLY
SMALL COUNTY --
BUT THEY'RE VERY SMALL COUNTIES
IN WHICH THE CAPACITY AND THE
STAFFING TO ACTUALLY FILL THOSE
COMPLIANCE --
RESPONSIBILITIES IS SOMEWHAT
LACKING --
WE HAVE AND WILL BE PREPARING --
LETTERS GOING OUT TO A SUBSET OF
COUNTIES --
RELATING TO THEIR FAILURE TO THE
FEDERAL VIOLENCE THAT WERE DUE --
FOR DELIVERY SYSTEMS HAD TO FILE
THOSE NETWORK FILING SO MANAGED
CARE DENTAL --
SUBSTANCE USE DISORDER AND
MENTAL HEALTH AND THERE IS A
SUBSET OF COUNTIES ON THE MENTAL
HEALTH SIDE THAT HAVE NOT COME
INTO COMPLIANCE WITH THEIR
CORRECTIVE ACTION PLANS AND SO I
WOULD POINT TO THAT AS BEING ONE
OF THE AREAS THAT.
WE CONTINUE TO HAVE CONCERN
AROUND -- WE
THINK THAT YOU KNOW COMPLIANCE
WITH THE BASIC ISSUES ARE THE
BASIS ASPECT ASPECTS OF THE
PROGRAM ARE IMPORTANT BECAUSE
ONCE YOU CAN MASTER THE BASICS
THEN WE CAN GO ON TO TALKING
ABOUT --
BIGGER BROADER MORE AND
INNOVATIVE CHANGES --
I THINK THE OPPORTUNITIES THAT
WE SEE IN FRONT OF US AS A
DEPARTMENT AND CERTAINLY WANTING
TO WORK WITH --
THE COUNTIES AND THE LEGISLATURE
AS WELL AS THE FEDERAL
GOVERNMENT EXTERNAL STAKEHOLDERS
IS THE RENEWAL OF THE WAIVERS WE
HAVE AN ELEVEN FIFTEEN WAIVER
THAT EXPIRES ON DECEMBER THIRTY
FIRST OF TWENTY TWENTY AND ARE
NINETEEN FIFTEEN WAIVER EXPIRES
IN JUNE OF TWENTY TWENTY SO
THERE'S A LITTLE BIT OF A
MISSING.
TIME FRAME THERE BUT I THINK
WHAT WE'RE THINKING OF IS HOW DO
WE CONTINUE AS A DEPARTMENT AND
AS A STATE TO PUSH THE
BEHAVIORAL HEALTH ASPECTS OF THE
INDIVIDUAL'S NEEDS CLOSER TO THE
OVERALL DELIVERY SYSTEM SUCH
THAT WE'RE NOT EXPECTING PEOPLE.
WITH A SERIOUS MENTAL ILLNESS
HAVE TO NAVIGATE DIFFERENT
DELIVERY SYSTEMS --
WE AS A DEPARTMENT ARE --
TAKING A LOOK AT OUR OWN
DIVISIONS AND DOING INTEGRATION
WITHIN OUR OWN DIVISIONS WE HAVE
ANNOUNCED A REORGANIZATION OF
OUR EXISTING MENTAL HEALTH AN S.
U. D. DIVISIONS --
COLLAPSING THEM INTO A
BEHAVIORAL HEALTH DIVISION I'M
SEPARATING OUT THE MEDI CAL FROM
THE NON MEDICAL ASPECTS BUT WE
ALSO THINK THAT THAT'S IMPORTANT
BOTH AS AS STATE DEPARTMENT AS
WELL AS PROGRAM MEDICALLY. TO
CONTINUE --
TO HAVE OUR STAFF BE SITTING
CLOSER TO OTHER DELIVERY SYSTEMS
AND CREATING THAT BODY OF
EXPERTISE SUCH THAT THE
INDIVIDUAL BENEFICIARY.
WHO IS RECEIVING THOSE SERVICES --
DOESN'T HAVE TO HAVE SUCH A
COMPLICATING EVEN IF IT'S
COMPLICATED ON THE BACK AND THEY
SHOULDN'T HAVE TO FIGURE OUT THE
COMPLICATION ON THE FRONT END.
SO I I POTS ON THE WAIVERS --
AS KIND OF ONE OF THE MOST
EXCITING CONSEQUENTIAL --
THINGS THAT WE ARE LOOKING
FORWARD TO ENGAGING IN LATER
THIS YEAR AND THE NEXT YEAR --
FOR FOR CERTAIN AS IT PERTAINS
TO THE WAIVER RENEWALS ON BOTH
SIDES.
AND THEN LASTLY I THINK WHAT YOU
WILL I CAN'T WHILE HE KATE
DIRECTOR LOOK FAR OUT INTO THE
FUTURE -- AS
YOUR AGENDA WOULD KNOW KIND OF
WHAT'S THE NEXT FIVE TO TEN TO
FIFTEEN YEARS LOOK LIKE --
A LOT OF THE THINGS THAT WE
STRUGGLE TO EITHER IMPLEMENT OR
OPERATIONALIZE TODAY AT A STATE
LEVEL ARE --
HISTORICAL VESTIGES OF A PROGRAM
THAT HAS BEEN BUILT OVER DECADES
AND SO DECISIONS THAT WERE MADE
IN THE EIGHTIES DECISIONS THAT
WERE MADE IN THE NINETIES
DECISIONS THAT WERE MADE IN THE
TWO THOUSANDS.
WE STILL HAVE --
TO WORK ACCORDING TO THOSE
DECISIONS BUT THEN THERE HAS
BEEN OVERLAY AND CHANGES AND
DIFFERENT FUNDING SOURCES.
AND I THINK THAT WHAT WE LOOK AT
FROM FIVE TO TEN TO FIFTEEN
YEARS OUT IS.
HOW DO WE HAVE --
COUNTY MENTAL HEALTH PLANS HOW
DO WE HAVE PROVIDERS HOW DO WE
HAVE MANAGED CARE PLANS WORKING
IN A BETTER ALIGNMENT WITH EACH
OTHER -- WE
MAY NEVER BE ABLE TO FULLY
INTEGRATE THOSE BECAUSE OF
EITHER FINANCING OR OTHER
COMPLICATIONS BUT I THINK WHAT
WE REALLY WANT TO SEE IS A
CONTINUED BOTH --
INCREASED RELIANCE ON EACH OTHER
AS WELL AS OUR THEIR FINANCIAL
WAYS THAT WE CAN TIE SERVICES
TOGETHER THROUGH THOSE ENTITIES
SUCH THAT THEY ARE INCLINED TO
WORK TOGETHER AS OPPOSED TO
BEING --
WORKING IN SILOS I THINK THAT WE
IMAGINE A WORLD IN WHICH WE ARE
DOING A LOT MORE --
INNOVATIVE FINANCING AS OPPOSED
ASIDE ON A SEAT.
I'M SORT OF FINISHERS THESE ARE
VERY VERY HEAVY DOCUMENTATION
RELIANT TYPES OF FINANCING
MECHANISMS IN WHICH A COUNTY
PAYS. TWO DOLLARS FOR A SERVICE
THEY SUBMIT A CLAIM TO US WE
DRIVE DOWN A DOLLAR FROM THE
FEDERAL GOVERNMENT AND THEN WE
PAY IT BACK TO THEM.
THAT IS NOT NECESSARILY A WAY
THAT IS THE MOST --
EFFICIENT OR EFFECTIVE WAY OF
DELIVERING HEALTHCARE TODAY'S SO.
THAT I'M HAPPY TO TAKE QUESTIONS
AND CERTAINLY LOOK FOR TO THE
CONVERSATION.
THANK YOU TO FORGET WILL TAKE
QUESTIONS AFTER WE'VE HEARD FROM
BOTH PANELS SO.
THIRD AFTERNOON I'M KAREN LARSON
I'M THE DIRECTOR OF HEALTH AND
HUMAN SERVICES FOR YOLO COUNTY --
IT'S HONOR TO BE HERE IT'S A
PRIVILEGE TO BE SPEAKING ON
BEHALF OF THE UNDERSERVED
POPULATION IN CALIFORNIA THAT
ARE STRUGGLING WITH SEVERE
MENTAL ILLNESS AND AND OUR
YOUNGER PEOPLE WHO ARE DEALING
WITH EMOTIONAL DISTURBANCE AND
POVERTY AND TOXIC STRESS AND A
LOT OF TRAUMA.
AND I THINK THAT IT'S TIMELY
THAT WE'RE HAVING THIS
DISCUSSION TODAY BECAUSE IN
RECENT YEARS IT'S BECOME
ABUNDANTLY CLEAR THAT MOST OF
THE MAJOR SOCIETAL ISSUES WERE
FACING HAVE.
SUBSTANCE USE AND MENTAL HEALTH
AT THE IT'S HOMELESSNESS OR
CRIMINAL JUSTICE OR CHAO WELFARE
ALL OF ALL OF THOSE ISSUES HAVE
SUBSTANCE ABUSE AND MENTAL
HEALTH INTERWOVEN IN THEM AND WE
HAVE TO FIGURE OUT A WAY. TO
PARTNER TAKE IT TO BETTER
OUTCOMES FOR ALL OF THOSE HUMAN
BEINGS.
AM I THINK IT TOO I IT'S NICE TO
SIT UP HERE WITH JENNIFER AND TO
HEAR GO AFTER HER AND TO BE ABLE
TO SAY THAT I AGREE WITH ALMOST
EVERYTHING SHE SAID SO.
THAT THAT'S NICE THAT --
BECAUSE I DON'T THINK WE
NECESSARILY AGREE ON EVERYTHING
BUT I THINK WE BOTH ARE
COGNIZANT OF WHAT.
WHAT PROBLEMS WE'RE FACING WHAT
CHALLENGES WE HAVE AS A STATE
AND IN OUR MENTAL HEALTH SYSTEM?
AND THE OPPORTUNITIES FOR
IMPROVEMENT I THINK WE WERE VERY
SIMILAR IN THE WAY WE SEE US
MOVING FORWARD.
AM I I THINK IT.
YOU ALLUDED CAM JENNIFER ALLUDED
TO THIS A LITTLE BIT BUT OUR
MENTAL HEALTH SYSTEM HAS BEEN
CREATED OVER YEARS IN RESPONSE.
TO LEGISLATIVE CHANGES SOME
LAWSUITS AND THEN A MYRIAD OF
FEDERAL REQUIREMENTS THAT SEEM
TO JUST PILE ON TOP OF ONE
ANOTHER INSTEAD OF KIND OF
FIGURING OUT A WAY FOR THOSE
THINGS TO WORK SEAMLESSLY.
SO WHAT WHAT WORKS WELL.
AT THE SLIDES ARE JUST AS MUCH
TO KEEP ME ON TRACK AS FOR ALL
OF YOU -- I
AS YOU ALL KNOW WE HAD THE
AFFORDABLE CARE ACT THAT'S BEEN
AN AMAZING THING FOR OUR
STATEMENT CALIPH WE HAVE A LOT
MORE CALIFORNIANS THAT.
ARE ON MEDICARE ALL AND A LOT
MORE --
CALIFORNIANS THEY'RE RECEIVING
BEHAVIORAL HEALTH CARE AND WHILE
THERE'S STILL PLENTY OF WORK TO
DO WITHIN THAT.
IT'S AN IMPROVEMENT OVER WHERE
WE WERE BEFORE THE AFFORDABLE
CARE ACT --
WE ALSO IN CALIFORNIA ARE LUCKY
ENOUGH TO HAVE THE MENTAL HEALTH
SERVICES ACT --
AT WHILE IT IS ROLLED OUT
DIFFERENTLY IN EVERY COUNTY IT
HAS BEEN.
A GREAT WAY FOR COUNTIES TO BE
ABLE -- TO
BUILD SERVICES THAT AREN'T
NECESSARILY BILLABLE TO A MEDIC
COW FEE FOR SERVICE SYSTEM --
MENTAL HEALTH SERVICES ACT HAS --
GROWN A LOT OF OUR OUT REGION
ENGAGEMENT --
A LOT OF THESE KIND OF WRAP
AROUND SERVICES A LOT OF
SERVICES --
FOR CLIENTS WHO ARE UNWILLING OR
UNABLE TO COME THROUGH THE FRONT
DOOR OF A BUILDING THAT'S CALLED
MENTAL HEALTH SO IT'S REALLY
ALLOWED UNITIES AND PARTNER WITH
OUR COMMUNITIES TO ADDRESS THOSE
ISSUES.
AM I AND I THINK ONE OF THE
THINGS THAT THAT WE DO REALLY
WELL AS COUNTY MENTAL HEALTH OR
AT THE LOCAL LEVEL IS TO PARTNER
WITH.
OUR OTHER COUNTY PARTNERS TO SEE
THE SAME POPULATION TO THERE'S
CROSS OVER WHETHER IT BE OUR
EDUCATIONAL PARTNERS PROBATION
CHILD WELFARE OUR PRIMARY CARE
PROVIDERS --
WE PARTNER PRETTY WELL WITH THEM
I I HAVE A FEW EXAMPLES OF THE
LAST FEW YEARS --
THAT'S THE STATEWIDE INITIATIVES
THAT HAVE BEEN PRETTY SUCCESSFUL
WE HAD SB EIGHTY TWO A FEW YEARS
AGO WHICH ALLOWED US TO HAVE A
LOT MORE RESPONSE AVAILABLE AT
THE LOCAL LEVEL FOR CRACK FOR
PEOPLE IN MENTAL HEALTH CRISIS
WE WERE ABLE TO BUILD.
CRISIS RESIDENTIAL AS AN URGENT
CARES AND HAVE MOBILE CRISIS
RESPONSE TEAMS.
ON A CONTINUUM OF CARE FORM.
WHICH IS SOMETIMES SEEN AS A
FOUR LETTER WORD HAS FORCED OUR
SYSTEMS TO WORK TOGETHER TO
REALLY IMPROVE BEHAVIORAL HEALTH
OUTCOMES FOR THERE ARE CHILDREN
INVOLVED IN THE CHILD WELFARE
SYSTEM. TO BRING THOSE USE HOME
FROM CONGREGATE CARE SETTINGS
AND PROVIDE THEM WITH TRAUMA
INFORMED BEHAVIORAL HEALTH
SERVICES.
AT THE STEPPING UP MOVEMENT HAS
BEEN ADOPTED BY MANY COUNTIES
THROUGHOUT CALIFORNIA AND IT'S
AIMED AT REDUCING THE NUMBERS OF
MENTALLY ILL IN CUSTODY --
AND IT'S BEEN PRETTY SUCCESSFUL --
AND THEN THE DRUG MEDICAL
ORGANIZED EVERY SYSTEM HAS BEEN
GREAT FOR THOSE COUNTIES WHO
HAVE CHOSEN TO OPT IN --
AGAIN IT PROVIDES.
RESIDENTS OF CALIFORNIA WITH
BENEFITS THAT THEY HAVE NEVER
HAD BEFORE THAT ARE --
NOT ONLY HELP THE RESIDENTS BUT
HELP THE STATE IN TERMS OF
TRYING DOWN ADDITIONAL FEDERAL
FUNDS.
AND LAST BUT CERTAINLY NOT LEAST
ARE NO PLACE LIKE HOME AND SHE
DID WHICH IS MOVING FORWARD I
THINK THERE WERE SEVERAL
COUNTIES THAT APPLIED FOR THAT
FUNDING AND I'M EXCITED TO SEE
HOW HAVING MORE HOUSING
OPPORTUNITIES FOR PEOPLE
STRUGGLING WITH MENTAL ILLNESS --
WILL HELP TO AMELIORATE
HOMELESSNESS AND HELP THEM BE
MORE STABLE.
AM.
I THINK IT WOULD BE GREAT TO SEE
AND MAYBE THESE HAPPEN AND WE
DON'T SEE THEM AT THE COUNTY
LEVEL BUT TO SEE SOME OF THAT
CROSS DEPEND DEPARTMENTAL WORK
HAPPEN AT THE STATE LEVEL.
IT OFTEN FEELS LIKE DIFFERENT
STATE DEPARTMENTS.
ARE NOT SPEAKING TO ANOTHER ARE
NOT.
TOWARD THE SAME AND AND THAT
WOULD BE A REALLY NICE THING FOR
US TO SEE AND I THINK
HOMELESSNESS IS GONNA DEMANDED
OF US RIGHT WE HAVE.
SO MANY STATE DEPARTMENTS
WORKING ON HOMELESSNESS AND WE
ALL SHOULD BE WORKING TOGETHER
AND HOPEFULLY HEADED TOWARDS THE
SAME METRICS [inaudible]
SO.
WHAT NEEDS IMPROVEMENT?
UNFORTUNATELY THE SLIDE --
I WAS ACTUALLY A LITTLE HARDER
TO FIGURE OUT HOW TO LIMITED
THAN -- TO
WHAT I WAS GONNA PUT ON IT --
THESE ARE JUST SOME OF THE STATS
THAT THAT ARE STAGGERING --
WHILE AN ESTIMATED 5% OF
CALIFORNIA STRUGGLE WITH SERIOUS
MENTAL ILLNESS AN ESTIMATED 25%
OF OUR HOMELESS CALIFORNIANS ARE
SMI.
THAT'S BASED ON SELF REPORT AT
POINT ON THE AT THE POINT IN
TIME COUNTS THE ACTUAL
PERCENTAGE IS MUCH HIGHER.
IN CALIFORNIA THE SUICIDE IS THE
LEADING CAUSE OF DEATH FOR YOU
JUST TWENTY FIVE TO THIRTY FOUR
AND THE THIRD LEADING CAUSE OF
DEATH FOR YOUTH AGE.
TEN TO TWENTY FOUR OUR SUICIDE
RATE IN CALIFORNIA IS HIGHER
THAN OUR HOMICIDE RATE BY ALMOST
DOUBLE SO YOU'RE MORE LIKELY TO
TWICE AS LIKELY. TO HARM
YOURSELF AND TO BE KILLED BY
SOMEONE ELSE IN OUR STATE.
YET IF WE COMPARE OUR INVESTMENT
IN PREVENTION VERSUS PUBLIC
SAFETY.
THERE'S NOT A COMPARISON --
AND ALSO THAT APPROXIMATELY 21%
OF CALIFORNIAN EIGHT STATEWIDE
HAVE BEEN IDENTIFIED AS A SEMI.
AGAIN THIS IS TAKEN AT BOOKING
BASED ON SELF REPORT AND WE KNOW
THERE ARE PEOPLE THAT ARE IN
CUSTODY.
THAT DON'T SELF REPORT THEIR
DIAGNOSES.
AND LAST BUT CERTAINLY NOT LEAST
WE CAN'T FORGET OUR LITTLE
PEOPLE WHICH I FEEL LIKE WE DO
ON OCCASION AT ONE IN THREE USED
TO ASPECTS OF FOSTER CARE IN
CALIFORNIA.
EXPERIENCE HOMELESSNESS WITHIN
TWENTY FOUR MONTHS.
AND THEIR TRAJECTORY IN OUR
STATE.
IS SUCH THAT FORMER FOSTER YOUTH
ARE DISPROPORTIONATELY
REPRESENTED IN OUR ADULT POINT%
IN TIME COUNT.
AS WE THAT WE DO EVERY YEAR AND
I THINK.
ALL OF THE STATISTICS JUST
INDICATE THAT OUR SYSTEM ISN'T
WORKING AS WELL AS IT SHOULD BE.
I THINK UP A PART OF IT.
THE ISSUE IS THAT OUR SYSTEM
INCENTIVIZE IS THE WRONG THINGS
AND WE'D LIKE TO GET IT TO A
PLACE IN PARTNERSHIP WITH THE
STATE.
TO FIND A WAY TO INCENTIVIZE THE
RIGHT THINGS AND GET TO THE
WORDS THE OUTCOMES --
AND IMPROVE THE TRAJECTORY OF
ALL OF THESE.
SO WE HAVE SOME CURRENT
STRUCTURAL CHALLENGES.
AGAIN THIS MAY BE I I'M JUST
KIND OF SAYING THE SAME THINGS
THAT JENNIFER DID AN EACH COUNTY
MANAGES THEIR OWN BEHAVIORAL
HEALTH BENEFITS SO THAT MEANS
EACH COUNTY BEHAVIORAL HEALTH
BENEFIT LOOKS A LITTLE DIFFERENT --
WE MISSED OPPORTUNITIES --
FOR FISSION SEES OF SCALE AND
AND THE REALLY SMALL COUNTIES
HAVE A REALLY HARD TIME --
MANAGING THAT --
THE REQUIREMENTS ASSOCIATED WITH
MANAGING PAPER HEALTH BENEFITS.
WE HAVE A RELATIVELY INEFFICIENT
FEE FOR SERVICE REIMBURSEMENT
STRUCTURE THERE'S SOME PRETTY
ARDUOUS DOCUMENTATION WE HAVE.
TO BILL BY THE MINUTE AND AT WE
HAVE TO DOCUMENT FUNCTIONAL
IMPAIRMENT AND IT'S NOT FOCUSED
ON WELL BEING ON RECOVERY IT'S
FOCUSED ON A MEDICAL MODEL
SYSTEM DESPITE THE FACT THAT.
ALL EVIDENCE SHOWS IS THAT THOSE
MORE SOCIAL MODEL PROGRAMS
ACTUALLY ACHIEVE MUCH BETTER
OUTCOMES FOR THE PEOPLE WE SIR.
AM I THINK THE THE CROSS SYSTEM
CARE COORDINATION WE CAN'T TALK
ABOUT THAT ENOUGH I AM GOING TO
TALK ABOUT IT AGAIN.
THE INTEGRATIONSLIDE BUT I
THINK IT'S WHERE WE HAVE THE
BIGGEST BENT POTENTIAL BENEFITS
IS WHEN WE ALL WORK TOGETHER --
ACROSS SYSTEMS TO ADDRESS THESE
KIND OF SOCIAL DETERMINANTS OF
HEALTH THAT --
REALLY --
DISPROPORTIONATELY AFFECT MENTAL
ILLNESS AND I LITTLE PEOPLE THAT
ARE INVOLVED IN MULTIPLE SYSTEMS
THROUGHOUT THE TRAJECTORY OF
THEIR LIFE --
OUR ERA.
OUR MENTAL HEALTH CONSUMERS I'M
SURE YOU'VE ALL HEARD THIS STAT
AND IT SHOULD OF BEEN ON THE
LAST FLIGHT BUT IT'S ON THIS ONE
IT.
DIE ON AVERAGE TWENTY FIVE YEARS
YOUNGER THAN THEIR COUNTERPARTS
OF PREVENTABLE CHRONIC
CONDITIONS AND I WE ALL AGREE
THAT THAT'S NOT THE WAY WE WANT
TO TAKE CARE OF OUR PEOPLE THAT
ARE STRUGGLING.
I THINK THE TO FURTHER COMPOUND
THE THE LIMITED SPENDING BECAUSE
EVEN THOUGH WHERE THE SEVENTH
LARGEST ECONOMY IN THE WORLD
WHERE THE FORTY EIGHTH IN TERMS
OF SPENDING ON OUR MEDICARE
POPULATION. TO FURTHER COMPOUND
THIS LIMITED SPENDING.
WE SPEND AT LEAST THIRTY CENTS
OF EVERY DOLLAR ON
ADMINISTRATIVE KIND OF FUNCTIONS --
OVERHEAD.
AND THEN ON TOP OF THAT MOST
COUNTIES HAVE.
TO BUDGET OR FIGURE OUT A WAY TO
HAVE ABOUT TWENTY CENTS OF EVERY
DOLLAR DISALLOWED IF THEY AREN'T.
PERFORMING TO THAT RAGS THAT THE
FEDERAL GOVERNMENT LAYS DOWN.
SO THAT MEANS THAT OFTENTIMES
COUNTIES ARE HAVE FIFTY CENTS OF
EVERY DOLLAR TO GIVE TO THE
PEOPLE THEY SERVE.
IN IN YOLO WEEK WHO WE ARE
RELATIVELY SMALL WE USED TO
BUDGET FOR A MILLION DOLLARS A
YEAR FOR AUDIT EXCEPTIONS AND
THEN WE HAD A 30% OF OUR CLAIMS
DISALLOWED.
SO WE FIXED IT BUT IT CAME AT A
COST BECAUSE WE HAD TO HIRE
ADMINISTRATIVE STAFF.
RATHER THAN CLINICAL STAFF AND
IT'S NOT THE MOST EFFICIENT USE
OF RESOURCES.
SO SUGGESTIONS FOR IMPROVEMENTS
TO THE STATE RIGHT BENEFITS --
I I DO MY BEST IN THIS
PRESENTATION TO KIND OF TALK
ABOUT SHORT MID TERM KIND OF
THINGS WE CAN DO AND THEN MAYBE
LONGER TERM.
I THINK PURSUING I AM D.
EXCLUSION.
MAKES REALLY GOOD SENSE I THINK
MOST OF US AGREE THAT IT DOES I
THINK WE CAN PROBABLY GET THERE
AND IT BRINGS DOWN ADDITIONAL
FEDERAL FUNDS WHICH IS ALWAYS
HELPFUL.
I'M REINFORCING UPSTREAM
INVESTMENT I DON'T THINK ANY OF
US HAVE A CHOICE I THINK IT'S
WHAT WE ALL HAVE TO DO I THINK
WITH OUR NEW ADMINISTRATION WERE
ABSOLUTELY HEADING THIS WAY --
THE FOCUS IN THE MOST RECENT
BUDGET ON UNIVERSAL SCREENING
FOR TRAUMA AND THEY SHIFT
TOWARDS A MORE UPSTREAM MAKES
REALLY GREAT SENSE AND IT'S
EXCITING.
IN TERMS OF LOOKING AT THE LONG
TERM OUTCOMES OF THE PEOPLE WE
SERVE.
AND THEN MOVING TO THIS PAY FOR
PERFORMANCE MODEL OR AWAY FROM
FEE FOR SERVICE KIND OF MODEL I
THINK.
WHATEVER IT LOOKS LIKE THE WAY
WE'RE DOING IT NOW ISN'T REALLY
WORKING FOR IT FOR THE PEOPLE WE
SERVE IT'S NOT WORKING FOR THE
COUNTIES I WOULD ARGUE IT'S
PROBABLY NOT WORKING VERY WELL
FOR THE STATE.
AND SO WE'D LIKE TO GET TO A
PLACE WHERE WE'RE PAYING FOR
OUTCOMES THAT WE'RE LOOKING AT
OUTCOMES AND INCENTIVIZING THOSE
POSITIVE OUTCOMES FOR THE PEOPLE
WE SERVE [inaudible]
SO INTEGRATION.
AGAIN THIS IS ONE THAT I THINK
WE HAVE SOME SHORTER TERM THINGS
WE CAN DO AND AND LONGER TERM I
THINK WE WOULD ALL AGREE THAT.
INTEGRATING CARE FOR MENTAL
HEALTH SUBSTANCE USE AND
PHYSICAL HEALTH MAKES REALLY
GOOD SENSE I DON'T THINK MOST OF
US WOULD HAVE DESIGNED THE
SYSTEM THAT WE CURRENTLY HAVE
THAT.
BIFURCATED AT LEAST AND TRY FOR
KATE IT WHICH I DON'T THINK IT'S
ACTUALLY A WORD AT BEST --
WE AT AND IT'S A LONG ROAD TO
GET TO FULL INTEGRATION I THINK
IT'S A PRETTY HEAVY LIFT AND SO.
I THINK THAT STARTING WITH --
STRENGTHENING THE INTEGRATION
BETWEEN MENTAL HEALTH AND
SUBSTANCE USE DISORDER TREATMENT
MAKES REALLY GOOD SENSE I THINK
THERE SOME EASY THINGS WE CAN DO
IN THE SHORT TERM TO REALLY.
GROW THAT INTEGRATION --
AYE I DO THINK THERE ARE SOME
THINGS THAT WE CAN DO --
TO GROW THE INTEGRATION WITH.
I WOULD LOVE TO SEE AN
INVESTMENT IN TRAINING PRIMARY
CARE PROVIDERS TO INCREASE THEIR
SCOPE AND COMFORT IN TREATING
PEOPLE WITH SERIOUS MENTAL
ILLNESS.
I DON'T MEAN NECESSARILY
TREATING THEIR MENTAL ILLNESS I
MEAN JUST HAVING TIME IN A VISIT.
TO TREAT SOMEBODY'S PHYSICAL
HEALTH CONDITION TO STRUGGLING
WITH SM I..
AND ACTUALLY INCENTIVIZE THEM
AND ALLOW THEM SOME EXTRA TYPE
OF REIMBURSEMENT FOR THOSE
VISITS BECAUSE THEY ARE GOING TO
TAKE LONGER THAN FIFTEEN MINUTES
IN EVERY SINGLE CASE --
I THINK IT WOULD BE GREAT IF WE
COULD SUPPORT ALIGNMENT OF
HEALTH AND BEHAVIORAL HEALTH
OUTCOMES TOGETHER --
AND FIGURE OUT A WAY. TO
INCENTIVIZE THAT ARE OR OR GROW
THAT THEM.
BREAK DOWN THE SILOS I GUESS
BETWEEN THE FUNDING BETWEEN
BEHAVIORAL HEALTH AND PHYSICAL
HEALTH.
AM I THINK WE CAN ALL GET TO
THIS PLACE OF INTEGRATION IF WE
WORK TOGETHER ACROSS SYSTEMS I
HAVE EVERY CONFIDENCE THAT
EVERYONE DOING THIS WORK IS
COMMITTED TO DOING BETTER BY THE
PEOPLE WE SERVE INTO --
IMPROVING THOSE OUTCOMES FOR THE
PEOPLE WHO ARE CURRENTLY DYING
OF CHRONIC CAM PREVENTABLE
CONDITIONS.
SO THIS IS OUR VISION FOR
BEHAVIORAL HEALTH TRANSFORMATION.
I'LL TALK AGAIN ABOUT --
A SHORTER TERM AND LONGER TERM.
GOALS AND I'M GONNA CHANNEL A
LITTLE BIT OUR NEW SURGEON
GENERAL FOR CALIFORNIA.
SPECIFICALLY THE EPILOGUE FROM
HER NEW BOOK IF YOU HAVEN'T READ
IT I WOULD HIGHLY RECOMMEND IT --
I I WANT US TO ALL BE BOLD IN
OUR VISION OF THE FUTURE WHERE
EVERY MEDI CAL BENEFICIARIES WHO
NEEDS MENTAL HEALTH SERVICES
GETS THOSE SERVICES.
WHEN THEY WANT THEM IN THE PLACE
THAT'S COMFORTABLE FOR THEM?
AM IT WOULD BE REALLY GREAT IF
WE COULD GET TO A MODERNIZE KIND
OF VERSION OF MEDICAL NECESSITY
THAT REALLY LOOKS AT THOSE --
TOXIC STRESS AND AND TROM IN A
CARE EARLIER IN THEIR LIFE.
SO THAT WE DON'T HAVE SUCH
HORRIBLE AND OUTCOMES ON THE
BACK END OF THEIR LIFE SPAN --
FOCUSING ON QUALITY OF CARE AND
OUTCOMES --
I'VE TALKED ABOUT THAT THAT'S
ONE OF OUR RECOMMENDATIONS
SIMPLIFYING HOWEVER WE CAN
BILLING INCLUDE CLAIMING.
FIGURING OUT HOW TO REDUCE THAT
ADMINISTRATIVE BURDEN.
FINDING A WAY TO GROW OUR WORK
FORCE THIS I CAN'T SAY ENOUGH.
I'LL SAY IT TWICE HAVE FINING
WAY TO GROW OUR WORK FORCE.
AND IN MAYBE THE SOME OF THE
NONTRADITIONAL WAYS --
I'M SURE YOU'VE ALL HEARD ABOUT
HERE WORK FORCE IN BRINGING IN
PEOPLE WITH LIVED EXPERIENCE TO
HELP THOSE PEOPLE THAT ARE
STRUGGLING WE REALLY FIND THAT'S
ONE OF THE MOST EFFECTIVE
STRATEGIES WE CAN EMPLOY --
AS WE'RE DOING THIS COMMUNITY
BASED SERVICES.
IT WOULD BE GREAT IF WE COULD
FIND A WAY TO TELL OUR STATE
WIDE STORY IF WE COULD --
FIND A WAY TO NOT HAVE FIFTY SIX
DIFFERENT SYSTEMS OR A CUSTOM
COMMON METRICS THAT ARE FOCUSED
ON QUALITY THAT WE COULD REPORT
OUT AND SHARE.
AND GET FEEDBACK ON GET
TECHNICAL ASSISTANCE SO THAT WE
COULD MOVE TOWARDS A BETTER
SYSTEM FOR ALL.
AM HAVING REGIONAL --
MODELS MIGHT BE AN INTROSPECTIVE
MIGHT BE THE FOREVER STEP
BECAUSE WE'RE SUCH A LARGE STATE
BUT HAVING SOME REGIONAL MODELS
MIGHT HELP US GET THERE SOONER
RATHER THAN.
HAVING A STATEWIDE SYSTEM.
AND IT WOULD BE GREAT TO HAVE A
SET OF RULES OR GUIDELINES FOR
THE BREADTH OF THE ENTITLEMENT
PROGRAMS --
I THINK ABOUT STANDING ORDERS
THAT DOCTORS OFTEN GIVE US IF
THIS THAN THIS AND SO IT WOULD
BE REALLY GREAT FOR THE THOSE OF
US MANAGING THE CARE TO HAVE A
CLEAR OUTLINE OF WHAT IS
EXPECTED.
AS PROVIDERS OF SERVICE FOR THE
PEOPLE THAT WERE INTENDED TO
SERVE.
HALF OF THESE RECOMMENDATIONS
THE DIVIDENDS WILL BE PAID --
WELL INTO THE FUTURE I THINK WE
HAVE SOME HEAVY LIFTING TO DO I
I THINK WE HAVE NEVER BEFORE
SEEN SO MANY PARTNERS.
COMING TO THE TABLE SAYING
THEY'RE WILLING TO HELP US GET
TO THE SOLUTION AND SO I'M
ENERGIZED BY BY THE MULTIPLE
HEARINGS THAT ARE HAPPENING THIS
MONTH AROUND MENTAL HEALTH AND
ALL OF THE LEGISLATIVE IDEAS
THAT I SEE AROUND THIS TOPIC --
I WOULD LOVE TO SEE A FUTURE
WHERE WE'RE REDUCING
HOMELESSNESS.
JUVENILE JUSTICE INVOLVEMENT
CHAO WILL FOR INVOLVEMENT AND
IMPROVING THE HEALTH OUTCOMES
FOR THOSE WHO ARE SUFFERING WITH
MENTAL ILLNESS --
I THINK WE CAN GET THERE IF WE
ALL WORK TOGETHER THANK YOU.
THANK YOU VERY MUCH --
OTHER QUESTIONS FROM THE PAN.
I THANK THANK YOU SO VERY MUCH --
APPRECIATE THANK YOU BOTH FOR
YOUR PRESENTATIONS --
DIRECTOR TENT AND ALSO DOCTOR
LARSON. TO REPRESENT PART OF
YELLOW COUNTY APPRECIATE THE
WORK THAT YOUR DEPARTMENT DOES --
I GUESS.
LAST LAST HEARING --
I BROUGHT THE ISSUE ABOUT STATE
OVERSIGHT.
AND I GUESS --
AND ACTUALLY HEARING --
DOCTOR LARSON'S TESTIMONY AND
TALK ABOUT WHAT'S OUR STATE WIDE
STORY IN SOME SENSES THAT SAM
BUT FRUSTRATED I DON'T KNOW WHAT
STATEWIDE STORY IS BECAUSE IT'S
COUNTY BY COUNTY BY COUNTY NOT
THAT.
DIFFERENT COUNTIES ARE DOING
SOME REALLY WONDERFUL STUFF.
RIGHT -- BUT
YEAH LAST HEARING WHAT WE HEARD
WAS IS THAT OUT AT LEAST ON THE
MEDI CAL SIDE --
BECAUSE IN NINETY ONE
REALIGNMENT ESSENTIALLY --
YOU KNOW COUNTIES HAD RESOURCES
JUST BASED ON HOW THAT CASCADE
OF TAX REVENUE FALLS DOWN SO I
GUESS THE FIRST QUESTION IS IS
THAT -- FOR
FOR DHS IS IS THAT --
IN TERMS OF OVERSIGHT OVER THE
PROGRAM IS THERE SOME ASSESSMENT
AS TO WHAT THE THE NEED OUR
DEMAND ON MENTAL HEALTH SERVICES
THAT WITH THE REASON ACTUALLY
HAS A VERY THE MEDI CAL SITE.
WE HAVE A BECAUSE WE WERE FOR
NEEDS BASED ON THIS CASCADE OF
REVENUE THAT FALLS AND WHATEVER.
FINALLY IT LANDS IN THE MIDDLE
HEALTH POD IS WHAT THEY GOT TO
WORK WITH WHAT THE MATCH.
ON THE FEDERAL SIDE BUT THERE
MAY BE A DISCONNECT BETWEEN THAT
AND THE THE AND THE NEED IN AND
THE COUNTY BUT ARE WE DOING SOME
ASSESSMENT SO WE KNOW WHERE THIS
WHERE THAT'S HAPPENING AND HOW
HOW SEVERE IT IS --
I DON'T THINK THAT IT'S IT'S
PROBABLY NOT THAT EASY SO THERE
IS A IS EASY YEAH THERE'S A
REALIGNMENT FUNDING SOURCES --
THE NINETY ONE REALIGNMENT AS
YOU NOTED IN THE TWO THOUSAND
ELEVEN REALIGNMENT --
COUNTIES ARE ABLE TO USE BOTH
THOSE FUNDS SOURCES AS WELL AS
MENTAL HEALTH SERVICES ACT FUNDS
AS WELL AS CAN GENERAL FUNDS IF
THEY CHOOSE TO THERE'S SOME
LIMITED.
AND HEALTH BLOCK GRANT FUNDS --
AND THEN OBVIOUSLY THE FEDERAL
FUNDS THE WAY THAT REALIGNMENT
WAS DONE ON WINDOWS NINETY ONE
IN TWO THOUSAND ELEVEN IS THE
COUNTIES ARE RESPONSIBLE FOR THE
ENTITLEMENT.
I MEAN THEY ARE RESPONSIBLE FOR
PROVIDING WHATEVER'S NECESSARY
FOR THE INDIVIDUALS MEETING THAT
ELIGIBILITY CRITERIA AND MEETING
MEDICAL NECESSITY THE FUNDS
SOURCES NOT NECESSARILY --
TO B. YOU KNOW I TRACKING WITH
THE PERSON'S INDIVIDUAL MEDICAL
NEEDED IS A YOU KNOW OBVIOUSLY A
VERY COMPLICATED RELATIONSHIP
BETWEEN THE STATE AND THE
COUNTIES IN TERMS OF HOW
REALIGNMENT FUNDS HAVE BEEN
DIVVIED UP THEIR TAX.
SOURCES THAT YOU KNOW BASED ON
HOW THE STATE IS DOING
ECONOMICALLY THAN FUND SOURCES
FLOW DOWN AND VARIOUS --
STREAMS BUT I THINK THAT --
WE WORK REALLY CLOSELY WITH THE
COUNTIES --
ON THE ACCOUNTING FOR THOSE
FUNDS OBVIOUSLY AS IT RELATES TO
THE C. PEAS AND THE DRAWDOWN OF
THE FEDERAL DOLLARS --
THERE IS.
SOME PROVISIONS IN THIS IN THE
STATUTE --
AROUND COUNTY FUNDING FOR STE --
SERVICES SUCH AS LIKE I AM DIS --
IN WHICH COUNTIES ARE
RESPONSIBLE FOR PAYING FOR
INSTITUTES FOR MENTAL DISEASE --
STAYS THERE IS NO F. P.
ASSOCIATED WITH THAT COUNTIES
ARE RESPONSIBLE FOR PAYING FOR
THOSE SERVICES --
WE HAVE REMINDED THE COUNTIES
THROUGH RECENT AYE ENDS THAT
THEY'RE RESPONSIBLE FOR THAT.
THERE ARE PROVISIONS IN THE
STATUTE THAT IF IT COUNTY SAYS I
DON'T HAVE THE FUNDING TO
CONTINUE TO PROVIDE THE SERVICE
FOR SERVICES FOR INDIVIDUALS IN
MY COUNTY.
THEY CAN COME TO THE STATE THEY
HAPPEN THEY DON'T HAVE THE FUNDS
SOURCES AND THEN A CONVERSATION
WITH INTO AND TO MY HISTORICAL
KNOWLEDGE NO COUNTY HAS EVER.
HAD THAT CONVERSATION WITH THE
STATE.
OKAY FIRST I GUESS --
WELL I KNOW IT'S COMPLICATED AND
I THINK HAVING SOME ASSESSMENT
AS TO HOW WERE YOU KNOW.
BECAUSE WE HAVE AGAIN FIFTY
EIGHT DIFFERENT COUNTIES AS YOU
AS YOU MENTIONED.
KNOWING WHERE WE ARE WITH
RELATIVES EACH COUNTY AND THE
RESOURCES THEY HAVE AVAILABLE I
THINK IS IMPORTANT BECAUSE THE
YOUR ACCESS TO MIDDLE HOW SHOULD
DEPEND ON WHICH GEOGRAPHY.
I MEAN I AND AND SO --
I THINK THAT'S SOMETHING THAT WE
NEED TO TO TO LOOK AT THINK
ABOUT --
YEAH I LAST YEAR ACTUALLY THE
LAST YEAR THE YEAR BEFORE I TO
CHEER TO HEARING --
WILL LOOK AT THE STEINBERG US TO
LOOKING AT DIFFERENT INNOVATIONS
IN MENTAL HEALTH AND WE ARE SHE
HEARD FROM THE MEDICAL DIRECTOR
AND AND THE STATE OF NEW YORK AT
AND I COULD DO IS GO WHILE.
INSIDE BASICALLY WE DON'T HAVE
MUCH OVERSIGHT OVER WHAT HAPPENS
AND IN IN IN EACH COUNTY SO WELL
I SAID MANY COUNTIES ARE DOING
REALLY WONDERFUL THINGS.
WE DO WE HAVE MINIMUM STANDARDS
WE TO ACTUALLY APPRECIATE --
THE DOCTOR LISTEN YOU TALKED
ABOUT -- YOU
KNOW COMMON METRICS IN FACT LAST
YEAR I HAD A BILL --
THAT SAID THAT MAYBE WHAT WE
SHOULD DO THE OF A PROCESS TO
ESTABLISH STATE MENTAL HEALTH
GOALS.
AND METRICS IT'S THERE'S
ACTUALLY NO MANDATE TO THE
COUNTY IS TO ACTUALLY HAVE TO DO
ANYTHING FOR THE STATE MENTAL
HEALTH GOALS BUT LEAST WE WOULD
COLLECT STATEWIDE.
A SET OF METRICS ON ON ON THESE
A FEW ITEMS IN WHICH WE SAY WHAT
WE WANT TRIED TO BEND THE CURVE
ACROSS THE STATE AND STILL UP TO
THE COUNTY HOW MUCH THEY WANT TO
PUT INTO DOING THAT ARE NOT IN
EITHER A DOING IT SO THEY'LL
NEED.
ANYMORE MONEY.
BUT DOWN AT LEAST ALLOWS US TO
TELL STATEWIDE STORY AND DEBT
FOR EXAMPLE --
YOU KNOW --
THE OPIOID CRISIS RIGHT NOW I
KNOW SOMETHING --
DOCKED WITH THIS --
STRUGGLING WITH IN HIS DISTRICT
AT SOMETHING I THINK MANY OF US
ARE STRUGGLING WITH.
AS WELL.
I I CAN'T SAY AND WE HAVE A
HEARING ABOUT THAT SO WE'LL BE
TALKING A LITTLE BIT LATER --
BUT I'M NOT SURE I CAN SAY WELL
DO WE ACTUALLY HAVE.
IF DIFFERENT COUNTY STORIES BUT
WE HAD TO WE HAD HOW COME WE
DESCRIBE OR STATEWIDE EFFORT IN
TRYING TO TACKLE THAT IN TERMS
ACCESS TO TREATMENT RIGHT --
SO -- SO
WHAT ARE SOME THOUGHTS ABOUT --
IS IT THE BILL OF FORTUNATELY
DID NOT PAY OKAY ACT WE CAN HAVE
A PROCESS EVERY FIVE TO TEN
YEARS WE STEP WISH.
STATEWIDE MENTAL HEALTH GOALS
SET A SET OF FIVE METRICS THAT
PEOPLE THAT EVERY COUNTY HAS
REPORT ON TO AT LEAST AND THEN
THAT WAY WE WOULD HAVE THE ABLE
TO TELL THE PEOPLE CALIFORNIA
OVERALL.
WE MADE PROGRESS WE DID MAKE
PROGRESS ON THESE PARTICULAR
GOALS AND PEOPLE NEED COUNTY CAN
SAY ARE WE DOING ENOUGH IN OUR
COUNTY TO TRY TO ADDRESS THESE
ISSUES AND THIS IS A PRIORITY IN
OUR COUNTY SO CAN YOU SPEAK TO
THAT.
SURE SO I THINK --
A COUPLE OF THINGS IT'S NOT ED.
I THINK WE HAVE SET OUT --
THE MEASURES THAT WE HAVE ON THE
MENTAL HEALTH SIDE WE CERTAINLY
ARE --
GETTING DATA FROM THE COUNTY
MENTAL HEALTH PLANS AS IT
RELATES --
TO THERE'S AN EQ RO SO EXTERNAL
QUALITY REVIEW ORGANIZATION THAT
HAS RESPONSIBILITY FOR GOING
INTO THE COUNTIES THERE ARE A
CONTRACTOR TO US BUT THEY GO OUT
TO EACH OF THE COUNTIES.
THEY'RE PULLING QUALITY DATA SO
THEY'RE GOING INTO FILES AND
BENEFICIARIES AND A MEASURING
FOR CERTAIN OUTCOMES WE HAVE
SOME -- DATA
THAT WE TAKE TODAY BOTH ON A
STATEWIDE BASIS AS WELL AS ON A
COUNTY BASIS --
JUST LOOK AT METRICS I THINK
THERE'S A LOT OF METRICS THAT
HAVE NOT YET BEEN DEVELOPED AT A
NATIONAL LEVEL AS IT PERTAINS --
TO MENTAL HEALTH --
I THINK PART --
IT'S MUCH MORE OF A QUALITATIVE
AND QUANTITATIVE TYPE OF MEASURE
AND IT REQUIRES --
CHART POLLS WHICH ARE OBVIOUSLY
A LOT MORE DIFFICULT THAN USING
ADMINISTRATIVE DATA WHICH WE GET
AT THE STATE OBVIOUSLY FAIRLY
WELL.
I THINK --
WHEN WE TALK ABOUT OUTCOMES --
TWO OF THE TOOLS THAT WE HAVE
RECENTLY AGREED TO USE --
AS IT PERTAINS TO THE USE
POPULATION SO WE HAVE BOTH THE
PSC WHICH IS THE PEDIATRIC
SENTENCES CHECKLISTS AT FIRST
AND CANS WHICH IS THE CHILD
ADOLESCENT BEASTS AND STRENGTH
THERE WE GO CHILD.
SO I KNOW THE ACRONYMS BUT NOT
WITH THE STAND --
FOR WE AS A DEPARTMENT SHOWS
BOTH OF THOSE --
FOR USE IN THE MEDICAL
POPULATION FOR ALL CHILDREN ARE
GETTING SPECIAL TO MENTAL HEALTH
SERVICES THROUGH THE COUNTIES
THOSE ARE ASSESSMENT TOOLS BUT
THEY ARE ALSO OUT WE ARE GOING
TO BE USING THOSE FOR OUTCOMES
DATA MEASUREMENTS --
THE COUNTIES I ARE RESPONSIBLE
FOR REPORTING THAT DATA TO US IN
AN AGGREGATED WAY SO I WOULD SAY
THAT I'M A LOT OF THE INTERNAL
INFRASTRUCTURE AND
ADMINISTRATIVE MECHANICS.
OF DOING BETTER DATA IS UNDER
WAY AND IS IT FULLY --
DEMONSTRATING OUT COMES AT A
BROAD LEVEL NO I THINK THAT DATA --
AND AS YOU CAN APPRECIATE COMING
FROM A LARGE MEDICAL.
CONGLOMERATE ITSELF IS IT
SOMETIMES A LOT OF WORK TO GET
THE SYSTEM SET UP AND THEN ONCE
YOU DO AND YOU START TO SEE THE
DATA YOU DO SOME VALIDATION AND
YOU MAKE SURE THAT --
YOU'RE WORKING WITH THE PROVIDER
OR THE PLAN IN THIS CASE TO
STATE YOU KNOW THIS IS THE DATA
WE GOT FROM YOU DOES THAT MAKE.
SENSE AND THEY SAY OH IT DOESN'T
LOOK RIGHT TO US LET US GO BACK
AND TEST THE SYSTEM TO MAKE SURE
THAT THE YOU KNOW THE METRICS
ARE SET THE RIGHT WAY.
SO I WOULD SAY --
SOME OF THE THINGS THAT WE HAVE
DONE OUR VERY MUCH GEARED
TOWARDS LOOKING AT OUTCOMES I
THINK THAT THE OTHER THINGS THAT
WE'VE DONE AT THE STATE LEVEL.
ABOUT TELLING OUR STORY FROM A A
BROADER PERSPECTIVE --
GET DOWN TO THINGS LIKE THE
WHOLE PERSON CARE PILOT IN WHICH
WE HAVE BASICALLY PUSHED --
VARIOUS COUNTY ORGANIZATIONS
TOGETHER AND SAID YOU NEED TO
YOU NEED TO WORK TOGETHER TO
IDENTIFY YOUR POPULATIONS THAT
NEED THE MOST.
CONSISTENT SUPPORTED COORDINATED
THIS POPULATIONS CHOSEN BY THE
COUNTIES ARE INDIVIDUALS WITH
MENTAL ILLNESS --
OR HOMELESSNESS OR INCARCERATION --
ISSUES AND SO I THINK THAT A
STATEWIDE LEVEL WE ARE WORKING
TO DEVELOP THOSE DATA SYSTEMS TO
DEVELOP THOSE RELATIONSHIPS --
BECAUSE YOU KNOW YOU HAVE TO
BUILD THE BASICS BEFORE YOU CAN
THEN KIND OF GO TO THE NEXT YEAR
IN TERMS OF EITHER
SOPHISTICATION INNOVATION OR
MORE YOU KNOW KIND OF
COMPLICATED --
ANALYSIS IN TERMS OF OUTCOMES
AND SO YOU KNOW IT IS A WORK IN
PROGRESS AND I THINK THAT --
HAVING THE COUNTY MENTAL HEALTH
PLANS TREATED IN A SIMILAR WAY
AS OUR MEDICAL MANAGED CARE
PLANS IN TERMS OF ENCOUNTER DATA
SAID MISSION NETWORK FILENE'S
ALL THE COMPLIANCE IS YOU'LL
START TO SEE A GROWING --
KIND OF SOPHISTICATION AND HOW
WE LOOK AT DATA AND THEN HOW THE
COUNTIES ARE REPORTING IT TO US
AND THEN THAT HELPS YOU KNOW
CERTAINLY ANSWER QUESTIONS THAT
YOU HAVE AROUND OUTCOMES.
OKAY WELL I APPRECIATE THAT
THERE'S PROGRESS BEING MADE THAT
**** SAY THAT STILL COLLECTING
DATA AND MONITORING WHICH I KNOW
THE DEPARTMENT DOES A LOT OF
THIS ONLY.
A PARTIAL STEP WE MENTION THE TO
LINK THOSE TWO OUTCOMES IS THAT
TELLING OUR STORY RIGHT AND THE
WATER RESULTS AND ALSO SITTING.
IDENTIFY WHAT OUR GOALS ARE SO
THAT WE ARE ACTUALLY TRYING TO
MEASURE METRICS THAT MATTER TO
THOSE GOALS SO OTHERWISE WE GET
METRICS BUT WE'RE NOT GERMAN
ACTING ON THEM.
I THINK THAT'S WHAT FINALLY --
I APPRECIATE THE CONVERSATION
ABOUT INTEGRATION --
TRYING TO INTEGRATE OUR MENTAL
HEALTH WITH THE MEDIC HOW --
THE FOR BOTH OF YOU --
ACTUALLY JUST LAST WEEK LAST
WEDNESDAY --
THE SENATE HEALTH COMMITTEE DID
A HOLE HE I WOULD MAKE NOTE THAT --
WELL NOT EVERYONE ALWAYS AS AS I
STILL MENTAL HEALTH IS GENERALLY
A CHRONIC CONDITION --
WHICH FORTUNATELY WE DO NOT HAVE --
FOR MOST DENTAL HEALTH
CONDITIONS A TREATMENT THAT WITH.
YOUR SOMEONE OF IT THAT
SOMETHING THEY HAVE.
TO THAT WE CAN MANAGE AN
IMPROVING TREAT IT'S VERY
TREATABLE FOR MANY PEOPLE BUT
IT'S IT'S AN ONGOING ISSUE AND
SO AS WE'RE LOOKING AT THAT --
DO YOU GET THAT MUCH BETTER
OUTCOMES --
WITH INTEGRATION --
AND AND AS YOU NOTE DOES NOTED
IN THE TESTIMONY --
HEALTH IS LINKED TO PHYSICAL
HEALTH THE BRAIN IS NOT SEPARATE
FROM THE REST OF THE BODY I MEAN
I KNOW WE AT THIS WHOLE
ARISTOTLE THING IN THE PAST
ABOUT THAT --
BUT IT YOU KNOW THE BRAINIS IT
AS A PHYSICAL ORGAN AS WELL AS
AND AND SO THE THEY INTERACT AND
OF COURSE WE TALK ABOUT SOCIAL
TO TERMS OF HEALTH.
SO -- WE'VE
GOT TO FIGURE OUT HOW TO BETTER
INTEGRATE AND I THINK WHEN WE
LOOK AT OUR VARIOUS --
WAIVERS AND SO FORTH AND I KNOW
OF TRADE THESE DIFFERENT MODELS
AND WE TALK ABOUT THE HISTORY.
OF AT SOME POINT.
WE ARE HERE TODAY AND WE NEED TO
LOOK TO THE STUDIES HISTORY --
YOU KNOW WE WE NEED RECOGNIZE IT
BUT WE NEED TO MOVE BEYOND
HISTORY TO AND SAY WHAT IS THE
KIND OF MODEL WANT TO MOVE
TOWARD AND NOT SIR STICK TO THE
WHAT WE ALWAYS DONE IT THIS WAY
SO WHICH CAN KEEP DOING IT THAT
WAY -- SO WE
NEED TO MOVE FORWARD ON ON THAT --
AND SO -- NO
I THINK THERE'S A LOT OF WORK TO
DO -- AND I
APPRECIATE WHAT YOU'RE SAYING
BUT I I'D LIKE TO SEE MORE
THINGS MOVING A BIT QUICKER AND
NOW I THINK PEOPLE ARE KIND OF
FRUSTRATED.
WITH -- THE
WITH WHERE WE ARE RIGHT NOW AND
AND THE PROP SIXTY THREE MONEY --
WE KNOW THE NEED IS THERE BUT
YET -- WHAT
YOU KNOW A LOT OF --
AND COUNTIES WERE EVEN SOME THE
COUNTIES ARE SITTING ON THE
MONEY RIGHT.
AND THEY WEREN'T GETTING IT OUT
AND THAT THAT WAS FRUSTRATING --
AND YOU KNOW THAT THE ACTUALLY
WE HAD THIS WHOLE DISCUSSION
ABOUT HOW THE THE PART BECAUSE
GOOD SERVICES TO GETS AN
ALLOCATION PROP SIXTY THREE TO
MONITOR HOW THE MONEY'S GOING TO
THE COUNTIES WASN'T TRACKING
THAT.
AND YOU KNOW WHAT THEY WERE
SPENDING AND SO NO THAT'S PASSED
THAT'S PAST HISTORY NOW BUT WE
WILL BE SURE WE KNOW WE TOLD
PEOPLE ACCOUNTABLE FOR THE FUNDS
THEY'RE OUT THERE BECAUSE PEOPLE
THE VOTERS PASSED THAT MONEY
EXPECTING THAT THINGS ARE GONNA
BE DONE WITH THAT MONEY THAT.
HAS HAPPENED IN SOME COUNTIES
AND SOME OTHER PLACES IT HASN'T
AND SO --
YOU KNOW WE NEED IT WE DO IN
ORDER TO MAINTAIN PUBLIC TRUST
WE NEED TO SHOW THAT WE'RE
MAKING PROGRESS THAT THERE.
THAT THAT THE DOLLARS ARE GIVING
US ARE BEING USED AND BEING USED
TO GOOD GOOD EFFECT IN THAT WE
HAVE THAT STORY TO TELL BOTH
LOCALLY AND STATEWIDE SO --
SO I I APPRECIATE YOU BEING HERE
I KNOW THAT MANY YOU BOTH OF YOU
ARE DOING SOME SOME GOOD WORK
BUT WHAT I THINK WE HAVE A WE
NEED TO MOVE THE BEST.
THANK YOU MISTER CHAIR AND WANT --
TO LOOK AT THOSE SLIDE --
PAGE THREE THAT YOU BROUGHT UP
FROM SOME OF THE AREAS WITH
THEIR YOUTH.
THAT ARE THERE AND AREAS IT
NEEDS IMPROVEMENT --
IN IN YOLO COUNTY --
WE COME FROM --
IN SAN MARINO COUNTY WE WERE
ABLE.
TO START TO PUT TOGETHER DATA ON
THE HOMELESS YOUTH POPULATION
THAT'S OUT THERE AND A LOT OF
THIS AMIR'S THE INFORMATION
THAT'S HERE NOW. ONE OF THE
THINGS WE ALSO --
START TO MOVE FORWARD WITH IN IN
THE JOSHUA TREE AREA IT WAS A
CRISIS HE STABILIZATION UNITS --
BRICK AND MORTAR --
SO FREE FOR SOME OF THESE
COMPONENTS INTO A
DESTABILIZATION CRISIS AREA
DESTABILIZING THEM ULTIMATELY --
LAW ENFORCEMENT THE EMERGENCY
ROOMS -- THE
IMPACTS THAT WERE BEING DONE
THERE WE'RE NOW --
MINIMIZE BECAUSE OF THAT SO.
SEEN THAT THERE'S SUCH A AN AREA
WITH OUR OUR OUR YOUNG PEOPLE
ARE OUR YOUTH.
IN AGES YOU KNOW FROM K. THROUGH
TWELVE ALL THE WAY TO TWENTY
FOUR TWENTY FIVE THOSE AGES IN
THAT AGE GROUP THAT I THINK WE
NEED TO HAVE A A A BETTER FOCUS
ON SOME OF THOSE THINGS.
DO YOU THINK THAT THE CRISIS
STABILIZATION UNITS --
IF THEY'RE CONSTRUCTED IN AREAS
WOULD SERVE TO THAT ROLE AS FAR
AS LOOKING AT THE MENTAL HEALTH
ISSUE IT AND SELL.
I WILL SAY THE STATURE
CALIFORNIA SO NOT JUST YOLO
COUNTY SO IN A WHITE THIS IS THE
ISSUE -- I
THINK CRISIS STABILIZATION UNITS
HAVE APLACE IN CERTAIN
COMMUNITIES.
I I THINK A BETTER INVESTMENT OF
OUR RESOURCES WOULD BE TO GET
BEFORE ANYBODY EVER GETS TO THE
COULD.
POINT TO GET FARTHER UPSTREAM
AND TAKE CARE OF THEM EARLIER
BEFORE THEY END UP IN CRISIS AND
I I I THINK WE HAVE SOME MODELS
AND SOME --
EXAMPLES OF HOW TO DO THAT THOSE
CRISIS STABILIZATION UNITS
ALTOGETHER BUT I DO THINK WE
HAVE SOME --
OPPORTUNITIES FOR MORE UPSTREAM
INVESTMENT TO KEEP OUR CHILDREN
ARE YOU SOUND ARE ADULTS FROM
GETTING INTO THAT CRISIS
SITUATION.
SO YOU THINK MOVING.
IN TOGETHER IN UNISON SO SOME OF
THESE --
DIFFERENT PROGRAMS BECAUSE WE
SEE IT OF A LOT OF THAT
HAPPENING --
IN OUR COMMUNITIES NOW WITH THEM
THE MENTAL HEALTH CRISIS AND
DIFFERENT THINGS THAT ARE GOING
ON IN OUR COMMUNITIES.
I'M CRISIS STABILIZATION --
AREAS AS WELL AS PREVENTIVE AT A
EARLY AGE AND EARLY --
IN SOMEONE'S EARLY LIFE.
ANY OTHER YES.
THANK YOU CHRIS --
I WOULD ASK ABOUT WHAT YOUR
EXPERIENCE HAS BEEN.
WITH REGARDS TO THE UNDOCUMENTED
COMMUNITY ACCESS TO MENTAL
HEALTH --
WHETHER --
THERE'S OBVIOUSLY DIFFERENCES
AND AND WHO IS ELIGIBLE MONTHS
THEY UNDOCUMENTED.
BUT AND WHAT CAN BE DONE.
TO IMPROVE.
JUST LIKE OVERALL FOR MEDI CAL
BUT WHAT CAN WE DO TO IMPROVE --
MENTAL HEALTH SERVICES TO THE
UNDOCUMENTED COMMUNITY SURE
GREAT QUESTION --
SO -- YOU
KNOW FIRST AS ALL CHILDREN
REGARDLESS OF DOCUMENTATION
STATUS UP THROUGH THE AGE OF
EIGHTEEN ARE ELIGIBLE FOR FULL
SCOPE MEDICAL BENEFITS I THINK
WHICH IS OBVIOUSLY --
IMPORTANT BECAUSE THAT CERTAINLY
GUARANTEES THOSE CHILDREN HAVE
ACCESS TO THE FULL RANGE OF MEDI
CAL ENTITLEMENT SERVICES
INCLUDING SPECIALTY MENTAL
HEALTH SERVICES.
I'M OBVIOUSLY AS PART OF THE
GOVERNOR'S INCREASING THAT
ELIGIBILITY UP TO THE AGENT
THROUGH THE AGE OF TWENTY FIVE
FOR INDIVIDUALS WITHOUT --
SATISFACTORY DOCUMENTATION
STATUS IS ANOTHER POPULATION
THAT WILL BE --
ABLE TO USE THE FULL SCOPE OF
THE SPECIAL TO MENTAL HEALTH
SERVICES EITHER IF THEY'RE AT
UNDER THE AGE OF TWENTY ONE OR
IF THERE OVER THE AGE OF TWENTY
FIVE TWENTY ONE I THINK --
THE ONE OF THE MORE NOTABLE
THINGS ABOUT CALIFORNIA --
IS THE FACT THAT WE HAVE --
TAKEN A LOT OF STEPS OVER THE
COURSES --
TIME TO ADOPT DIFFERENT
FINANCING --
MECHANISMS TO SUPPORT STATE
GOALS AND THE MENTAL HEALTH
SERVICES ACT IS CERTAINLY ONE OF
THOSE IN WHICH THE FUNDS THAT
FLOW TO THE COUNTIES --
THROUGH AN HSA ARE SAYS AND
SUPPORT --
DIRECT SERVICES AND SUPPORT
THOSE FUNDS ARE NOT AND TIED TO
MEDI CAL ELIGIBILITY PER SE THEY
CAN BE USED ON OTHER POPULATIONS
AND SO.
I WOULD PROBABLY DEFER TO I'M
KAREN FOR YOU KNOW KIND OF
SPECIFICS AROUND WHAT THE
COUNTIES ARE USING WITH THOSE
FUNDS BUT THERE ARE A VARIETY OF
FLEXIBLE FUND SOURCES SO THAT IF
AN INDIVIDUAL.
THAT IS UNDOCUMENTED --
COMES TO A COUNTY MENTAL HEALTH --
PROGRAM AND SAYS I'M IN NEED OF
MEDICAL SERVICES THEY CAN USE
OTHER FUN SOURCES THAT ARE NOT
RELATED --
TO MEDI CAL ENTITLEMENT FUNDS I
THINK ALSO --
FOR INDIVIDUALS THAT ARE IN A
QUEUE CRISIS AND IN NEED OF
INPATIENT SERVICES THERE ARE ON
CIRCUMSTANCES IN WHICH THE STATE
WOULD BE PAIN UNDER LIMITED
SCOPE EMERGENCY MEDICAL SERVICES
ESPECIALLY IF SOMEONE HAD --
SOMETHING AS SERIOUS AS LIKE A
FIFTY ONE FIFTY DESIGNATION AND
WERE HARM TO THEMSELVES OR TO
SOMEONE ELSE AND SO.
IT'S NOT --
IDEAL AND I THINK THAT THERE ARE
STEPS THAT CALIFORNIA HAS BOTH
TAKEN AND ARE PREPARING TO TAKE
AROUND.
INCREASING COVERAGE IN PROVIDING
FULL SCOPE TO KAREN ON CHINESE
PAY FOR A I'M SO GLAD SHE'S JUST
DID USE AN HSA FUNDS TO FUND OUR
LOCAL PROGRAM WHERE WE USE PROMO
TORAS TO DO OUT REACH INTO OUR
MIGRANT CAMPS AND IT'S ACTUALLY
WITH OUR COMMUNITY HEALTH OUR
LOCAL COMMUNITY.
HEALTH CENTER WHERE MANY OF OUR
POPULATION WHO ARE UNDOCUMENTED
ALREADY HAVE RELATIONSHIPS
BECAUSE IT'S A MIGRANT HEALTH
CENTER AND SO.
IT NOT ONLY HAD THE BENEFIT OF
FUNDING MEANT THE REAL HEALTH
SERVICES BUT ALLOWED THEM TO
HAVE NO STIGMA THEY CAN GO IN
THE SAME DOOR TO SEE THEIR
DOCTOR AS THEY SEE THE
BEHAVIORAL HEALTH PROVIDER.
AND CULTURALLY THAT'S A LOT MORE
APPROPRIATE THAN ASKING THEM TO
COME TO MY BUILDING WHERE IF YOU
GO THROUGH A CERTAIN DOOR
EVERYBODY KNOWS WHERE THEY'RE IS
THERE.
IS THERE ANY CONNECTION AS FAR
AS THE NEEDS --
AND OR ACCESS BETWEEN THE YOUTH
HAVING ACCESS BUT NOT THOSE.
OVER --
NINETEEN RIGHT NOW.
NO THAT WAS IS IT IMPACT --
THEIR ABILITY OR THEIR
MOTIVATION OR DO THEY FEEL.
LIKE THEY SHOULDN'T TO GOAL --
HOW HAVE YOU SEEN ANY
INDICATIONS OF?
THE FACT THAT WE'RE SPLITTING UP
YEAH.
FAMILIES.
FROM THOSE WHO ARE ELIGIBLE AND
THOSE WHO ARE NOT.
WELL AND I'M I'M NOT A CLINICIAN
BUT I WILL CERTAINLY TRY TO PLAY
ONE ON TV RIGHT AT THIS MOMENT --
I KNOW THAT --
TYPICALLY AND THEN A Q.
PSYCHOTIC BREAK OR SCHIZOPHRENIA
IS USUALLY DIAGNOSED WHEN
SOMEONE IS IN THEIR LATE TEENS
EARLY TWENTIES.
I THINK THAT AND THIS IS NOT
JUST TO THE UNDOCUMENTED
POPULATION BUT TO ANY POPULATION
AND CALIFORNIA THAT WE SERVE --
THE PTSD T. MANDATE AROUND
SERVICES --
FOR CHILDREN UNDER THE AGE OF
TWENTY ONE SO IN MEDI CAL THE
PST T. BENEFIT IS A BROAD
BENEFIT THAT SAYS ESSENTIALLY WE
HAVE TO DO WHATEVER IT TAKES TO
AMELIORATE ADDRESS.
THE CONDITION --
AND SO THAT REALLY MEANS THAT
THEY HAVE A LOT MORE SERVICES
AVAILABLE TO THEM --
ESPECIALLY AROUND MENTAL HEALTH
AND THEN WHEN THEY HIT THE AGE
OF TWENTY ONE THAT MANDATE IS NO
LONGER APPLICABLE AND MEDI CAL
FOR ANY POPULATION AND SO.
IN SOME CASES IT'S IT IS AN
UNFORTUNATE RUBBED THAT
INDIVIDUALS WHO ARE PROBABLY
JUST BEING DIAGNOSED WITH A
SERIOUS MENTAL ILLNESS WOULD
ALSO BE AT THE POINT IN TIME IN
WHICH THE MANDATE FOUR EPS DUE
TO SOME SERVICES AND THOSE TYPES
OF AVAILABILITY OF SERVICES.
DISAPPEARS --
IF THEY'RE STILL MEDI CAL
ELIGIBLE OBVIOUSLY THEY STILL
ARE ACCESSING SERVICES BUT THE
BROADNESS OF THAT BENEFIT IS
REALLY KIND OF SPECIFIC AN
INDICATIVE JUST TO TO CHILDREN
UNDER THE AGE OF TWENTY ONE I
THINK THAT --
JUST BY THE NATURE OF WE'LL SKIP
SERVICES TO THIS POPULATION --
A IS IMPORTANT BECAUSE BOTH THE
CHILD I'M A CERTAINLY AS THEY
GET OLDER BUT ALSO THE PARENTS
KNOW THAT THE SERVICES EXIST
SOME OF THESE CHILDREN --
MAY FIRST ENCOUNTER A MENTAL
HEALTH PROFESSIONAL IN THE
SCHOOL SYSTEM WHICH I THINK WE
HAVEN'T REALLY TALKED ABOUT --
BUT IF THE CHILD HAS A
BEHAVIORAL HEALTH ISSUE OR SEER
SUMMERS MOTION DISTURBANCE
SOMETIMES THAT IS MANIFESTING IN
THE SCHOOL SETTING.
IN WHICH THE SCHOOL WITHIN REACH
OUT TO THE COUNTY --
IN THERE WOULD BE A REFERRAL
MADE -- AND
THEN YOU WOULD THEN ALSO BEGAN
TO HAVE SERVICES DELIVERED TO
THE CHILD WHICH I THINK. TO THE
EXTENT THAT WE AS A STATE HAVE
SAID WE WILL SUPPORT AND FUND
THAT SERVICE --
IT'S ALSO PARENT --
IMPORTANT FOR THE PARENTS TO
KNOW THAT SUCH THAT THEY CAN
MAKE SURE THAT THE CHILD IS
ACCESSING THOSE SERVICES AS WELL
AS WHEN THE CHILD.
GROWS OLDER THEY KNOW THAT THEY
STILL CONTINUE TO EXCESS.
THANK YOU.
I THINK GO WILL PRECEDE THE
INFORMATION WE MAY HAVE SOME
FOLLOW UP QUESTIONS AND WE'LL
GET BACK TO YOU IN WRITING BUT
IN THE INTEREST OF MOVING ALONG
WE HAVE A WE HAVE TWO MORE
PANELS SO.
OUR NEXT PANELIST ON MENTAL
HEALTH --
MEDI CAL MENTAL HEALTH COVERAGE
FOR CHILDREN WE HAVE THREE
SPEAKERS --
PLEASE COME ON FORWARD --
CAM LEWIS IS THE MANAGING
ATTORNEY FOR THE NATIONAL HEALTH
LAW PROGRAM.
THE ANDHRA THE UNDER CLARK
HARVEY IS DIRECTOR POLICY AND
LEGISLATIVE AFFAIRS FOR THE
CALIFORNIA COUNCIL OF COMMUNITY
BEHAVIORAL HEALTH AGENCIES.
SAY THAT ONE FAST THREE TIMES --
AND THEN FRANK MECCA'S EXECUTIVE
DIRECTOR OF THE COUNTY WELFARE
DIRECTORS ASSOCIATION WITH ACID
YOU TRY TO KEEP YOUR COMMENTS
FIVE MINUTES OR SO.
THAT'S GOOD THANK YOU SO MUCH.
AND WE'LL START WITH HIM.
GOOD AFTERNOON IT'S NICE TO BE
HERE THANK YOU FOR HAVING ME --
IT'S I IT'S MY PRIVILEGE TO TALK
ABOUT THE MANHOLE SERVICE
DELIVERY SYSTEM IT'S SOMETHING
THAT I IT'S NEAR AND DEAR TO MY
HEART -- I
HAVE BY WAY BACKGROUND BEEN
WORKING IN THE MENTAL HEALTH
SYSTEM.
IN ABOUT AN AROUND IT FOR ALMOST
THIRTY YEARS --
I WORKED FOR A DECADE AS A
PATIENT'S RIGHT TO HAVE A KID IN
THE COUNTY AND SAN DIEGO COUNTY
WHERE I WAS RESPONSIBLE FOR
INSURING THE RIGHTS OF CHILDREN
YOUTH AND ADULTS.
ACCESS TO MENTAL HEALTH SERVICES
WERE DELIVERED.
ALSO --
WASN'T LEAD COUNSEL IN A CLASS
ACTION CASE ON BEHALF OF
CHILDREN THE KD ES LAWSUIT. TO
ENSURE THAT --
MENTAL HEALTH SERVICES WERE
BEING DELIVERED ACCORDING TO THE
PST TEAM MANDATE SO WE DEVELOPED
HOME AND COMMUNITY BASED
SERVICES FOR CHILDREN AND YOUTH
IN CALIFORNIA.
THAT'S BEEN IMPLEMENTED NOW AND
ALSO WORK YOU KNOW DAILY WITH
ADVOCATES AROUND THE STATE.
BOTH -- YOU
KNOW LEGAL SERVICES ADVOCATES --
SEE CLIENTS COME INTO THEIR
OFFICE EVERYDAY WHO NEED ACCESS
TO MENTAL HEALTH SERVICES AND
ARE HAVING DIFFICULTY GETTING
THOSE SERVICES SO --
BECAUSE OF THE TIME YOU KNOW
CONSTRAINTS ON I WANT TO LIMIT
MY COMMENTS I'M GONNA FOCUS ON
TWO SPECIFIC QUESTIONS.
AND ONE IS THE FIRST ON WHAT
NEEDS IMPROVING THE MEDI CAL
MENTAL HEALTH DELIVERY SYSTEM.
SO I LIKE TO YOU KNOW START WITH
THAT QUESTION MY TALKING ABOUT A
PARTICULAR EXAMPLE THAT I HAVE
RECENTLY SEEN A CASE THAT.
WAS BROUGHT TO MY ATTENTION ITS
ONGOING TODAY.
A FIFTEEN YEAR OLD USE OF WHO
HAS MULTIPLE MENTAL HEALTH
DIAGNOSIS INCLUDING.
DEPRESSION SUICIDAL IDEATION
OBSESSIVE COMPULSIVE DISORDER AS
WELL AS SUBSTANCE USE DISORDER.
IS GETTING SERVICES FROM HER
HEALTH PLAN --
THROUGH AT AND IT AN EATING
DISORDER SPECIALIST.
ALSO HAS A PSYCHIATRIST TO THE
COUNTY MENTAL HEALTH PLAN.
HER CONDITION BECAME MUCH WORSE
AND BOTH HER EATING DISORDER
SPECIALIST AS WELL.
AS THE PSYCHIATRIST RECOMMENDED
THAT SHE GET RESIDENTIAL
TREATMENT.
SHE IN NOVEMBER SHE RECEIVED IT
AND I'LL FORMER HEALTH PLAN
BASICALLY SAYING THAT THEY WERE
NOT RESPONSIBLE TO PROVIDE THAT
SERVICE AND THAT SHE SHOULD GO
TO THE COUNTY.
THE MOTHER WENT TO THE COUNTY IN
THE COUNTY AND ASK THEM FOR THE
SERVICES.
COUNTY SAID THEY COULD NOT
PROVIDE THOSE SERVICES AND THAT
SHE SHOULD GO TO THE HEALTH PLAN.
SO THIS IS A NOVEMBER.
TWENTY EIGHTEEN YOU KNOW NOW
WE'RE HERE IN MARCH OF TWENTY
NINETEEN AND ONLY OVER THREE AND
A HALF MONTHS LATER STILL THOSE
SERVICES HAVE NOT BEEN DELIVERED
TO THAT CHILD.
ANA IN IN THE INTERIM SHE HAS
YOU KNOW SHOOT SOMEONE WHO IS
BULIMIA ANOREXIA IS LOST
ADDITIONAL FIFTEEN POUNDS HAS.
REQUIRED EMERGENCY ROOM
TREATMENT ON MULTIPLE OCCASIONS
AND HAS BEEN INVOLUNTARILY
DETAINED.
SO YOU KNOW THIS IS
UNFORTUNATELY NOT AN ANOMALY OF
KINDS OF CASES THAT WE SEE --
YOU KNOW THESE ARE THE KINDS OF
ISSUES THAT I THINK FACE USE AND
AND CHILDREN EVERY DAY IN THE
SYSTEM AS WELL AS ADULTS.
IT'S NOT SURPRISING TO SAY THE
SYSTEM IS FRAGMENTED YOU'VE
HEARD ABOUT THAT.
I THINK QUITE A BIT.
THEY FINANCIAL INCENTIVES WHEN
YOU BIFURCATED SYSTEM ARE TO
DENY CARE AND TO REFER PEOPLE TO
THE OTHER SYSTEM.
THAT'S WHAT HAPPENS TODAY THAT
IS BECAUSE OF THE DIFFERENT
FUNDING STREAMS AND
ACCOUNTABILITY THAT'S WHAT
HAPPENS TO CHILDREN AND YOUTH IN
PARTICULAR.
IT'S NOT DESIGNED WITH BENEFITS
YEARS AT THE CENTER OF THE
SYSTEM --
YOU'VE KNOW THAT THEIR FIFTY SIX
MENTAL HEALTH PLANS THERE ARE
TWENTY TWO HEALTH PLANS ARE IN
MULTIPLE COUNTIES --
THE STATE DEPARTMENT OF HEALTH
CARE SERVICES IS DIRECTLY
RESPONSIBLE TO ENSURE THAT THIS
ENTITLEMENT IS DELIVERED TO
CHILDREN IN YEARS.
AND THERE IS NOT ENOUGH
OVERSIGHT OF MENTAL HEALTH PLANS
AND HEALTH PLANS TO MAKE SURE
THAT HAPPENS.
THIS IS AN A FEDERAL ENTITLEMENT
E. PST T. THAT WE'RE TALKING
ABOUT AND IT SHOULD NOT BE
DELIVERED DIFFERENTLY IN EVERY
COUNTY AND IT SHOULD NOT BE THAT
YOU CAN GET A SERVICE AND ONE
CAN YOU CAN GET IN AND OTHER.
THAT IS NOT CONSISTENT WITH THE
FEDERAL ENTITLEMENT [inaudible]
SO.
REALLY WHAT HAPPENS IS
BENEFICIAL LEFT ON THEIR OWN AND
IF THEY'RE LUCKY THEY GO TO A
LEGAL SERVICES ATTORNEY AND
MAYBE THAT I GET A CALL AND WE
TRY TO WORK OUR WAY THROUGH THAT
SYSTEM. THREE OF THE ISSUES I
THINK I WANT TO TALK ABOUT THAT
MAKE THIS MOST CHALLENGING ART.
THEN LACK OF REFERRAL TRACKING
BETWEEN THE PLANS.
THE INADEQUATE COORDINATION AND
THE LACK OR THE THE LACK OF
ACCESS TO CONTINUITY OF CARE.
SO JUST BRIEFLY.
THE THERE IS NO REAL REQUIREMENT
THAT.
INDIVIDUALS WHO WERE BEING
SURVIVAL SYSTEMS ARE BEING
TRACKED AND THAT THAT.
THAT THE THE INDIVIDUAL WHO IS
BEING SEEN BY ONE IS ACT THEY
ACTUALLY KNOW WHAT'S HAPPENING
WITH THE OTHER SYSTEM.
THAT'S PARTLY DUE TO THE LACK OF
REQUIREMENT THAT THEY TRACK IT'S
ALSO DO THE FACT THAT THE DATA
SYSTEMS ARE COMPLETELY
INCOMPATIBLE.
AND SO EVEN THOSE GOOD HEALTH
PLANS THAT ARE ACTUALLY DOING
TRACKING THEY'RE DOING IT
MANUALLY.
NOT AN AUTOMATED WAY AND SO NG
IS THOSE YOU KNOW THEY'RE
BASICALLY TRYING TO FIGURE OUT
WHAT SERVICES THOSE CHILDREN AND
YOUTH ARE GETTING AND THEY
OFTENTIMES DON'T KNOW WHAT THE
OTHER SYSTEMS PROVIDING AYE
MEANS NOT JUST HEALTH CARE BUT
IT'S MENTAL HEALTH CARE --
SECONDLY THE IN TERMS OF AN
ADEQUATE COORDINATION DESPITE
THE FACT THAT THERE ARE
REGULATIONS ON THE BOOKS.
IN TITLE NINE THAT REQUIRE THAT
THERE BE A MEMORANDUM OF
UNDERSTANDING BETWEEN EACH PLAN
IN EACH MENTAL HEALTH PLAN.
THOSE MEMORANDUMS OF
UNDERSTANDING ARE VERY DIFFERENT
THEY'RE ALL VASTLY --
YOU KNOW A DIFFERENT IN TERMS OF
BOTH THE AMOUNT AND THE TYPE OF
COORDINATION THAT'S OCCURRING IN
THE DETAIL THAT'S IN THOSE
MENTAL.
HEALTH MO USE WE'VE ANALYZED
EVERYONE OF THEM IN A REPORT
THAT WE DID IN NOVEMBER --
TWENTY EIGHTEEN AND SO AS A
RESULT OF THAT THERE'S REALLY IN
QUITE A BIT OF DIFFERENCE IN HOW
THAT COORDINATION IS HAPPENING
OR NOT HAPPENING.
AND THAT LACK OF KIND OF
CONTINUITY OF COORDINATION
ESSENTIALLY MEANS THAT.
PEOPLE ARE GOING FROM PLAN TO
PLAN AND THERE REALLY ISN'T A
HAND OFF IT'S LIKE OKAY YOU GET
FROM ONE PLAN.
AND YOU GET SET HANDED OFF TO
THE OTHER PLAN AND THEY DON'T
REALLY KNOW WHAT HAPPENS AFTER
THAT AND UNFORTUNATELY THAT
MEANS THAT.
PEOPLE ARE ENDING UP REALLY
SCOTT BETWEEN THESE TWO SYSTEMS.
SO -- KIND
OF THIRD I WANT TO SAY THAT THE
LACK OF CONTINUITY OF CARE SO
PARTLY THAT'S DUE TO LACK OF
TRACKING THAT WE JUST TALKED
ABOUT THE LACK OF REFERRAL
COORDINATION OF CARE --
IT LITERALLY LEADS TO PROBLEMS
WITH CONTINUITY OF CARE
SENSUALLY GET CAUGHT IN THE
MIDDLE SO.
THERE'S ALSO NO GUIDANCE BY THE
DEPARTMENT REALLY IN THIS AREA
THERE SOME RECENT GUIDANCE BUT
IT'S REALLY NOT ENOUGH IN TERMS
OF ENSURING THAT INDIVIDUALS
AREN'T HAVING THEIR CARE.
LAPS OR BEING INTERRUPTED IN THE
MIDDLE OF TREATMENT SO.
IT IN PARTICULAR THE EXAMPLE I
GAVE YOU IS ABOUT WHERE THERE IS.
A DISPUTE BETWEEN THE PLANS
ABOUT WHO IS RESPONSIBLE AGAIN
YOU'D THINK THAT THERE'D BE A
WAY TO WORK THAT OUT WHAT
HAPPENS IS THE BENEFITS YOU JUST
LEFT CAUGHT IN THE MIDDLE EVEN
THOUGH THEY CAN FILE A GRIEVANCE.
THEY CAN USE THOSE LEGAL
REMEDIES AVAILABLE TO THEM BUT
BUT OFTEN TIMES IT DOESN'T
RESOLVE THE PROBLEM AND YOU'VE
GOT YOU KNOW YOU'VE GOT LAYERS
OF KIND OF DUE PROCESS THAT YOU
HAVE TO GO THROUGH INCLUDING
FAIR HEARING RIGHTS TO GET.
TO A RESOLUTION WHICH TAKES
MONTHS --
ALSO AT WHAT HAPPENS IF YOU HAVE
NO CONTINUITY OF NETWORK.
OF OF THE OF A NETWORK BETWEEN
THE PLANS WHICH IS WHAT ALSO
EXACERBATES THIS PROBLEM.
YOU MAY END UP WITH A CHILD OR
YOUTH BEING SERVED BY ONE SYSTEM
AND HAVING LET'S SAY
PSYCHOTHERAPIST AND THEN.
HAVING TO BE SORT OF HANDED OFF
TO ANOTHER SYSTEM WHICH SHOULD
NOT HAPPEN AND START OVER WITH A
NEW THERAPIST THAT'S NOT THE
STANDARD PRACTICE THAT SHOULD BE
HAPPENING TODAY --
JUST KIND OF FINALLY I THINK ON
THIS ISSUE OF CONNIE DO CARE.
THERE ARE ALSO THERE'S A STATE
WAY THAT THEY HAVE DIVIDED UP
RESPONSIBILITY BETWEEN PLANS
WHICH YOU MAY HAVE HEARD ABOUT
IN LESS HEARING AROUND MILD TO
MODERATE TO SEVERE IMPAIRMENTS.
THIS BILL --
I KNOW I'VE EXHAUSTED BILLY
ADVOCATE ON THIS ISSUE BUT THERE
SHOULD NOT BE APPLYING THIS
REQUIREMENT TO CHILDREN.
THIS IS THE ENTIRE APS SEED
ENTITLEMENT IS VERY BROAD AND
KIDS SHOULD NOT BE TURNED AWAY
FROM CARE BECAUSE THEY HAVE A
SEVERE IMPAIRMENT A MILD OR
MODERATE IMPAIRMENT IT IS ABOUT
WHAT'S MEDICALLY NECESSARY.
AND WHAT HAPPENS IS THESE KIDS
DO GET TURNED AWAY AND WE'VE
SEEN THAT ROUTINELY IN
PARTICULAR BY MENTAL HEALTH
PLANS.
THROUGH SCREENING MECHANISMS ARE
OTHER WAYS OF DENYING KIDS CARE --
AT THE FRONT END BECAUSE THEY
DON'T ALSO BECAUSE THE
REGULATIONS THAT WE HAVE ON THE
BOOKS AROUND MEDICAL NECESSITY
ARE VERY CONVOLUTED AND THEY'RE
IN CONSISTENT WITH THE STATUTE.
FOR MEDICAL NECESSITY WHICH WE
FIX LAST YEAR IN THE LEGISLATION --
THROUGH SB.
TWELVE EIGHTY SEVEN SO HOW DO WE
BETTER INTEGRATE THAT CERTAIN
THOSE GET THAT CARE I MEAN I
HAVE NOT COME TO THIS DECISION
LIGHTLY BUT OVER MANY MANY YEARS
OF BEING INVOLVED IN THE SYSTEM
I HAVE.
NOW TAKEN THE POSITION THAT I
THINK A FULLY INTEGRATED SYSTEM
IS THE DIRECTION THAT WE NEED TO
GO IN.
WE HAVE MANY MANY YEARS OF
EXPERIENCE OF FRAGMENTED
DELIVERY SYSTEM WE HAVE.
AS YOU'VE HEARD EARLIER ON THE
PANEL.
YOU KNOW YOU SEEN ONE CAN YOU
SEEN ONE COUNTY THAT IS NOT AN
ENTITLEMENT THAT IS ABOUT A A
FRAGMENTED SYSTEM THAT DOES NOT
WORK.
BUT IT IS GOING TO TAKE TIME TO
GET THAT TO BE DONE RIGHT
THERE'S GONNA NEED TO BE A VERY
CAREFUL STAKEHOLDER PROCESS
THERE'S GOING TO NEED TO BE
GUARDRAILS PUT IN PLACE THERE'S
GOING TO BE NEED TO BE.
READING THE STANDARDS DEVELOPED
AND IN PARTICULAR FOR CHILDREN
AND YOUTH BECAUSE THE SERVICES.
IN SPECIALTY MAHAL BUT CHILDREN
YOUTH GET ARE VERY DIFFERENT
THAN A MEDICAL MODEL TYPE OF
SERVICE THAT'S DELIVERED AN
OFFICER IN A CLINIC.
THAT MOST OF THE HEALTH PLANS
ARE FAMILIAR WITH IN A
COMMERCIAL SIDE.
THERE ARE HOME AND COMMUNITY
BASED SERVICES THEY COULD BE
PROVIDED ON THE SOCCER FIELD
THAT COULD PROVIDE IN THE HOME.
IT COULD BE PROVIDED IN THE
SCHOOL.
BUT THERE ARE SERVE AT TIMES AND
THERE PROVIDED A LOT OF TIMES BY
PARA PROFESSIONALS UNDER THE
CLINICAL SUPERVISION.
AND THOSE ARE SERVICES THAT ARE
NOT EASY TO DELIVER THEIR
FIDELITY PRACTICE THAT NEEDS TO
BE LEARNED AND IT NEEDS TO BE
CONTINUED SO.
THAT THAT NETWORK NEEDS TO BE IN
PLACE IF THEY'RE GOING TO BE --
MOVING UNDER THE AUTHORITY OR
RESPONSIBILITY OF THE HEALTH
PLAN.
BUT WHAT WE CAN DO NOW IN SORT
OF IT I'VE ALREADY TALKED ABOUT
IS PUT IN PLACE SOME LEGISLATION
THAT SPECIFICALLY ADDRESSES
RIGHT NOW TODAY.
THAT REFERRAL IN TRACKING SYSTEM
BETTER COORDINATION REQUIREMENTS
AND MORE ACCOUNTABILITY.
AND ALSO --
TO ENSURE THAT THERE IS KIND OF
THE OF CARE AND THAT'S GONNA
REQUIRE THE DEPARTMENT ACTUALLY
DO MORE THAN IT'S DOING TODAY TO
OVERSEE WHAT'S HAPPENING IN THE
STATE.
IT IS NOT OKAY FOR THE STATE
DEPARTMENT TO SAY WE ARE NOT
RESPONSIBLE FOR WHAT HAPPENS IN
A PARTICULAR COUNTY BECAUSE A
REALIGNMENT FUNDING OR ANY OTHER
REASON IT IS A MEDICAID
ENTITLEMENT AND THERE IS THE
OTHER SINGLE STATE AGENCY
RESPONSIBLE --
SO I BELIEVE IN MY WRITTEN
TESTIMONY AND ALSO I'M OPEN FOR
QUESTIONS GREAT THANK YOU AND
WE'LL WE'LL TAKE QUESTIONS AT
THE END SO.
GO AHEAD DR KERR [inaudible]
GOOD AFTERNOON.
I'M WE UNDERTAKE HARVEY
REPRESENTING THE CALIFORNIA
COUNCIL FOR COMMUNITY BE EVER
HOLD AGENCIES WE REPRESENT
MENTAL HEALTH AND SUBSTANCE USE
DISORDERS --
NONPROFIT COMMUNITY BASED
ORGANIZATION TO CONTRACT WITH
COUNTY SAN THANK YOU FOR THE
OPPORTUNITY TO SHARE A SUMMARY
OF OUR MEMBERS FEEDBACK OF
WHAT'S WORKING WELL AND AREAS OF
IMPROVEMENT FOR CHILDREN'S
MEDICAL SERVICES.
SO GENERALLY LET'S START OFF
WITH THE POSITIVE ARE PROVIDERS
APPRECIATE WHEN THINGS WORK WALL
THEY CAN WORK WITHIN A
COMPREHENSIVE SYSTEM OF CARE
THAT IS TAILORED TO THE
POPULATION THAT SERVED.
IN INCLUDES ACCESS TO CARE
ELEMENTS SUCH AS NO COPAY A WIDE
ARRAY OF SERVICES AND IT
REIMBURSES PROVIDERS FOR THEIR
TOTAL CLINICAL AND CASE
MANAGEMENT TIME.
BUT THEY SEE OPPORTUNITIES FOR
IMPROVEMENT AS FOLLOWS THE
CURRENT COST REIMBURSEMENT
SYSTEM IS VERY RESTRICTIVE FOR
EXAMPLE THE MINUTE BY MINUTE
BILLING DOES NOT INCENTIVIZE
PROVIDERS TO FOCUS ON VALUE
BASED CARE AND OUTCOMES AS MISS
LARSEN NOTED IN HER OPENING
COMMENTS. FOR EXAMPLE IT ALSO
DISK DIFFICULT TO GET MENTALLY
ILL CHILDREN THE RESIDENTIAL
CARE WHEN NEEDED AT THIS
POPULATION REQUIRES MULTIPLE
SERVICES AND RESOURCES AND IT'S
QUITE BURDENSOME ON PROVIDERS.
WHEN WE LOOK AT SCHOOL BASED
MENTAL HEALTH TREATMENT TING
SILOS SO THAT ALL STUDENTS ARE
ABLE TO GET THE SERVICES FOR
THEIR BEHAVIOR AND EDUCATION
NEED REGARDLESS OF INSURANCE OR
MEDICAID ELIGIBILITY?
AND OVERWHELMINGLY OUR PROVIDER
SHARE CONCERNS ABOUT BURDEN SOME
CLINICAL CHARTING STANDARDS AND
THE NEED FOR PAPERWORK REDUCTION
AND UNIFORMITY AND PAPERWORK
STANDARD ACROSS ALL OF THE
COUNTY OF LOS THE TRANSITION
FROM IN A CHILDREN'S MEDICAL --
MEDICAL EXCUSE ME MEDICAL TWO
ADULTS SERVICES WHEN THEY TURN
TWENTY ONE CAN BE REALLY ABRUPT
AND WARRANTS BETTER CONTINUITY
OF CARE.
AS WAS JUST MENTIONED.
NO ONE WE EXAMINE THE MENTAL
HEALTH PLANS PROVIDERS DESIRE
BETTER COORDINATION BETWEEN
COUNTY MH PEAS ONE CLIENTS MOVE
BETWEEN COUNTY SERVICES ARE
OFTEN DROPPED OR DELAYED AS WAS
NOTED DURING THIS LIST OF
TESTIMONY.
AND THEY'RE ALSO CONCERNED ABOUT
THE CURRENT SYSTEM'S INABILITY
TO GET A FIX CLIENTS WAS FINDING
A PROVIDER WHEN THEY NEED A
LOWER LEVEL OF KERR WHEN THEY'RE
DOING WELL.
MANAGED CARE ORGANIZATIONS
TYPICALLY HAVE FEWER LOCATIONS
AND THEY DON'T ALWAYS PROVIDE
ROBUST COMMUNITY BASED SERVICE
HAS.
SO IT'S CLEAR TO ALL OF US THAT
THE INTEGRATION OF BEHAVIORAL
HEALTH AND PHYSICAL HEALTH IS
ESSENTIAL.
I IN FACT THE CALIFORNIA
HEALTHCARE FOUNDATION RELEASED A
REPORT JUST LAST MONTH THAT
FOCUSED ON THIS GOAL. TO THIS
AND WE BELIEVE THAT THE STATE
MONTHS FIRST FUND PILOT PROGRAMS
THAT TEST THE INTEGRATION OF
BEHAVIORAL HEALTH AND PHYSICAL
HEALTH AND COMMUNITY BASED
SETTINGS.
WE ALSO THINK THAT STATES AND
COUNTY SHOULD INVEST MORE IN
HEALTH IN OUR INFORMATION
EXCHANGES AND PROVIDE THESE TO
CBO'S SO THAT AN INDIVIDUAL'S
COLLECTIVE ELECTRONIC MEDICAL
RECORD PLATFORM CAN SHARE
INFORMATION WHEREVER THEY GO FOR
TREATMENT.
WE ALSO BELIEVE IN BROADENING
THE DEFINITION OF MEDICAL
NECESSITY FOR CHILDREN.
IF THE STATE VIEW CHILDREN'S
ACCESS TO MENTAL HEALTH SERVICES
THE SAME WAY WE VIEW PHYSICAL
HEALTH VACCINATIONS MORE KIDS
WOULD GET SERVICES REGARDLESS OF
WHETHER THEY MEET MEDICAL
NECESSITY CRITERIA.
I KNOW TIME IS SHORT PSALTIS AND
WITH A QUOTE FROM ONE OF OUR
PROVIDERS.
COUNTY AGENCIES ARE STAFFED BY
ESPECIALLY THE PROGRAM OFFICIALS
AND STAFF THAT WE KNOW AN INTER
INTERACT WITH HOWEVER BY THE
VERY NATURE OF LARGE GOVERNMENT
ENTITIES.
IT'S INEVITABLE THAT THERE'S
GOING TO BE AND INEFFICIENCIES
BUT PROVIDERS HAVE THE ABILITY
TO BE MORE RESPONSIVE TO THE
NEEDS OF CLIENTS BY SCALING AND
ADJUSTING SERVICES IN A NUMBER
OF FASHION.
SO COUNTY AGENCIES AND PROVIDERS
NEED TO WORK TOGETHER THEIR
NATURAL PARTNERS THEY CAN REALLY
ENRICH OUR COMMUNITIES YET WE
CONTINUE TO CRY OUT FOR THE
ABILITY AND PERMISSION TO JUST
BE MORE EFFICIENT.
THANK YOU FOR THE OPPORTUNITY TO
SHARE COMMENTS.
THANK YOU VERY MUCH MISTER MAKER.
THANK YOU MISTER CHAIRMAN FRANK
MECCA THE EXECUTIVE DIRECTOR OF
THE COUNTY WELFARE DIRECTORS
ASSOCIATION.
OUR MEMBERS ADMINISTER MOST OF
THE PUBLICLY FUNDED HUMAN
SERVICES PROGRAMS INCLUDING
FOSTER CARE CHILD WELFARE
SERVICES AND CAL WORKS IN OUR
WINDOW.
INTO -- THE
ISUE TODAY IS THROUGH CHILDREN
THAT ARE THE CLIENTS OF OUR
AGENCIES HAVE SUFFERED
SIGNIFICANT TRAUMA.
CHILDREN HAVE SUFFERED ABUSE AND
NEGLECT IN CHILDREN WHO ARE
LIVING IN POVERTY OFTEN VERY
DEEP POVERTY WHAT WE KNOW ABOUT
THE CHILDREN IN OUR SYSTEM.
A 100% OF THE CHILDREN IN UP IN
THE FOSTER CARE SYSTEM HAVE
EXPERIENCE SIGNIFICANT TRAUMA.
NOT JUST FROM THE ABUSE AND
NEGLECT THE BECAUSE THE
INTERVENTION BUT FROM THE
REMOVAL ITSELF AND BEING PLACED --
IN OUT OF HOME CARE.
ON CHILDREN AND CAL WORKS
FAMILIES LIVE EXPERIENCE
MULTIPLE TRAUMAS IN CALIFORNIA
ALMOST 20% 21%.
OF CHILDREN LIVE IN POVERTY IN
ANOTHER 25% ARE LIVING NEAR THE
POVERTY LINE.
AND WE DO KNOW THAT LEFT
UNTREATED TRAMMELL HAVE A
LIFELONG IMPACT ON THEIR BRAIN
DEVELOPMENT AND THAT OFTEN LEADS
TO CHRONIC HEALTH CONDITIONS AND
OTHER POOR OUTCOMES.
THAT ARE VERY COSTLY TO SOCIETY.
NATIONAL STUDIES FIND THAT 70%
OF FOSTER CHILDREN HAVE
SIGNIFICANT MENTAL HEALTH NEEDS
YET COMPARATIVELY FEW ARE BEING
MEANING FULLY SERVED.
AND OUR CURRENT SPECIALTY MENTAL
HEALTH SYSTEM --
AND I WOULD POINT OUT SOMETHING
THAT -- AT
THE LAST HEARING MUCH THERE WAS
MUCH DISCUSSION ABOUT
PENETRATION RATES --
THE PENETRATION RATE ON THE
DEFINITION OF IT IS ONE CONTACT
A YEAR AND THAT CONTACT COULD BE
AN ASSESSMENT.
AND THE FINDING THAT THE CHILD
IS NOT ELIGIBLE FOR ANY FURTHER
SERVICES.
SO THE STATE OF CALIFORNIA WORK
WITH ADVOCATES TO COME UP WITH
AN ENGAGEMENT TRAIT IT'S FIVE
CONTACTS YEAR.
AND IT REALLY REFLECTS MORE
MEANINGFUL ENGAGEMENT WITH THE
SYSTEM [inaudible]
I IN --
CALIFORNIA 36% OF FOSTER KIDS
STATEWIDE MEET THE ENGAGEMENT
RATE -- IT'S
DECLINING IT VERY SIGNIFICANTLY
FROM COUNTY TO COUNTY.
THAT'S COMPARED TO NATIONAL
STUDIES THAT SUGGEST THAT 70% OF
KIDS.
IN FOSTER CARE HAD SIGNIFICANT
BEHAVIORAL HEALTH NEEDS. FOR ALL
CHILDREN NOT JUST FOSTER%
CHILDREN FOR ALL CHILDREN ON
MEDI CAL THE SPECIALTY MAIL HELP
PENETRATION RATE IS ABOUT 4%.
THE ENGAGEMENT RATE IS ABOUT 3%
AND BOTH ARE DECLINING --
OFTEN MENTAL HEALTH SERVICES
HAVE BEEN SERVED UNDER
TRADITIONAL MEDICAL MODEL THAT
MY COLLEAGUES HAVE TALKED ABOUT
FOR KIDS IN THE CHILD WELFARE
SYSTEM IN KIDS OF EXPERIENCE
SIGNIFICANT TRAUMA.
THE FIFTY MINUTE OFFICE VISIT IN
A CLINICAL SETTING IS NOT WHAT
MAKES SENSE FOR THEM THEY MORE
OFTEN BENEFIT FROM SOCIAL MODEL
COMMUNITY AND HOME BASED
SERVICES THAT ARE DELIVERED IN
THE CONTEXT OF THE COMMUNITIES.
WHERE WE NOT JUST TREAT THE
NEEDS OF THE CHILD BUT WE
SIMULTANEOUSLY SUPPORT THE NEEDS
OF THE CARE GIVERS?
THERE ARE VERY FEW MENTAL HEALTH
SERVICES FOR CHILDREN UNDER THE
AGE OF EIGHT DESPITE WHAT WE
KNOW ABOUT THE IMPACTS OF TRAUMA
ON YOUNG DEVELOPING BRAINS.
SO FROM THAT STANDPOINT OF THE
SYSTEM THAT ENGAGES IN KIDS AT
ITS SUFFERED SIGNIFICANT TRAUMA
WHAT WE NEED --
OUR KID NEEDS KIDS NEED SERVICES
TIMELY.
I NEED SERVICES DELIVERED IN THE
CONTEXT OF THEIR FAMILIES AND
THEIR COMMUNITIES --
AND WE NEED SUPPORT FOR CARE
GIVERS SO THAT THEY CAN HELP
CHILDREN HE'LL NOT JUST THE
CLINICIAN --
THAT'S TREATING THEM.
AND WE NEED A FULL CONTINUUM OF
SERVICES EARLY INTERVENTION ALL
THE WAY TO ALTERNATIVES TO
HOSPITALIZATION.
THE GOOD NEWS IS WE KNOW MORE
ABOUT ADVERSE CHILDHOOD
EXPERIENCES AND TRAUMA WE KNOW
WHAT WORKS --
BASED ON DECADES OF RESEARCH
INCLUDING RESEARCH BY THAT
RECENTLY APPOINTED SURGEON
GENERAL WE KNOW A LOT ABOUT THE
IMPACT OF ACES --
WE KNOW THE WRAPAROUND PROGRAMS
WITH FAMILIES --
THAT WE WE SEE IN PLACES IN THE
STATE WORK FOR FOSTER KIDS WE
KNOW THAT PEER SUPPORT BASE
SERVICES THAT ARE OFTEN --
DELIVERED IN SCHOOL SETTINGS OR
OR IN HOME BASE SETTINGS OR OR
INTEGRATED WITH OTHER COMMUNITY
BASED CHILD SERVING AGENCIES
WORK -- YOU --
HEARD ABOUT SCHOOL BASED SO --
SERVICES IN MONTEREY COUNTY FOR
EXAMPLE YOU HEARD ABOUT SOME.
ON SERVICES THAT ARE BEING DONE
IN YOLO COUNTY WHICH IS IT DOING
EXCELLENT THINGS SO WE WE KNOW
WHERE THINGS WORK THE OTHER GOOD
NEWS IS THAT THE PST T. THE
FEDERAL ENTITLEMENT.
CAN COVER A MUCH BROADER ARRAY
OF SERVICES CONSISTENT WHAT WHAT
WITH WHAT WE KNOW KIDS NEED.
IT'S NOT CAPPED --
THE FEDERAL EXPECTATION IS THAT
ANY KID THAT'S ELIGIBLE RECEIVE
SERVICES.
AND CHILDREN UNDER A P. P. STT
ARE ENTITLED TO CONDITION FOR
WHICH THE CHILD MEETS MEDICAL
NECESSITY REGARDLESS OF WHETHER
IT'S CURRENTLY IN THE STATE PLAN.
AND PREVENTION IS EXPLICITLY AN
EXPECTATION IN THE FEDERAL
ENTITLEMENT.
SO HOW DO WE HOW DO WE GET THERE
FROM HERE --
OUR FIRST RECOMMEND A DACIAN IS
THE STATE CAN BE MORE
INTENTIONAL BALL INTENTIONAL
ABOUT FULLY ARTICULATING THE
ARRAY OF SERVICES.
THAT WE ALL EXPECT TO SEE IF
WE'RE GOING TO BE FOR FILLING
THE FEDERAL ENTITLEMENT --
WE NEED TO EXPAND A REYES --
TO FROM EARLY PREVENTION --
THROUGH ALTERNATIVES TO
HOSPITALIZATION AND WE SHOULD
THINK ABOUT WAYS TO CODIFY THOSE
EXPECTATIONS IN ALKHAN
MONITORING SYSTEMS AND PERHAPS
AND STATUTES AND REGULATIONS.
WE DESPERATELY NEED TO MODERNIZE
THE DEFINITION OF MEDICAL
NECESSITY. ONE REASON GAUGE
MEANT RATES AND PENETRATION
RATES ARE SO OUR LOW IS THAT WE
HAVE A DEFINITION OF MEDICAL
NECESSITY THAT IT'S TOO OFTEN A
BAR NOT MATT.
MY CHILDREN HAVE EXPERIENCED
SIGNIFICANT TRAUMA AND
MODERNIZING OUR NOTIONS OF WHAT
IS MEDICAL NECESSITY SO THAT WE
CAN LEARN FROM DECADES OF
RESEARCH ABOUT TRAUMA I THINK
WOULD.
WOULD EXPAND SERVICES TO A
BROADER ARRAY OF OUR OF OUR
POPULATION.
THE LEGISLATURE'S CREATED
BUILDING BLOCKS TO DO JUST THAT
YOU PASSED AB THREE FORTY TO
REQUIRE SCREENING FOR TRAUMA FOR
EVERY KID.
IN MEDI CAL AND YOU PASSED SB
TWELVE EIGHTY SEVEN AS MY
COLLEAGUE POINTED OUT WHICH
REQUIRES THE STATE TO UPDATE THE
DEFINITION OF MEDICAL NECESSITY --
I THINK AS A STATE WE NEED TO BE
MORE INTENTIONAL INTENTIONAL
ABOUT PROVIDING TRAINING AND
TECHNICAL ASSISTANCE TO COUNTY
SOME PROVIDERS.
SO WE COULD TAKE THOSE EXCELLENT
POCKETS AND AND WHAT WE KNOW
THAT WORKS.
AND MAKE MAKE IT BROADLY X. AND
IN FACT FULFILL THE INTENTION
AND THAT'S THE SPIRIT IN THE LAW.
THAT -- THAT
CHILDREN WHO ARE ENTITLED TO
THOSE SERVICES RECEIVE THEM MY
COLLEAGUES HAVE TALKED ABOUT
WORKFORCE DEVELOPMENT AND I
WON'T -- SAY
ANYTHING MORE ABOUT THAT HERE
OTHER THAN THIS IS AN ISSUE NOT
JUST ABOUT CHILD PSYCHIATRISTS.
THAT IS THAT THAT IS AN AREA
WHERE WE NEED TO IMPROVE THE
WORK FORCE BUT WE NEED TO
IMPROVE THE WORK FORCE FOR PARA
PROFESSIONALS PSYCHIATRIC NURSES
PURE PARTNERS AND OTHER
COMMUNITY BASED PROVIDERS.
PERHAPS MOST SIGNIFICANTLY I
THINK WE CAN DO A BETTER JOB AND
HOW WE USE DATA TO OVERSEE AND
CONTINUALLY IMPROVE THE QUALITY
OF OUR PROGRAMS.
IN THE CHILD WELFARE PROGRAM AND
SOON IN THE COW WORKS PROGRAM WE
HAVE A DATA DRIVEN OUTCOME BASED
OVERSIGHT SYSTEM --
THAT WE CAN LEARN FROM.
IF WE ASK HOW DO WE KNOW HOW THE
KIDS ARE DOING IN THE CHILD
WELFARE SYSTEM.
AT ANY MOMENT YOU CAN LOG ONTO A
PUBLICLY AVAILABLE WEBSITE
MANAGED BY UC BERKELEY AND YOU
CAN SEE BY QUARTER BY COUNTY.
HOW KIDS IN THE CHILD WELFARE
SYSTEM ARE DOING ARE THEY BEING
REUNIFIED TIMELY ARE THEY BEING
REVIEW ARE THEY BEING RE ABUSED
WHILE THEY'RE IN CARE?
EITHER ADOPTIONS BEING PERFORMED
IN A TIMELY BASIS OUR COUNTY
WORKERS MEETING THEIR MONTHLY
VISITATION REQUIREMENTS.
THAT INFORMATION IS AVAILABLE BY
COUNTY BY QUARTER IN ITS
STRATIFIED BY A WHOLE HOST OF
DEMOGRAPHIC CHARACTERISTICS --
OF OF YOUTH.
BOMB THAT THE AVAIL QUALITY
IMPROVEMENT YOU DON'T PENALIZE
COUNTIES YOU EXPECT THAT
COUNTIES USE THAT DATA FOR SELF
REFLECTION AND SELF IMPROVEMENT.
AND THAT CONTINUOUS GUADALUPE
QUALITY IMPROVEMENT APPROACH
THAT'S NOT PUNITIVE --
BUT BUT AS I SAID IT'S ABOUT
QUALITY IMPROVEMENT I THINK
THERE ARE LESSONS THAT WE CAN
LEARN TO BUILD ON WHAT DIRECTOR
CANS TALKED ABOUT AS EXISTING
STATE PROGRAMS. TO BETTER USE
THE DATA THAT WE HAVE --
SOME SOME --
OUTCOME MEASURES THAT WE MIGHT
THINK ABOUT IMPROVE SCHOOL IN
BAY AT PERFORMANCE.
OUT EDUCE SUICIDE RATES FOSTER
CHILDREN REUNIFYING WITH THEIR
FAMILIES.
I WOULD LIKE TO SECOND THIRD AND
FOURTH THAT THE NEED FOR
SIMPLIFICATION AND BILLING OUR
COLLEAGUES ARE SPENDING WAY TOO
MUCH TIME.
ON A REALLY BYZANTINE REALLY
UNPRODUCTIVE --
BILLING --
BILLING SYSTEM WE NEED TO
MAXIMIZE THE RECEIPT OF FEDERAL
FUNDING UNDER EP STT ITS BROAD --
IT SUPPORTS MANY THINGS --
THAT THAT MOST THINGS THAT CHOI
SHOULD EXAMINE THE X. THAT --
SUFFICIENCY OF FUNDING IF THERE
ARE GAPS BETWEEN WHAT CHILDREN
NEED AND WHAT WE HAVE REASONABLY
AVAILABLE THE STATE SHOULD THINK
ABOUT WAYS TO WORK WITH COUNTIES
TO FILL IN THOSE GAPS.
AND FINALLY WE NEED TO THINK
ABOUT RISK SHARING --
IF WE SIMPLIFY BILLING AND WE DO
BETTER TRAINING AND TECHNICAL
ASSISTANCE ON HOW TO DO BILLING
AND HOW TO COMPLY WITH AUDITS IN
AN INCREASINGLY CAPRICIOUS
FEDERAL GOVERNMENT NONE THE LESS --
MAKES AUDIT EXCEPTIONS AND
COUNTIES HAVE DONE THE RIGHT
THING.
I'M AND WE HAVE IN GOOD FAITH
DELIVERED IMPORTANT SERVICES AND
WE GET INAPPROPRIATE LEADING --
BY A FEDERAL GOVERNMENT THAT HAS
AN ANTI CALIFORNIA BIAS --
THE COUNTY SHOULD BE INDEMNIFIED
FROM THE RISK OF THAT IF IF IF
THE EXPECTATION ON COUNTIES IS
BE MORE ACCOUNTABLE ABROAD IN
THE RAY OF SERVICES.
I MEAN REALLY STEP UP UP THE
DELIVERY THE STATE REALLY NEEDS
TO HAVE OUR BACK --
IN TERMS OF MAKING SURE THAT WE
ARE NOT INAPPROPRIATELY.
PENALIZED ON BECAUSE THAT'S
FUNDING THAT COULD BE USED FOR
SERVICES.
THANK YOU VERY MUCH.
THANK YOU VERY MUCH --
QUESTIONS.
THANK YOU FOR YOUR PRESENTATIONS --
I KNOW I KNOW THAT --
DEFINITION MEDICAL NECESSITY IN
THE PST TEASE CAM OUT BUT QUITE
FREQUENTLY AND ALL YOUR
TESTIMONY EVEN THE PREVIOUS
TESTIMONY.
I KNOW WE HAD SB AS A TWELVE
EIGHTY SEVEN WHICH SETS A GOAL
OF THE STAB WISHING YOU
DEFINITIONS BY TWENTY TWENTY TWO
IS THERE A WAY WE COULD DO THAT
FASTER ARE.
KEYS TO I MEAN I'M HERE I WILL
SAY LIKE THIS IS A BIG PROBLEM
SO.
WHAT WE DO TO MOVE ON IT MORE
QUICKLY WE DID PASSED
LEGISLATION LAST YEAR?
IF I COULD I'D JUST LIKE TO
CLARIFY THE SINS WERE THE
SPONSORS OF THAT LEGISLATION
THAT.
THE GOAL OF THAT LAW WAS TO
ENSURE THAT STATE LAW WAS
CONSISTENT WITH THE FEDERAL LAW
WHICH IS.
ENOUGH YOU KNOW US CODE --
THAT REGULATIONS AND GUIDANCE
ARE UPDATED TO BE CONSISTENT
WITH THAT BECAUSE AS I MENTIONED
EARLIER A LOT OF OUR REGULATIONS
ARE VERY OLD AND CONVOLUTED AND
THEY ADD IN.
A WHOLE LAYER OF COMPLICATION ON
TOP OF THE FEDERAL LAW WHICH IS
UNNECESSARY AND CREATES --
BURDEN IN ACCESSING CARE IF
WE'RE GONNA BROADEN IT BE ON THE
FEDERAL LAW THAT WOULD OBVIOUSLY
BE ON THE STATE TO PAY FOR BUT I
YOU KNOW CERTAINLY I'M NOT
STANDING IN THE WAY OF THAT.
PLAN.
OKAY SO GIVEN THE FACT WE PASS
IT ON TO RECALL EXACTLY THE
DETAILS I MEAN SO WHAT NGUYEN.
SO I ASSUME THAT THE THE SOURCE
WEEKS AWAY SOME OLD STATE
REGULATIONS AND SO FORTH SO THAT
PLACE RIGHT NOW OR WHAT WHAT
WENT WENT WENT IS CHANGE GONNA
HAPPEN.
WELL THE LAWS IN PLACE NOW RIGHT
THE REGULATIONS CAN BE
ELIMINATED NOW AND WE'VE ASKED
THE DIRECTOR TO DO THAT BECAUSE
THE IT GIVES THEM THE AUTHORITY.
I'M NOT LISTENING THE APA TO
ISSUE GUIDANCE BEFORE THE
REGULATIONS ARE ISSUED IN TWENTY
TWENTY BY TWENTY TWENTY TWO IS
TO MENTION.
SO THAT COULD BE DONE TODAY
THROUGH A A GUIDANCE ALL COUNTY
LETTER OR MENTAL HEALTH.
S. CDS LETTER SUCH.
YES DR I ALSO THINK THAT IN
ADDITION TO MODERNIZING THE
DEFINITION AND REGULATIONS WE
REALLY NEED TO THINK ABOUT
TRAINING AND TECHNICAL
ASSISTANCE BECAUSE WE DO HAVE A
SITUATION WHERE THERE'S A
SIGNIFICANT AMOUNT OF VARIATION
ABOUT WHETHER A SIMILARLY
PRESENTING CHILD.
WOULD MEET MEDICAL NECESSITY IN
ONE COUNTY AS OPPOSED TO ANOTHER
COUNTY.
AND SO THAT'S NOT BECAUSE
COUNTIES DON'T WANT TO SERVE
KIDS -- IT'S
DEFINITIONS HAVE NOT BEEN THAT
WE NEED TO BE INTENTIONAL AS A
STATE WITH A COUNTIES IN
PARTNERSHIP WITH YOU --
TO TO EXPAND ON TRAINING AND
TECHNICAL ASSISTANCE TO MAKE
MORE CONSISTENT THAT --
THE RESULTS OF THE APPLICATION
OF THE MEDICAL NECESSITY TEST.
OKAY AND I KNOW --
THE DIRECTOR OF DHS IS NOT ON
THE PANEL BUT I DO SEE HER IN
THE AUDIENCE SO HOPEFULLY WE CAN
GET A TIME LINE ON WHEN WE WILL.
FIX THOSE REGULATIONS.
AND I UNDERSTAND IT COULD BE
DONE VERY SHORTLY.
ACCORDING TO LAW THAT WE PASSED
OKAY -- SEND
A REVIEW.
THANK YOU.
THANK YOU FOR ALL THE
INFORMATION YOU PROVIDED --
I HAVE A COUPLE OF QUESTIONS I
KNOW I'VE HEARD IT FROM ALL OF
YOU KNOW ARE YOUR PRESENTATIONS
WORKFORCE IS AN ISSUE.
I'M JUST WONDERING YOUR OPINION
WHAT IS THE BIGGEST ISSUE AS IT
PERTAINS TO ATTRACTING AND
RETAINING --
HEALTH PROFESSIONALS AND WHAT
CAN WE DO AS A LEGISLATURE. TO
TO MAKE THAT BETTER AND ATTRACT
MORE PEOPLE IN THAT PROFESSION.
WELL IT'S REALLY THE NUMBER ONE
ISSUE FOR OUR MEMBERS RIGHT NOW
ATTRACTING AND RETAINING --
FOLKS IN THE AD IN THE PAPER
HEALTH WORKFORCE I'M IN ONE ONE
STRATEGY IS REALLY TO INCREASE
THE NUMBER OF LOANS TO INCREASE
THE NUMBER I HAVE --
SCHOLARSHIPS --
AND STATEMENTS THAT ARE OFFERED --
IN A DISH TO BOLSTER OUR
BEHAVIORAL WORK FIRST PIPELINE
I'M STARTING IN HIGH SCHOOL
REALLY EDUCATING FOLKS ABOUT
WHAT DOES THIS MEAN AND ALSO --
ADDING TO THE PIPELINE BY
ALLOWING PEERS AND OTHERS
PROMONTORIES WERE MENTIONED
EARLIER --
SO IT'S REALLY THAT PIPELINE
APPROACH THAT YOU KNOW
STRENGTHENS AND THEN --
PROVIDING THE INCENTIVES --
THAT WE ALL TEND TO FOCUS ON A
LOT -- IN
ADDITION WHEN WE THINK ABOUT --
ALLIED HEALTH CARE WORKERS WE
NEED.
TO PROVIDE RAINING FOR THEM AS
WELL TO BE ABLE TO ASSIST US IT
REALLY DOES HAVE TO BE A TEAM
APPROACH AND WE TALK ABOUT
INTEGRATED CARE A LOT --
BUT WE REALLY HAVE TO PUT OUR
MONEY WHERE OUR MOUTH AS ALSO
WHEN WE LOOK AT RESIDENCY SLOTS
I KNOW THAT THOSE CAN BE LIMITED
IN TRAINING SLOTS FOR ALL TYPES
OF DIFFERENT PROFESSIONALS WE
TEND TO JUST LOOK AT MEDICAL
PROFESSIONALS PSYCHIATRIST CHILD
PSYCHIATRISTS --
IN PARTICULAR AND NOT
WITHSTANDING HAT A VERY
IMPORTANT AREA TO FOCUS ON I
THINK WHAT WAS MENTIONED EARLIER
THOUGHT THERE ARE POLICIES
ACROSS THE BOARD WITH IT --
BE HERE FOR HEALTH WORK FOR SO
WE NEED TO LOOK AT THE COMMUNITY
COLLEGES WE NEED TO LOOK AT THE
UC AND CSU IS IN THE TRAINING
PROGRAMS THAT WE HAVE AND IF WE
HAVE ENOUGH SLOTS FOR FOLKS.
SO GET RELIEF FOR ME BOILS DOWN
TO THAT PIPE --
ON THE OUTCOME [inaudible]
THANK YOU.
AND THAT THAT WORKFORCE
COMMISSION ACTUALLY TALKED ABOUT
A TEN YEAR PLAN ESSENTIALLY --
PRETTY.
EXTENSIVE PLANTED TO BOLSTER
WORKFORCE A LOT OF THIS
BEHAVIOUR AS BASED ON BEHAVIORAL
HEALTH NEEDS AND AND GRAB THE
OBVIOUSLY REALLY CRITICAL --
LISTENING TO YOUR YEAR THERE'S
COMMON THEME AMONG YOUR
PRESENTATIONS HERO
INEFFICIENCIES AND CHALLENGES
WITH.
OUR HAVING TO BUILD HEARD IN THE
EARLIER SESSION TO THAT --
SO MUCH SO MUCH RESOURCES ARE
TIED UP IN ADMINISTRATIVE COSTS
THAT THERE I THINK THE FROM --
MISS LARSEN WE HEARD THAT --
30% ADMINISTRATIVE COST OR
COUNTIES TO AND MRS PROGRAMS
PLUS ANOTHER 20% BASED ON ON ON
SERVICES THAT ARE DENIED --
AND SO NOW YOU'RE ONLY HOW THESE
KINDS OF THINGS ARE EXTREMELY
EXTREMELY FRUSTRATING --
AND GIVE US YOU KNOW GIVE GIVE
GIVE A LOT OF HEARTBURN FOR UP
HERE PERSONALLY --
ONE OF THINGS THAT --
MISTER MAC AND AND ONE QUESTION
I HAD FOR YOU BECAUSE I I WILL
GET QUESTION YOU GUYS YOU TO
ANSWER QUESTIONS I WAS LOOKING --
FOR AS FAR AS IN THINGS THAT ARE
THAT ARE CRITICAL AND AND AND
WHAT CAUGHT ME WILK WHAT I
WONDERED AS WE START LOOKING
SOMEWHERE BACKGROUND INFORMATION
WITH MISTER MECCA WE TALKED UP
PENETRATION ENGAGEMENT RATES ON
THEIR THEIR LOW --
BUT THEIR DECLINING.
SO WHY ARE THEY DECLINE THERE
ARE THERE LOW IN THEIR DECLINING
FURTHER WIRE THEY DECLINING --
I DON'T HAVE THE DEFINITIVE
ANSWER TO THAT QUESTION WE'VE
HEARD THAT THAT TO SOME DEGREE --
CHILDREN ARE BEING SERVED --
BY PROP SIXTY THREE SO CONNIE'S
COUNTIES ARE USING MENTAL HEALTH
SERVICES ACT MONEY --
AND NOT E. PST T. --
I DON'T KNOW HOW SORT OF WIDELY
THAT IS THE CASE --
BUT IT'S IT'S DEFINITELY --
TROUBLING PHENOMENON.
SO THE BEES SO YOU SO YOUR YOUR
FEELINGS ARE BEING POTENTIALLY
BEING SERVICE SOMEWHERE ELSE.
THE INCIDENCES IT ISN'T GOING
AWAY RIGHT AND I DO I DO THINK
IT GETS TO TRYING TO FIND
STRATEGIES. TO MAKE MORE.
CONSISTENT ACROSS COUNTIES WHEN
CAN USE THE PST IF YOU.
IF YOU PRESENTED CHILD TO
EXCELLENT COUNTY ADMINISTRATORS
IN BEHAVIORAL HEALTH --
YOU MIGHT GET DIFFERENT MEDICAL
NECESSITY FOR PARTICULARLY PST
T. SERVICE --
AND IT'S IT'S NOT A SIMPLE THING
AND I DON'T THINK THE GUIDANCE
FROM THE FEDERAL GOVERNMENT HAS
BEEN PARTICULARLY CLEAR --
BUT THAT ENTITLEMENT IS
EXTREMELY BROAD.
AND I DO THINK WE HAVE A SICK WE
HAVE A TERRIFIC OPPORTUNITY TO
WORK TOGETHER TO SAY WHAT DO.
WHAT DO WE IN CALIFORNIA BELIEVE
HE PST T. REQUIRES AND IF WE
DON'T SEE THIS SET OF SERVICES
EVERYWHERE WE GO?
AND IF A CHILD IN. TO HIM --
AND THEN A CHILD IN KERN WHO
KIND OF PRESENT IN THE SAME WAY
WE GET.
YOU KNOW REASONABLY SORT OF CALM
AND DIAGNOSIS IN THE DEFINITION
OF MEDICAL NECESSITY IN WHAT
WHAT SHOULD THEY GET THERE'S A
LOT OF ROOM I THINK --
IN PARTNERSHIP WITH THE COUNTIES
IN THE STATE TO IMPROVE
CONSISTENCY AND TO BROADEN --
ACCESS TO THE ENTITLEMENT AND TO
THE EXTENT THAT THE FEAR FEDERAL
AUDITS IS --
A CONCERN ABOUT YOU KNOW.
WE WANT TO PUSH THE ENVELOPE BUT
WHAT HAPPENS IF I HAVE TO SET
ASIDE A MILLION DOLLARS IN MY
BUDGET JUST BECAUSE I'M ASSUMING
I'M GONNA GET AUDIT EXCEPTIONS --
WE DO HAVE TO WORK WITH OUR
FEDERAL PARTNERS --
AND TO THE EXTENT THAT WE
BELIEVE IN CALIFORNIA THAT
CHILDREN SHOULD BE GETTING STUFF --
AND THAT THE PST T. ON THE CLAIM
AT AND THE FEDERAL GOVERNMENT
SAYS AFTER THE FACT SOMETIMES
MANY YEARS AFTER THE FACT NO
SORRY.
YOU SHOULD HAVE CLAIM THAT --
THE STATE NEEDS TO SHARE RISK
WITH US --
FOR DOING SO.
JUST ONE THING I WOULD ADD TO
WHAT FRANK SAID IS THAT YOU KNOW
THERE'S VERY INCONSISTENT --
PRACTICES AMONG COUNTIES NUND
THE INVESTMENT IN CHILDREN
SERVICES FROM THE REALIGNMENT
DOLLARS USE FOR CHILDREN AND FOR
ADULTS SOME MORE PLACES MORE
MONIES GOING TO ADULTS IF YOU
LOOK AT THE AMOUNT SPENT PER
CHILD IT'S VERY DIFFERENT IN
DIFFERENT PLACES DIFFERENT
COUNTY SO.
I THINK THAT INVESTMENT IS AN
ISSUE AND NEEDS TO BE LOOKED AT
IT SHOULD BE.
YOU KNOW BECAUSE A REALIGNMENT
THERE'S A SENSE THAT THESE ARE
THE COUNTY DOLLARS THAT THEY
NEED TO PROTECTIONS FOR SO THAT
THEY DON'T RUN OUT.
AND THAT MEANS THAT THERE'S A
BIT AT THERE'S TRIAGE BEING OF
OF DELIVERY OF SERVICES
INCLUDING TWO CHILDREN
REGARDLESS THE ENTITLEMENT IN
THE REGARDLESS THAT YOU COULD
GET ADDITIONAL FUNDS.
BEYOND THE CAPITATE YOU KNOW
BEYOND WHAT'S PROVIDES A
REALIGNMENT IF YOU NEEDED IT
JUST THAT THERE'S A PROCESS TO
DO THAT AND I THINK A LOT OF
COUNTIES JUST. TO HOLD ON TO
THAT AND BE CONSERVATIVE.
EXCEPT AS THINGS THAT ARE REALLY
BROADER ARE A POTENTIALLY
OBVIOUSLY IT TO IT A DOUBLE EDGE
SWORD AND AND THAT WELL I DON'T.
WANT.
TO BOX PEOPLE IN.
BROAD DOES BROAD DEFINITIONS
CREATE ARE OBVIOUSLY CREATED
SOME MAJOR CHALLENGES FOR PEOPLE
SO.
THANK YOU VERY MUCH FOR YOUR
TIME WITH THIS PROJECT ON WE
HAVE OUR OUR THIRD PANEL WERE
ACTUALLY BREAKING INTO AN ON
SORRY NO NO THAT'S OKAY.
I HAVE ONE MORE QUESTION AND
THIS IS JUST BASED ON A PERSONAL
EXPERIENCE AND I'M JUST CURIOUS
TO SEE A FONG.
IF YOU CAN ANSWER THIS QUESTION --
YOU KNOW I HEARD YOU SAY EARLIER
THAT THERE IS A LACK OF SERVICES --
MENTAL HEALTH SERVICES UNDER THE
AGE OF EIGHT SO I USED TO HAVE A
STUDENT WHO YOU WHO WAS
SCHIZOPHRENIC BASED ON WHAT
EVERYONE WAS TELLING ME BUT SHE
WAS CAUGHT IN THE MIDDLE WERE I
WAS TOLD THAT SHE WAS TOO YOUNG
TO BE DIAGNOSED AND AND QUALIFY
FOR SERVICES --
CAN YOU TELL ME STILL AGE IS A
OF THE REQUIREMENT FOR AGE IS
STORED ISSUE AS IT PERTAINS TO
DIAGNOSIS AND GETTING THOSE
SERVICES.
I MEAN I CAN TELL YOU FROM
EXPERIENCE THAT I MEAN THERE ARE
CLINICIANS IN THE AUDIENCE I'M
SURE THEY CAN ANSWER THIS BUT I
HAVE NOT SEEN A LIMITATION OF
AGE BEING A BASIS FOR NOT GIVING
IT DIAGNOSIS I'VE SEEN IT AT AGE
THREE I'VE SEEN IT MANY AGES.
SO I DON'T THINK THAT THAT ALONE
IS A CRITERIA FOR NOT SERVING A
CHILD NO MATTER WHAT THE AGE.
HOWEVER I'M I'M SURE THAT THERE
ARE CLINICAL FACTORS IN WHICH
YOU DON'T WANT TO GIVE
UNNECESSARILY OR INAPPROPRIATELY
A DIAGNOSIS AT A EARLY AGE UNTIL
YOU HAVE ENOUGH.
EVIDENCE THAT THEY MEET THE DS
I'M PREGNANT CRITERIA FOR THAT
PARTICULAR DIAGNOSIS BUT THERE
ARE A LOT OF DIAGNOSIS THAT ARE
DELIVERED THAT ARE LIKE NOT
OTHERWISE SPECIFIED OR NOT.
REALLY SURE WHAT'S GOING ON KIND
OF THING.
WHICH IS BASED ON THE
INFORMATION YOU SEE THAT THE
TIME THEY SAID SHE WAS TOO YOUNG
TO BE DIAGNOSED THAT SOMETIMES
THEY BELIEVE IT'S BEHAVIORS THAT
KIDS GROW OUT OF FUND WE WERE
CERTAIN WHAT SHE HAD IT WAS VERY
CLEAR.
BUT SHE COULDN'T GET SERVICES
AND MOM WAS STUCK IN THE MIDDLE
AS HE SAID JUST BEING PUSHED
AROUND FROM --
CLINIC TO CLINIC AND KNOW WHAT
NOBODY WOULD HELP OR SO I WAS
JUST WONDERING.
IF IF YOU KNOW BUT THANK YOU A.
S. YOU ANSWER MY QUESTION.
THANK YOU VERY MUCH.
SO WE'RE BREAKING OUR NEXT PANEL
INTO IN A IN A BE --
THERE'S A PART IT'S A VERY
PRETTY LARGE PANEL SO WE HAVE --
SEVEN SEVEN SPEAKERS ALL
TOGETHER --
OUR FIRST FOUR SPEAKERS --
SERRA AND THIS IS ON MENTAL
HEALTH COVERAGE MEDI CAL MEDICAL
MET MENTAL HEALTH COVERAGE FOR
ADULTS OUR FIRST --
PANELS WILL BE SIERRA GAVIN THE
CHEAP BEHAVIOR OFFICER OF
COMMUNICATOR HEALTH CENTERS IN
AN FQHC IN YOLO COUNTY.
MY OLD MAN WHO WAS THE CEO OF
HEALTH PLAN OF SAN MATTEO.
SIR OUR QUIZ TO HIS FIGHT --
VP OF ACCOUNT PARTNERSHIPS WOULD
BE CAN HELP OPTIONS OF
BEHAVIORAL HEALTH PLAN.
AND DOCTOR KEY ANDREA A BUNCH
WHO IS A PSYCHOLOGIST WITH THE
AND ALASKAN SHOULD TRY TO KEEP
YOUR COMMENTS TO FIVE MINUTES IF
POSSIBLE PLEASE SO THEY HAVE A
WE STILL HAVE.
FIVE MORE SPEAKERS AND PUBLIC
COMMENTS SO I APPRECIATE THAT
THE DISCUSSIONS HAVE BEEN GREAT
AND AND THE REALLY VALUABLE AND
I THINK IT ILLUSTRATES THE THE
CHALLENGES THAT WE FACE AND AND
AND CERTAINLY SET THE STAGE FOR
FUTURE HEARINGS ON THIS ISSUE SO --
SO THANK YOU VERY MUCH AND SO ON
SERRA GAVIN FIRST PLEASE.
THANK YOU.
SOME MEMBERS MY NAME IS SARAH
GAVIN I AM THE CHIEF BEHAVIORAL
HEALTH OFFICER AT COMMUNICATOR
HEALTH CENTERS.
COMMUNICATOR IS THE LARGEST
FEDERALLY QUALIFIED HEALTH
CENTER IN YOLO COUNTY RIGHT NEXT
DOOR AND I AM ALSO A LICENSED
MARRIAGE AND FAMILY THERAPIST
AND A LICENSED PROFESSIONAL
CLINICAL COUNSELOR.
AND IT PROVIDED DIRECT SERVICE
AND THE PROVISION OF SERVICES
AND ADDICTION TREATMENT AND
MENTAL HEALTH FOR FOURTEEN YEARS.
ELEVEN OF WHICH HAVE BEEN IN AN
FQHC SETTING SO MANY OF THE
COMPLICATED SYSTEM SO WE'RE
TALKING ABOUT TODAY I PROVIDED
DIRECT SERVICE IN THOSE
COMPLICATED SYSTEMS.
COMMUNICATOR IS A VERY UNIQUE
FQHC MOST FQHCS ARE PROVIDING --
THE PROVISION OF MENTAL HEALTH
SERVICES IN THE MILD TO MODERATE
CONTINUUM AND COMMUNICATOR AS
CONTRACTED WITH A YOLO COUNTY TO
PROVIDE THE FULL CONTINUUM OF
CARE FOR SPECIALTY MENTAL HEALTH.
AND DRUG MEDICAL SERVICES AND WE
ARE THE LARGEST DRUG MEDI CAL
PROVIDER IN YOLO COUNTY
CURRENTLY.
A CALIFORNIA'S AND MENTAL HEALTH
AND SUBSTANCE USE SYSTEM IS VERY
COMPLICATED AND WE HAVE PAIRED
ONE OF THE MOST COMPLICATED
SYSTEMS TO NAVIGATE WITH
PATIENTS LEAST LIKELY AND ABLE
TO NAVIGATE THEM.
PATIENTS THAT ARE SUFFERING OF
COURSE FROM ADDICTION --
ACTED IN A HOUSE OF SYMPTOMS
TRAGEDY AND AND TRAUMA AND
ISSUES RELATED TO POVERTY AND
STRESSORS AND TRANSPORTATION
ISSUES AND LANGUAGE BARRIERS AND
WE INVITE THEM INTO A SYSTEM OF
CARE.
AND WE MAKE IT VERY NUANCED AND
COMPLICATED FOR THEM TO BE ABLE
TO MANAGE IT AND I FEEL
PRIVILEGED TO BE ABLE TO WORK IN
AN FQHC SETTING FOR FQHCS CAN
SIMPLIFY THE PROCESS FOR CLIENTS
NAVIGATE CARE WE CAN.
OFFER SERVICES IN A D. SIGMA
TIES SETTING IN A WAY IN A VENUE
THAT CAN OFFER MOST THE SERVICES
UNDER ONE ROOF SO WE'RE ABLE TO
PROVIDE WARM HAND OFF AND LINK
PEOPLE DIRECTLY TO CARE.
SO WE DON'T HAVE TO REFER OUT IN
MOST CASES --
AND HELP THEM FIGURE OUT ANOTHER
CLUNKY SYSTEM.
AND SO IF OF TO WHICH THESE ARE
ONE OF THE I THINK MY MOST
PERFECT VENUES PROVIDING A FULL
CONTINUUM MENTAL HEALTH AND
SUBSTANCE USE SERVICES --
WHY AREN'T MORE FQHCS PROVIDING
CARE IN THE SYSTEM SO I'D LIKE
TO SHARE THAT THERE'S NOT MANY
FQHCS THAT ARE PROVIDING THIS
LEVEL OF CARE IN THE COMMUNITY?
AND I'D LIKE TO SHARE OF THREE
TOP REASONS WHY --
FIRST AS I MENTIONED AND IF
YOU'RE FAMILIAR WITH FQHCS WE
HAVE AN INTEGRATED SYSTEM IN
PRIMARY CARE AND DENTAL AND
COMPREHENSIVE PERINATAL SERVICES.
AND IT'S A HUGE BENEFIT FOR OUR
COMMUNITY AND OUR CLIENTS.
UNFORTUNATELY --
AND THERE'S BEEN ALSO LOTS OF
CONVERSATION TODAY ABOUT THE
BENEFITS OF INNER --
WOVEN OF PRIMARY CARE WITH
SUBSTANCE USE AND MENTAL HEALTH
SERVICES AND WHAT HAVE
BENEFITTED IS THE PATIENTS ARE
ACCESSING CARE.
UNFORTUNATELY FOR OF TO WHICH
YOU TO PARTICIPATE IN AS MODELS
TO CARE THE STATE HAS ACTUALLY
TAKEN THE POSITION THAT IN ORDER
FOR FQHCS TO PROVIDE THIS CARE
WE HAVE TO COMPLETELY.
SILO THE FQHC SIDE AND THE
SUBSTANCE USE AND SPECIAL TO
MENTAL HEALTH SIDE --
WHICH REALLY IS IN DIRECT
CONTRAST WITH SOME OF THE WORK
THAT WE'RE REALLY TRYING TO
ACHIEVE AND THE AND THE MOVE
THAT WE'RE TRYING.
TO MOVE FORWARD AND THE SECOND
PIECE AND I THINK THIS IS I'M
JUST ECHOING WHAT'S ALREADY BEEN
SAID IS THE ADMINISTRATIVE AND
DOCUMENTATION REQUIREMENTS FOR
SPECIAL TO MENTAL HEALTH AND
DRUG MEDI CAL OR PRETTY ONEROUS.
BURDEN SOME HAVING BILL THEM
MYSELF -- IT
AT OUR HEALTH CENTER IN SPECIAL
TO MENTAL HEALTH ON AVERAGE
CLINICIANS SPEND 40% OF THEIR
TIME CLINICIANS BEHAVIORAL
HEALTH QUESTIONS --
SPENT 40% OF THEIR TIME MANAGING
THE ADMINISTRATIVE AND
DOCUMENTATION STANDARDS OF CARE
AND THAT'S NOT INCLUDING THE
ADMINISTRATIVE STAFF MANAGED
JUST ALLOWANCES AND AND THE
DOCUMENTATION ITSELF SO.
WHEN YOU THINK ABOUT IN
CALIFORNIA THAT WE HAVEN'T
ACCESS TO CARE ISSUE FOR MENTAL
HEALTH AND THEN WE'RE TAKING
QUALIFIED HEALTH PROFESSIONALS
WHO ARE SEEING ARE ARGUABLY MOST
VULNERABLE PATIENTS OUR
COMMUNITY?
CHILDREN WITH --
SPECIALLY MENTAL HEALTH NEEDS
AND SUBSTANCE USE NEEDS AND WE
ARE CARVING OUT 40% OF THEIR
TIME IN ORDER TO PROVIDE CARE.
WE ALSO HAVE A HUGE WORKFORCE
CHALLENGE IN FIELD OF BEHAVIORAL
HEALTH AND THE NUMBER ONE REASON
I HEAR A CLINICIAN THAT WANTS TO
BE TRANSFERRED TO A DIFFERENT
DEPARTMENT.
OR TO LEAVE A NONPROFIT WORKING
TIME STAND MORE QUALIFIED MENTAL
HEALTH CLINICIANS AND IT'S
ESPECIALLY TRAGIC TO LOSE AND
THE PAPERWORK.
AND LASTLY ONE OF THE ON GOING
CHALLENGES WE HAVE IS IN ORDER
FOR US TO PARTICIPATE IN THESE
COUNTY --
FUNDED A CARVE OUT PROGRAMS IS
WE HAVE TO HAVE A CONTRACT WITH
THE COUNTY AND WE'RE LUCKY TO
HAVE ONE AND WE HAVE TO THEN RE
APPLY THROUGH A COMPETITIVE BRED
PROCESS EVERY THREE YEARS.
IN ORDER TO CONTINUE TO PROVIDE
DRUG MEDI CAL AND SPECIAL TO
MENTAL HEALTH SERVICES SO YOU
CAN IMAGINE THAT MAKES IT
EXTREMELY CHALLENGING TO BUILD
AND INVEST IN A STABLE PROGRAM
ONE EVERY THREE YEARS YEARS IT
COULD ESSENTIALLY RESET.
SO FOR THOSE REASONS --
MANY OF COMMITTEES ARE NOT
PARTICIPATING IN THE SERVICES ON
THAT WOULD BE A HUGE BENEFIT FOR
OUR COMMUNITY AND ACCURATE SHE'S
ARE REALLY EXPERTS IN PROVIDING
INTEGRATIVE CARE.
ON HAND AND HAVE EXPERTISE IN
PROVIDING CARE THE MOST
DISENFRANCHISED COMMUNITY
MEMBERS AND OUR COMMUNITY FEELS
VERY SAFE COMING INTO AN FQHC
SETTING TO TO RECEIVE CARE.
A FEW RECOMMENDATIONS WE HAVE IN
RESPONSE TO THAT IS --
ONE IS -- TO
LOOK CAN THIS IS NOT NEW BUT
LOOK AT THE BIFURCATED SYSTEM
AND A SIMPLIFIED TO ONE SOURCE
OF PAYMENT FOR ALL ACUITY LEVELS
TO HELP CLIENTS BE ABLE TO
NAVIGATE AND HELP OUR PROVIDERS
BE ABLE TO NAVIGATE IT.
AND SECOND TO LOOK AT MORE
INNOVATIVE PAYMENT METHODOLOGIES
THAT WOULD ACTUALLY INCENTIVIZE
INTEGRATION WITH PRIMARY CARE AN
FQHC SETTING SO THAT WOULD BE.
VALUE BASED PAYMENTS OR PAPER
PERFORMANCE ARE AS OPPOSED TO A
VERY SPECIFIC --
WAY OF BILLING I I MANAGE OVER
TWENTY FIVE DIFFERENT FUNDING
STREAMS WITHIN BEHAVIORAL HEALTH
AND ALL HAVE A VERY SPECIFIC AND
NUANCED ADMINISTRATIVE AND
CLINICAL AND DOCUMENTATION
REQUIREMENTS --
AND LAST IS TO REDUCE THE
DOCUMENTATION STANDARD FOR
SPECIAL TO MENTAL HEALTH WE JUST.
DO NOT HAVE THE ACCESS THAT WE
NEED TO PROVIDE THE NONPROFIT
SETTING.
AND I FEEL EXTREMELY PRIVILEGED
TO BE ABLE TO BE WORKING A
COMMUNICATOR AND SEEING THE WORK
THAT WE'RE DOING FOR THE
COMMUNITY AND WE ARE REALLY THE
CONTINUAL DOUBT PATIENT
CONTINUUM OF CARE FOR YOLO
COUNTY --
AND I HOPE THE CHANGES CAN BE
MADE THAT WOULD SUPPORT THE GOOD
WORK WE'RE DOING AND TO
INCENTIVIZE MORE FQHCS TO
PARTICIPATE IN THIS CARE SO.
I THANK YOU FOR YOUR TIME.
I AM ALSO SENDING A WRITTEN
TESTIMONY THANK YOU VERY MUCH
THANK YOU [inaudible]
PLEASE.
MY NAME IS MY OFTEN ON THE CO
THE HEALTH PLAN IS OF SAN MATTEO --
OUR PLAN IS ALSO A MEMBER OF THE
LOCAL HEALTH PLANS OF CALIFORNIA.
ON AND ALSO SPEAKING BEHALF ON
BEHALF OF THAT ORGANIZATION --
HEALTH PLAN IS A MATTEO IS A
COUNTY ORGANIZED HEALTH SYSTEM.
WE'VE HAD SENIORS AND PEOPLE
WITH DISABILITIES ENROLLED WITH
US SINCE THE BEGINNING NINETEEN
EIGHTY SEVEN AS WELL AS PEOPLE
WHO ARE DUALLY ELIGIBLE FOR BOTH
MEDICAID AND MEDICARE.
A LOT OF THOSE PEOPLE THAT ARE
DULY ELIGIBLE ARE --
COMPLEX --
MENTALLY ILL CLIENTS THAT ARE
ALL CLIENTS OF THE COUNTY PAPER
HEALTH SYSTEM.
SO I WANT TO FOCUS ON OUR LOCAL
SAID THE THINGS WE'VE BEEN
TRYING TO DO I THINK IT MIGHT BE
OF INTEREST TO YOU --
I THINK WE UNIQUE MAYBE THERE'S
ANOTHER PLAN BUT I HAVEN'T HEARD
ABOUT IT YET THAT --
WE CONTRACT WITH THE COUNTY
BEHAVIOR HEALTH AND RECOVERY
SERVICES --
FOR ALL OF OUR PLAN BEHAVIORAL
HEALTH AND SUBSTANCE USE
RESPONSIBILITIES.
ARE WE DO NOT CONTRACT WITH A
THIRD ENTITY --
A BEHAVIORAL HEALTH COMPANY WITH
ONE EXCEPTION WHICH ALL
EXPLAINED --
WE'VE HOW SO HOW WE GROWN OUR
COLLABORATION ARE CONTRACTING
ARRANGEMENT. ONE TWO THOUSAND
SIX WE STARTED A PROGRAM IT'S
CALLED A DUAL ELIGIBLE SPECIAL
NEEDS PLAN.
WHICH IS A PROGRAM ALL FEDERAL
PROGRAM FOR PEOPLE ELIGIBLE FOR
BOTH MEDICAID AND MEDICARE --
ODD COVERS THEIR MEDICARE
BENEFITS --
YOU KNOW MY INSTINCT I WAS NEW
TO HELP PLAN AND MY MY INSTINCT
WAS IMMEDIATELY TO CONTRACT WITH
THE COUNTY.
BECAUSE THE WHOLE POINT OF THE
DUAL ELIGIBLE SPECIAL NEEDS PLAN
PROGRAM IS TO COORDINATE
MEDICARE AND MEDICAID BENEFITS
CALIFORNIA HAS A RICH MEDICAID
BENEFIT FOR MENTALLY ILL PEOPLE
SO IT JUST MADE SENSE TO KEEP
THOSE --
MEDICARE AND AND MEDICAID
BENEFITS TOGETHER.
IN TWENTY FOURTEEN THE PLANS THE
MEDICAID MANAGED CARE PLANS WERE
GIVEN RESPONSIBILITY FOR MILD TO
MODERATE AND ON ALL SERVICES AND
ALSO SERVICES OFFER CHILDREN ON
THE AUTISM SPECTRUM.
AGAIN WE CONTRACTED WITH THE
COUNTY WE DID DOG CHANGE OUR
MINDS A COUPLE YEARS LATER
MUTUAL AGREEMENT ABOUT AUTISM IT
WAS NOT WORKING OUT AS WE WOULD
LIKE IT'S NOT AN AREA OF
EXPERTISE FOR OUR BEHAVIOR
HEALTH DEPARTMENTS WE CONTRACTED
WITH MAGELLAN.
SO THAT'S THE ONE EXCEPTION.
IN -- TWENTY
FOURTEEN WE ALSO STARTED THE IN
CALIFORNIA THE COUNT MANY
CONNECTS YOU SEE I THE TOOLS
DEMO.
AGAIN WE CONTRACT WE CONTINUE
CONTRACTING WITH THE COUNTY FOR
BEHAVIOR HEALTH AND SUBSTANCE
USE BENEFITS --
FOR THOSE MEDICARE FUNDED
BENEFITS.
SO WHAT'S WORKED WELL WITH THIS
ARRANGEMENT --
FIRST OF ALL DARK COUNTY
BEHAVIORAL DEPARTMENT PROVIDES
EXCELLENT CLIENT SERVICES THAT'S
REALLY WHAT THEY EXCEL AT THEY
DO A LOT OF INTEGRATION OF
PRIMARY CARE AND BEAVER HAULS
APPLES MENTAL HEALTH CLINIC
SITES IN PRIMARY CARE SITES --
THERE'S BEEN GREAT PROGRESS MADE
ON WHOLE PERSON CARE.
I THINK THE KIND OF ISSUES THAT
CAME LUIS WAS DESCRIBING WE GET
ON THE PHONE AND WE WORK OUT
ISSUES WE FIGURE OUT THE PAYMENT
LATER BUT AT CLIENT IS IN OUR A
MEMBER IS NEVER FAR FROM ANY
SERVICE ON BECAUSE IT'S IT MIGHT
BE YOU KNOW.
IT'S UNCLEAR WHAT SYSTEM THAT
SERVICE THOSE --
IS UNDER ONE AND HE IS ALL IS
REALLY HELPFUL SO PHARMACY PART
D. FOR EXAMPLE IS --
UNDER OUR RESPONSIBILITY HEALTH
PLANS RESPONSIBILITY.
I'LL JUST GIVING EXAMPLES
SEVERAL YEARS AGO --
WE HAD A MEMBER WHO
UNFORTUNATELY LOST ON ENROLLMENT
WITH US BECAUSE I HE HAD LOST
HIS --
MEDICAID ELIGIBILITY FOR A SHORT
TIME HE WAS RE ENROLLED IN
ANOTHER PART DEEP PLAN HE HAD
TROUBLE GETTING HIS MEDICATIONS.
WHY HE ENDED UP --
HAVING UP UP UP PSYCHOTIC BREAK
AND HE WAS SHOT DEAD BY THE
POLICE IN FRONT OF THIS --
ON FRONT OF HIS HOME BECAUSE YOU
SPREADING FAMILY MEMBERS OF
POLICE WITH THAT WITH A KNIFE.
SO I MEAN IT'S THE MEDICATION
PIECES SO IMPORTANT FOR PEOPLE
WHO ARE MENTALLY ILL --
WERE ALSO THE FOR STRUGGLE
REASONS WITH THE ONLY PLAN THAT
HAS MEDICAID MENTAL HEALTH DRUGS
CARVE DâN ON TO OUR PLAN AND
THAT IS WORK JUST EXTREMELY WELL
ON AT A LOCAL LEVEL.
ANOTHER EXAMPLE THAT SCHOOL
WHAT'S WORKED WELL WITH THE
DOLE'S DEMO IS THAT THERE ARE
SHARED OUTCOME GOALS AND SHARED
SAVINGS AVAILABLE IN THAT
PROGRAM IN A SMALL WAY.
SO -- WE
HAVE WORKED TOGETHER WITH
BEHAVIOR HEALTH AND WE SUCCEED
THE CALL CALL YOU WITHHOLD
MEASURES PAID BACK AND WE'VE
SHARED THE US SAVINGS WITH --
OUR BEHAVIOR HEALTH DEPARTMENT
AND I CAN.
I INTEREST OF TIME I CAN ANSWER
QUESTIONS ABOUT THAT LATER IF
YOU'RE INTERESTED --
WE'VE DONE --
A LOT OF INFORMATION SHARING WE
SHARE CARE PLANS AND I THINK WE
DO A GOOD JOB YOU CAN ALWAYS BE
IMPROVED AROUND JOINT CARE
COORDINATION OF OUR OUR FOR A
JOINT MEMBERS.
SO WHAT NEEDS IMPROVEMENT.
WELL FRANKLY IN THIS IS
FOLLOWING UP AND DIRECTOR CANS
COMMENTS ARE COUNTY AND I DON'T
THINK IT'S UNUSUAL IS NOT GOOD
AT PLAN --
ADMINISTRATIVE BUSINESS
FUNCTIONS SO COMPLIANCE NETWORK
MANAGING IN CONTRACTING.
UTILIZATION MANAGEMENT ALSO NEED
SOME WORK CLAIMS PAYMENT A CALL
CENTER GRIEVANCE AN APPEALS
REPORTING TO THE STATE AND AND
FEDERAL REGULATORS ON QUALITY
REPORTING.
I THINK THE PLANS ON GENERALLY I
MEAN -- IT'S
SO MUCH OF WHAT WE DO THAT WERE
BETTER AT THAT.
WE WE'D DELEGATED A LOT OF THOSE
FUNCTIONS TO OUR COUNTY PARTNER
WHEN WE DELEGATED SOME OF THESE
PROGRAMS.
AND NOW WE'RE WE THINKING THAT --
IS SO DIFFICULT FOR THEM TO DO
ADMINISTRATIVE --
TIME SUCK AND SO --
AND IT'S SIX INCREASINGLY
CHALLENGING AS DIRECTOR KANSEN
WITH THE NEW FEDERAL ON MEDIC
MEDICAID MANAGED CARE RULE.
SO OUR GOAL IS TO BOMB ACOSTA
JOINT CALL WITH THE COUNTY
HEALTH LEADERSHIP IS TO DEVELOP
A STRUCTURE WHERE THE HEALTH
PLAN REALLY CANDLES MOST THE
PLAN FUNCTIONS ACROSS ALL
PROGRAM SO IT'S NOT JUST.
THE PROGRAMS ARE RESPONSIBLE ONE
WOULD ALSO SERIOUSLY AT THE
CARVE OUT PROGRAM TO TO THE
EXTENT WE CAN UNDER THE CURRENT
ARRANGEMENT --
AND THAT THE THE COUNTY BEAVER
HEALTH DEPARTMENT REALLY FOCUS
ON PROVIDING SERVICE SERVICES
AND WHAT THEY DO BEST SO FOR
EXAMPLE.
WE WOULD RUN A CALL CENTER WE
WOULD COLLATE COLOCATED APRIL
STAFF AT THE CALL CENTER.
AND AND DIAL IT DOWN IN WE WE
HAD WAS TO HAVE A MUCH MORE
SOPHISTICATED CALL CENTER THAN
ANYTHING IF THEY CAN DO.
SO THAT'S JUST ONE EXAMPLE WHAT
WE MIGHT DO --
AND OUR GOAL IS THEN TO
INTEGRATE AS MUCH AS POSSIBLE
UNDER THE CURRENT FRAMEWORK.
SO MY ADVICE FOR THE STATE --
BASED ON OUR LOCAL EXPERIENCES
FIRST OF ALL --
WE WE STRONGLY SUPPORT THE
RECOMMENDATIONS FROM THE RECENT
REFERENCE IT'S CALLED A
BLUEPRINT.
ON WHICH CALLS FOR INTEGRATION
OF OF PHYSICAL BEHAVIOR HEALTH
AND SUBSTANCE USE SERVICES UNDER
ONE ENTITY.
BUT WE HAVE TO BE DONE REALLY
SLOWLY IT HAS TO BE DONE --
THROUGH A PHASE AND PROCESS SOME
COUNTIES ARE MORE READY TO DO
JACK ANOTHER'S COUNTIES AND SOME
PLANS I'M ALREADY DO THAT AND
OTHER PLANTS.
I THINK WE REALLY NEED TO EXPAND
MAINTAIN AND EXPAND THE DOLES
DEMONSTRATION BECAUSE AGAIN THE
MOST COMPLEX BEHAVIOR ALL
CLIENTS ARE DOUBLES AND SO WE
WANT TO MAKE SURE THAT WE'RE
COVERING THEM AS WELL AND THAT
WORK.
WE WE HAVE SOME LOCAL CONTROL
OVER THE PHARMACY PARTY BENEFITS.
AND THEN --
I THINK IT'S YOU KNOW I KNOW
THAT MOST OF MENTAL HEALTH
PHARMACY --
IS CARVED OUT NOW THE MOST
NEARLY ALL THE PLANTS BUT I NEED
TO I THINK UP I THINK IT SHOULD
BE WHICH IS SORT OF THE BECAUSE
AGAIN MEDICATIONS ARTS SO KEYED
TO THE CARE.
OF MENTALLY ILL AND NOT
SUBSTANCE AND CLIENTS WITH
SUBSTANCE USE DISORDERS.
THANK YOU.
THANK YOU VERY MUCH.
MISTER CHRIS.
WHAT A DIRT ROAD AT THE THINGS
WERE OUT OF ORDER BUT?
SO GOOD AFTERNOON THANKS FOR
HAVING ME MY AND THINGS THAT
HAVE TO DO TO TESTIFY MY NAME IS
THERE AREN'T QUEST.
I'M A VICE PRESIDENT WITH BEACON
HEALTH OPTIONS.
BEGIN AS THE LARGEST
INDEPENDENTLY OWNED SPECIALTY
BEHAVIORAL HEALTH ORGANIZATION
IN AMERICA WE SERVE --
WE WORK IN ALL FIFTY STATES
INCLUDING MANAGING MEDICAID FOR
THIRTEEN MILLION PUBLIC PROGRAM
BENEFICIARIES AND ABOUT TWENTY
STATES.
OUR MISSION DRIVEN ORGANIZATION
AND HERE IN CALIFORNIA WE WORK
WITH EIGHT MEDI CAL MANAGED CARE
PLANS. TO MANAGE THE SPECIAL THE
MILD TO MODERATE MENTAL HEALTH
SERVICES FOR NEARLY ONE IN THREE
MEDICARE BENEFICIARIES --
WE HAVE A NETWORK OF FOUR
THOUSAND INDEPENDENT PROVIDERS
AND TWENTY FIVE COUNTIES FROM
SAN DIEGO TO HUMBLE.
WITH REGARDS TO WHAT'S WORKING
WELL IN THE SYSTEM TODAY.
AND I THINK UNDOUBTEDLY MORE
MEDICARE BENEFICIARIES HAVE
ACCESS TO SERVICES TODAY THAN
THEY DID FIVE YEARS AGO BEFORE
THE ADDITION.
OF THE MILD TO MODERATE BENEFIT
I'M SO LAST YEAR WE PAID FOR
SERVICES FOR THREE HUNDRED AND
FORTY THOUSAND UNIQUE
BENEFICIARIES.
AND WE NEED TO CONTINUE TO DO
WORK TO EXPAND ACCESS.
PARTICULAR IN CERTAIN DIFFICULT
GEOGRAPHIES AND FOR CERTAIN
SPECIALTIES --
INTEL HEALTH IS A REALLY
IMPORTANT KEY --
TO HERE.
ABOUT FOUR THOUSAND UNIQUE
BENEFICIARIES USE TELEHEALTH
SERVICES LAST YEAR WHICH WAS
FOUR TIMES THE AMOUNT IN.
TWENTY SIXTEEN AND WE EXPECT
THAT TRADUCTOR YOU OF INCREASING
CONTINUE.
SO WE'VE EXPERIENCED STRONG
COLLABORATION WITH
REPRESENTATIVES FROM COUNTING --
COUNTY HEALTH DEPARTMENTS
INDIVIDUAL WILLINGNESS TO
COLLABORATE AND DO WHAT'S RIGHT
FOR BENEFICIARIES A STEADFAST.
BUT THE STRUCTURAL BARRIERS OF
LIP SPLITTING THE SYSTEM BASED
ON IMPAIRMENT LEVEL CHALLENGE
EVEN THE BEST OF INTENTIONS.
SAID INCREASES IN MINNESOTA
BURDENS LIMITS CONTINUITY OF
CARE AND IS FRAUGHT WITH
OPPORTUNITIES AND FROM THIS HAVE
TO DO A LACK OF INFORMATION
SHARING.
AND LIKE EVERYONE ELSE IS
ALREADY SAID TODAY IT HAMPERS
PERSON CENTERED CARE BECAUSE THE
FINANCING OFTEN DELIVERS THE
PROVIDER IN CARE SETTING.
AND NOT AN INDIVIDUALS NEEDS.
SOMEBODY IS A SORT OF MODIFIED
CASE STUDY JUST TO TRY TO
HIGHLIGHT THIS FOR YOU AND LET'S
USE THE EXAMPLE OF A MIDDLE AGED
WOMAN EXPERIENCING DEPRESSION OR
ANXIETY.
THE PAPER SCRIBE AN
ANTIDEPRESSANT AND ENCOURAGE YOU
TO CALL BEACON FOR THERAPY
REFERRAL.
WHEN SHE CALLS FOR STATE
REQUIREMENTS SHE UNDERGOES A
BRIEF SCREENING SCREENING TO
DETERMINE IF SHE FILES INTO MY
INTO MILD TO MODERATE BUCKET?
ORANGE THE MODERATE TO SEVERE
BUCKET.
WE WORK IN TWENTY FIVE COUNTIES
THAT MEANS EACH COUNTY HAS A
DIFFERENT PROCESS FOR
COORDINATING THOSE REFERRALS AND
A DIFFERENT CRITERIA.
ARE DIFFERENT STANDARDS FOR H.
SHE WILL GET SERVICE AS SO
LITERALLY THE SAME PERSON AND
ONE COUNTY MAY BE ACCEPTED INTO
SERVICES I WON'T BE IN ANOTHER
WE DO TRACK ALL OF THOSE
REFERRALS AS KIM SAID.
AND WE SCREEN ABOUT FORTY
THOUSAND PEOPLE LAST YEAR IN
ABOUT 96% STATE AT OUR LEVEL OF
CARE.
BUT ALL THAT TRACKING IS
ADMINISTRATIVELY.
BURDENSOME WHEN IT COULD
OTHERWISE BE SPENT ON MAKING
PEOPLE SO IN THIS CASE OF THE
WOMAN IS REFERRED TO A BEACON
THERAPIST --
BUT AFTER A FEW MONTHS LET'S SAY
HER DEPRESSION WORSENS AND SHE
SHE BECOME SUICIDAL SO SHE'S
ADMITTED TO A PSYCHIATRIC
FACILITY.
AT THIS POINT BEACON HER
THERAPIST HER HEALTH PLAN FOR
PRIMARY CARE PROVIDER NOBODY
KNOWS SHE'S BEEN ADMITTED TO THE
HOSPITAL BECAUSE THAT SERVICE IS
NOW PAID FOR MANAGED BY THE
COUNTY.
EACH COUNTY HAS A DIFFERENT
PROCESS FOR THE DISCHARGE
PLANNING.
BUT MORE THAN LIKELY SHE WON'T
BE RECONNECTED WITH HER BEACON
THERAPIST BECAUSE THAT THERAPIST
IS NOT PART OF THE COUNTIES
NETWORK.
NOT MEAN SHE HAS TO START OVER
ON HER TREATMENT JOURNEY.
THERE ARE INSTANCES WHEN
SOMEBODY WILL BE DISCHARGED
DIRECTLY FROM INPATIENT TO A
MILD TO MODERATE PROVIDER.
BUT IN THIS INSTANCE WE ARE
UNABLE TO PAY FOR CASE
MANAGEMENT COLLATERAL AND THE
OTHER REHABILITATION OPTION
SERVICES THAT CAN HELP ADDRESS
PSYCHO SOCIAL STRESSORS IN HER
LIFE.
THAT ARE REALLY IMPORTANT TO
HELP MAINTAIN SOMEBODY AT THE
MODERATE LEVEL.
SO WE BELIEVE THAT A BENEFICIARY
SHOULD BE ABLE TO ACCESS ALL
ALLOW WILL BENEFITS AND SERVICES
ACROSS THE FULL CONTINUUM FROM A
SINGLE COHESIVE PROVIDER NETWORK.
THERE ARE MANY WAYS TO ORGANIZE
A SYSTEM OF CARE TO ACHIEVE THAT
GOAL.
YOU CAN WORKS WITH MEDICAID IN
TWENTY STATES --
THEN WE SEE DIFFERENT VARIATIONS
OF ACHIEVING THAT GOAL.
BUT WE WOULD ENCOURAGE A SYSTEM
THAT REDUCES COMPLEXITY
EMPHASIZES PREVENTION AND EARLY
INTERVENTION.
ENSURES CONTINUITY OF CARE AND
PROMOTES TRANSPARENCY AND
QUALITY AN OUTCOME IMPROVEMENTS.
I MAY USE MY LAST MINUTE TO
FOCUS ON THE SYSTEM FOR EVENTS
THAT ARE FEASIBLE WITHIN THE
EXISTING REGULATORY FRAMEWORK
FOR CALIFORNIA.
AND THE FIRST THE STATE SHOULD
CONSIDER SOME BASELINE CREATING
SOME BASELINE EXPECTATIONS FOR
CRISIS SYSTEM DESIGN.
AND INFRASTRUCTURE AND PROVIDE
DIRECTIVES GUIDANCE TO COUNTIES
AND DATA SHARING FOR BETTER
COORDINATION PREVENTION AND
EARLY INTERVENTION.
SECOND CALIFORNIA SHOULD INVEST
IN A LARGE SCALE IN LARGE SCALE
REGIONAL PSYCHIATRIC
CONSULTATION PROGRAMS THAT
IMPROVE ACCESS AND QUALITY FOR
BY PROVIDING REAL TIME SUPPORT
TO PRIMARY CARE PROVIDERS.
THIS PROGRAM SHOULD BE PAYER
AGNOSTIC.
POTENTIAL FUNDING SOURCES COULD
BE PROP FIFTY SIX OR THE MENTAL
HEALTH SERVICES ACT.
AND LASTLY EXPAND THE ARRAY OF
SERVICES THAT MEDI CAL MANAGE
PLANT MANAGED CARE PLANS CAN PAY.
FOR THAT'S IMPROVING OUR ABILITY
TO MAINTAIN INDIVIDUALS AT THE
MODERATE LEVEL SO THEY DON'T
NEED SPECIAL TEAM AT THE HOUSE
SERVICES TO THE COUNTY.
THIS COULD INCLUDE PAYING FOR
FAMILY THERAPY COLLATERAL CARE
COORDINATION AND ALLOWING FOR
SERVICES RENDERED BY PEERS AND
INDIVIDUALS WITH EXPERIENCE.
I'VE SUBMIT AND I'VE SUBMITTED
MUCH MORE DETAILED WRITTEN
TESTIMONY --
BUT I APPRECIATE THE TIME TO
SPEAK WITH YOU TODAY.
THANK YOU VERY MUCH --
DOCTOR MUCH.
HI MINIS.
MY NAME'S COUNTERPUNCH I'M A
LICENSED PSYCHOLOGIST FOR THE
COUNTY OF LOS ANGELES.
AND I'M HERE TODAY AND IN MY
CAPACITY AS A MEMBER OF ESSAY
YOU.
SEVEN TWENTY ONE YOU CAN HAVE A
BETTER YOU MEMBERS.
THROUGHOUT THE STATE WHO WORK
FOR COUNTY BEHAVIORAL HEALTH.
I HAVE DEDICATED MY CAREER. TO
PROVIDING SERVICES THAT FOR AT
RISK AND UNDERSERVED COMMUNITIES
I'VE WORKED WITH.
CHILDREN AND ADOLESCENTS HEARING
CRISIS
WHICH CHILDREN AND
FAMILIES HERE PART AT THE DCFS
SYSTEM I WORK WITH JUVENILE
JUSTICE.
AND PRIVATELY I WORKED WITH
DEFENDANTS WHO ARE FACING ISSUES
OF COMPETENCY AND VETERANS.
IN MY CURRENT.
A. O. T. IS DESIGNED TO PROVIDE
AGGRESSIVE OUTREACH TO PEOPLE
WHO ARE HISTORICALLY RESISTANT
TO TREATMENT.
BY AGGRESSIVE I MEAN.
WE GO OUT WE OFFER SERVICES AND
EVEN IF THEY SAY NO WE KEEP
COMING BACK
.
THE GOAL OF DOT IT'S TO GET
INDIVIDUALS.
TO VOLUNTARILY AGREED TO
SERVICES.
BUT IF THEY CONTINUE TO REFUSE
WE HAVE THE OPTION OF MANDATING
THEM THROUGH COURT.
COUNTY SPECIALLY MENTAL HEALTH.
COLLABORATE ACROSS SYSTEMS.
WHEN THEY ARE FOR WE
AUTOMATICALLY AND IMMEDIATELY
COLLABORATE WITH THEM TO TRY TO
ENGAGE THE CLIENTS AND SERVICES?
THAT MEANS GOING AND MEETING LAW
ENFORCEMENT AND DRIVING AROUND
THEM FOR AN HOUR AND LOOKING FOR
CLIENTS GET ROW.
IT MEANS GOING TO A HOSPITAL AS
SOON AS THE HOSPITAL BECAUSE AND
HAD AND HAVING THEM INTRODUCED
US TO A CLIENT TO IMMEDIATELY
AND ENGAGE IN OUTREACH AND TRACK
[inaudible]
AB T.. ONE OF THE STRENGTH OF
OUR PROGRAM IS THE OUT REACHING
GAUGE MATT THESE ARE CLIENTS WHO.
DON'T WANT TO GO TO A CLINIC
THEY HAVE MANY HAVE DIAGNOSIS OF
SCHIZOPHRENIA AND A LOT OF
PARANOIA AROUND SYSTEMS.
SO OUT REACH LOOKS LIKE GOING
AND FINDING THEM ONCE A WEEK OR
TWICE A WEEK ON SKID ROW AND
BRING THEM.
BRINGING THEM LUNCH BRING THEM
BREAKFAST IT MEANS GOING OUT AND
TAKING A MAP AND TAKING THEM TO
SOCIAL SECURITY OFFICE AND
DRIVING AROUND FOR THE AFTERNOON.
WHILE PROVIDING MOTIVE
MOTIVATIONAL INTERVIEWING IN THE
CAR TO TRY TO ENGAGE THEM AROUND
TREATMENT WORK IS FUNDED WITH
MENTAL HEALTH SERVICES ACT
FUNDING AND OVER HALF OF OUR
CLIENTS.
ARE EITHER LINK WITH MEDI CAL OR
MEDI CAL ELIGIBLE.
BECAUSE THE COUNTIES FOCUS IS ON
SERIOUSLY MENTALLY ILL.
WE'RE ABLE TO USE THIS WHATEVER
IT TAKES MENTALITY. TO REACH
SOMEWHERE THERE WHERE THEY ARE
AS I SAID TWO WEEKS AGO I WAS AT
THE CLIENT AND WE WERE.
PICKING HER UP AND GETTING
GROCERIES.
SO WE'RE DOING WHATEVER IT
WHATEVER WE CAN WEAR FOR IT THEY
ARE TO TRY TO ENGAGE THEM AND
SHE MET.
OUR COUNTY BEHAVIORAL HEALTH
TEAMS.
CONSIST OF A RANGE OF LIFE AND
AN UNLICENSED INDIVIDUALS.
KINI MENTAL HEALTH WORKERS
PSYCHOLOGIST PSYCHIATRISTS
SOCIAL WORKERS ON A TEASE.
AND WE TRAINING GET EXPERIENCE
IN DIFFERENT.
COUNTY PROGRAMS BUILDING OUR
EXPERTISE ACROSS A RANGE OF
SPECIALIZED BEHAVIORAL NEEDS.
AS A COUNTY PROGRAM.
WE CAN HARNESS OUR EXPERTISE IN
THE PSYCHOSOCIAL MODELS OF
RECOVERY. TO PRIORITIZE THE
NEEDS OF THE MOST UNDERSERVED.
BUT OUR SYSTEM IS ALSO POSITION
TO SERVE THOSE WHO MAY BE AT
RISK OF DEVELOPING SERIOUS
MENTAL ILLNESS.
OUR PROGRAMS ARE SUPPORTED
THROUGH A COMBINATION AT ME TO
SAY MEDIC HOW.
FEDERAL STATE AND COUNTY FUNDING
STREAMS.
WELL IT'S CHALLENGING TO
UNDERSTAND EXACTLY HOW THE MONEY
FLOWS FOR THOSE OF US IN THE
FIELD LIKE ME.
THAT ARE DIRECTLY WORKING WITH
CHILDREN AND FAMILIES.
WHAT I DO UNDERSTAND IS THAT OUR
SERVICES ARE NOT LIMITED?
TO ONE THEY'RE NOT LIMITED TO
ONE GROUP OF INSURANCE OR
ANOTHER.
WE CAN COVER CLIENTS ARE
UNDOCUMENTED AND WE CAN HELP
THEM FIND MEDI CAL AND GAIN MEDI
CAL.
THE DOOR TO THE COUNTY SERVICES
OPEN ONCE A NEED IS IDENTIFIED.
CAN WE DO BETTER TO SERVE THE
POPULATIONS ABSOLUTELY I BELIEVE
WE CAN ALWAYS DO THAT DO BETTER.
CALIFORNIA IS IN NEED OF
BEHAVIORAL HEALTH SYSTEM
TRANSFORMATION AND EVOLUTION.
IT'S A NEED AT STATE LEVEL
LEADERSHIP.
AS THEIR USE BEHAVIORAL HEALTH
WORK FORCE BELIEVES THAT WE NEED
TO APPRECIATE THE BROADER ROLE.
THE COUNTY MENTAL HEALTH AND
LEVERAGE.
AND LEVERAGE THE EXPERIENCE AND
EXPERTISE OF THE COUNTIES AND
ANY FUTURE TRANSFORMATION. FOR
EXAMPLES COUNTIES IN THE STATE.
NEED TO WORK TOGETHER TO ENSURE
THERE'S A COMMON CLEARLY
ARTICULATED MINIMUM INSTEAD OF
COUNTY BEHAVIORAL SERVICES.
AND STANDARDS.
SHIFTING THE BY SHIFTING THE
FINANCIAL RISK AND
RESPONSIBILITY.
OF CARING FOR THOSE WHO ARE
SEVERELY AND PERSISTENTLY
MENTALLY ILL RISK UNDERMINING
THE INNOVATION THAT COUNTIES ARE
SPEARHEADING.
WE ALSO NEED TO DO MORE TO
INTEGRATE MENTAL HEALTH
ADDICTION AND PHYSICAL HEALTH
SERVICES.
WE NEED TO DO THIS AT THE
PROVIDER LEVEL WITH AN EMPHASIS
ON BUILDING OUT A PLAN FOR
INVESTING IN A RENEWED.
COMMUNITY BASED CONTINUUM OF
CARE.
THE COUNTY BEHAVIORAL HEALTH
SYSTEM.
MAY NOT BE PERFECT BUT THE
COUNTY'S VISION.
INNOVATION POTENTIAL AND
INITIATIVES THERE.
WE SEE WHAT'S POSSIBLE AT THE
COUNTY LEVEL.
WE SEE THAT IN OUR COOLEY
COLOCATED FACILITIES AND DCFS WE
SEE THAT WITH JUVENILE JUSTICE
WE SEE THAT WITH MY PROGRAM AND
EIGHTY WE NEED TO BUILD ON THE
MOMENTUM OF WHAT THE COUNTY IT'S
ALREADY PROVIDE.
AN INCREASE THE VENUES IN
CIRCUMSTANCES WHERE CLIENTS OR
SERVICE.
COUNTIES MEET PEOPLE WHERE THEY
ARE IF ANYTHING OF MY EXAMPLES
HAVE SHOWN THAT.
WHAT I WANT TO LEAVE YOU WITH
TODAY IS THAT WHILE SO MUCH OF
WHAT WE DO IMPACTS MEDI CAL
BENEFICIARIES THE WORK IS SO
MUCH MORE?
I WORK GOES WELL BEYOND THE FOUR
WALLS OF A CLINIC THAT MANY OF
OUR CLIENTS ARE GONNA WALK INTO
ANYWAY.
IT GOES BEYOND INSURANCE
ELIGIBILITY AND THE MEDICAL
NEEDS OF OUR CONSUMERS WE'RE A
SAFETY NET AND SUPPORT.
INDIVIDUALS WHO ARE LIVING WITH
MENTAL ILLNESS AND SUBSTANCE
ABUSE.
WITH YOUR HELP WE CAN DO MORE TO
MODERNIZE AN UPDATE OUR COUNTY
SYSTEM FOR HERE REAL HELL.
AND MAKE SURE SUPPORT IMPROVED
OVERALL HEALTH SO THE CARE IS
MORE APPROPRIATELY INTEGRATED.
FOR THE POPULATIONS WE SERVE
WE'RE ALREADY WORKING TO
INTEGRATE.
NOT JUST BETWEEN MENTAL HEALTH
AND PHYSICAL HEALTH BUT ALSO
WITH SUBSTANCE USE DISORDERS.
SOCIAL SERVICE HOUSING AND MANY
OTHER ASPECTS.
THANK YOU FOR YOUR TIME.
THANK YOU VERY MUCH THANK YOU TO
ALL OF YOU --
THANK YOU ALL FOR BEING HERE I I
WOULD.
I APPRECIATE THE TESTIMONY FROM
BOTH -- FROM --
A SCAM AND FROM A COMMUNICATOR I
KNOW USE --
IN MY DISTRICT HERE SACRAMENTO
AND ALSO FROM --
ALTMAN HEALTH PLAN SAN MATTEO I
WOULD NOTE THAT BOTH.
IF YOU ARE IN COUNTY IS THAT
SINCE THE OPERATING COUNTY
ORGANIZED HEALTH SYSTEM
PARTNERSHIP BE A MULTI COUNTY.
SO FORTH --
SO YOU PERHAPS CAN'T QUITE
ANSWER QUESTION.
I KNOW THAT --
DOCKED BUNCH HERE IN A TWO PLAN
MODEL ALTHOUGH YOU KNOW YOU'RE
NOT RUNNING THAT.
THE I UNDERSTAND YOU'RE NOT
ADMINISTRATIVE CAPACITY IN PART
I JUST DO WONDER ABOUT THIS
INTERFACE WHEN YEAH THAT ONE
WOULD ARGUE THAT PERHAPS --
AND WILL AND AND COUNTY
ORGANIZED HEALTH SYSTEMS WHERE
YOU HAVE ESSENTIALLY YOU HAVE
COUNTY WE'RE GONNA HELP AND
THERE'S A GREATER OPPORTUNITY
ARE THERE MAY BE GREATER EASE
AND TRYING TO FIGURE OUT HOW TO
BRING THE TWO TOGETHER
[inaudible]
WHERE AS?
WELL I ALWAYS COURSE IT'S OWN
UNIQUE THING WITH.
THE GIVEN ITS SIZE BUT ANY OF IT
TO PLAN MODEL WITH THE YOU KNOW
LA CARE.
HEALTH NET AND THEN YOU HAVE
MULTIPLE SUBCONTRACTS AT CETERA
AND SO HOW DOES A COUNTY MENTAL
HEALTH SYSTEM THEN MATCH UP
AGAINST THAT OR DO YOU HAVE A
THE SIDE.
THE TERMS OF THE THAT IS A TERMS
OF TRYING TO FIGURE OUT HOW WE
AND IT'S NOT YOU KNOW WE TALK
ABOUT INTEGRATION BETWEEN.
SUBSTANCE USE AND MENTAL HEALTH
WE TALK ABOUT INTEGRATION
BETWEEN THE HEALTH PLAN WHICH IS
MY OLD.
ADDRESS AND THIS GUY AND THEN WE
TALKED ABOUT AND THEN AND THEN
HOW.
AND THEN JUST THE PHYSICAL
HEALTH AND MENTAL HEALTH SO --
AT SO I GUESS IN SOME SENSES ANY
OBSERVATIONS FROM HEARING FROM
YOUR COLLEAGUES IN OTHER
COUNTIES --
YOUR EXPERIENCE IN LA --
AND TURN IN TERMS OF HOW WE DO
THIS INTEGRATION WHEN YOU HAVE --
AND AND AND PLACES AND WE DON'T
HAVE THAT IN PLACES WHERE YOU
DON'T HAVE --
BASICALLY JUST THE NEED TO
ENTITIES THE COME TOGETHER I
MEAN I REALIZE MAYBE MORE BUT
TWO MAJOR ENTITIES COME TOGETHER.
WELL.
YOU KNOW I I DO COME FROM A CO
HSN I AGREE IT'S MUCH EASIER ON
AND SEE WHAT JUST COUNTY I DON'T
THINK IT'S IMPOSSIBLE --
I THINK IT'S DEFINITELY MORE
COMPLICATED NOTHING'S POSSIBLE
BUT BUT WELL I THINK --
I'M THINKING ABOUT SAN DIEGO
WHICH HAS I THINK IT'S SEVEN
HEALTH PLANS ON BECAUSE THE
GEOGRAPHIC MANAGE CARE LIKE
SACRAMENTO.
AN ARM IN SAN DIEGO --
HAS DONE INTEREST YOU WORK OVER
THE YEARS AND IT'S ANOTHER AREA
BUT IT'S AN L. TSS LONG TERM
SERVICE SUPPORT WITH THEY'VE
ORGANIZES A COUNTY.
AND THEY HAVE ON RELATIONSHIPS
WITH ALL THE HEALTH PLANS AND I
THINK IT.
IT TAKES A LOT OF WORK BUT I
THINK WHERE --
YOU CAN HAVE A STANDARD COUNTY
PROCESS AND THEN WORK WITH THE
VARIOUS --
PLANTS -- SO
I I WOULDN'T GIVE UP ON IT
ENTIRELY MAYBE WANNA START WITH
THE CHS COUNTIES BUT I THINK
THERE'S SOME IMMIGRATION WORK
THAT HAS GONE ON IN OTHER AREAS
NOT PAPER HEALTH THAT MIGHT BE
VERY INSTRUCTIVE TO LOOK AT MORE.
MORE DEEPLY.
HE'S MADE MAYBE SOME STATE
MANDATES WOULD HELP.
WITHOUT REGARD TO GET COUNTY
YEAH I'M IN SACRAMENTO WE HAVE
GMC WE HAVE SIX HEALTH PLANS
RIGHT.
AND IT'S NOT THERE THEIR
RELATIONSHIP STRICTLY WITH THE
STATE CELL THAT'S PROBLEMATIC
BUT ANY OKAY.
ANY OTHER COMMENTS ON THAT AND
THE LA YEAH.
I KNOW YOU'RE NOT YOU'RE BEHALF
OF ELEMENTAL HEALTH DEPARTMENT.
THAT'S A DIFFICULT QUESTION AND
I CAN ONLY SPEAK FROM FROM MY
EXPERIENCE AND I KNOW JUST
INDIVIDUALLY IN WITH MY PROGRAM
WHEN I WHEN THINGS COME UP I
DON'T.
I DON'T THINK HEALTH PLANS I I
THINK CLINICALLY AND SO WHEN I
SAY WE HAVE A WHATEVER IT TAKES
MENTALITY THAT'S WHAT WE DO IS
SO IF SOMEONE HAS HAS HEALTHCARE
NEEDS THAT'S THAT'S CASE
MANAGEMENT.
WE JUST GO WE FIND THE HEALTH
PLAN WE TAKE THEM THERE WE GET
REFERRALS FROM BEGAN WE FOLLOW
AT SO IT'S HARD FOR ME BECAUSE I
DON'T I DON'T THINK AND AND
ADMINISTRATIVELY AND IN TERMS OF
THIS HEALTH PLAN OR IT JUST
SOUNDS LIKE CASE MANAGEMENT.
AND WE FOLLOW UP WHERE WE NEED.
WE WE CERTAINLY HEARD FROM THE
PREVIOUS PANEL THERE ARE PEOPLE
WHO ARE LITERALLY STUCK IN
BETWEEN WE HEARD FROM MY MY
COLLEAGUES THAT HAPPENED TO ONE
OF THE SO.
I DON'T UNDERSTAND THAT YEAH I I
I I CERTAINLY UNDERSTAND I MEAN
AS A FELLOW HEALTH PROFESSIONAL
WERE ON THE GROUND WHICH WE WE
TRY TO DO THAT RIGHT WE WE DON'T
TRY TO SAY WHICH HEALTH PLAN BUT
ULTIMATELY YOU DO RUN UP AGAINST
THE WHO'S GOING TO PAY. FOR IT
AND SO FORTH AND WHOSE GOOD FOR
ON FRANKLY WHEN THE REASONS I
AND IF FOR ANY FOR THE STATE
LEGISLATURE WAS TRYING TO
RECESSION WE HAD I HAD PATIENTS
TO I MAINLY FOCUS ON CHILDREN
WITH LEARNING AND FEARFUL
DISORDERS --
THAT -- I
PATIENTS GOT GOT STOCK AND AND
DOES SO AS MUCH AS I WANTED TO
BE AS A AS A SOMEONE ON THE
FRONT LINES --
TO BE EIGHT LET'S NOT PRETEND
THE PROBLEM PAY FOR IT RIGHT IS
GOING TO COVER IT HE'S GONNA
ACCEPT THEM BECAUSE IF PEOPLE
ARE GOING TO GET PAID.
IT WAS REALLY HARD TO GET THEM
CARE SO.
THANK YOU.
I FIND IT IT'S ACTUALLY EASY
EASIER FOR US WITH THE COUNTY TO
FIGURE OUT WHO'S GOING TO PAY
FOR IT AND HOW TO PAY FOR IT.
WITH OUR SPECIFIC PROGRAM WE'VE
ACTUALLY HAD MORE TROUBLE WITH
CLIENTS TO A PRIVATE INSURANCE
BECAUSE I THINK IT IS SIMILAR TO
WHAT THEY WERE SAYING EARLIER.
WITH THE PRIVATE INSURANCE THE
THE NEEDS THEY DON'T HAVE THE
SERVICES THEY DON'T HAVE THE
LEVEL OF TREATMENT THAT'S NEEDED.
SO WE CAN FIGURE OUT A WAY TO
PAY FOR IT WITH OUR OUR COUNTY
ARE INDIGENT FINDS BUT THEN ONCE
WE NEED TO REFER ON TO THE
CONTRACT THAT THEY WERE IN THE
SAME BOAT.
THAT NO ONE CAN DO IT.
I THANK YOU --
I I KNOW WE'VE BEEN TAKING SOME
NOTES I THINK WE'LL HAVE SOME
FOLLOW UP QUESTIONS FOR FOR YOU
AS WELL BUT I DID AT ONE
QUESTION DID HAVE --
THAT -- AS
IN LISTENING --
TO MISS OUR QUEST TALK ABOUT
BEACON YOU YOU YOU SAID TO BE A
PROVIDE SERVICES FOR ABOUT A
THIRD OF THE MEDI CAL.
AND OVER THREE MILLION MEDI CAL
BENEFICIARIES SO WE WORK SO WORK
WE CONTRACT WITH EIGHT MEDI CAL
MANAGED CARE PLANS WHOSE TOTAL
MEMBERSHIP.
IS MORE THAN THREE MILLION
MEDICARE BENEFICIARIES.
AND YOU HAVE FIFTY SIX COUNTIES
THAT DO THINGS FIFTIES.
SIX TWENTY FIVE OR TWENTY FIVE
COUNTIES THEY DO THINGS. TWENTY
FIVE DIFFERENT WAYS SO THAT
MAKES IT TO TO DO TO DEAL WITH --
IS THAT IS THIS DELIVERY SYSTEM
YOU NEED TO CALIFORNIA YOU DO DO
YOU TO WORK IN OTHER STATES YES
SO WE WORK WITH MEDICAID.
BUT THIRTY MILLION MEDICAID
LIVES IN TWENTY STATES --
CALIFORNIA'S BIFURCATION ON
IMPAIRMENT LEVELS IS UNIQUE AND
THE ONLY OTHER STATE THAT I'M
PERSONALLY AWARE OF THAT USED TO
DO THAT WAS WASHINGTON STATE.
IN WASHINGTON STATE IS IN AN
ACTIVE --
FIVE YEAR TRANSITION PLAN --
FRONT TO MOVE ALL OF THAT THE
PAPER HEALTH BENEFITS THAT WERE
CARVED OUT.
TO REGIONAL COUNTY LIKE ENTITIES
INTO THE MEDICARE MEDICAID
MANAGED CARE ORGANIZATIONS.
THEY'RE ON IN BEACON DOES WORK
THERE BUT OUR ROLE THERE IS
ACTUALLY TO MANAGE THE CRISIS
SYSTEM ON BEHALF OF AN ENTIRE
COMMUNITY.
BECAUSE ONE THING TO THINK ABOUT
IF YOU'RE GONNA CARVIN MEDICAID
BENEFITS INTO MANAGED CARE PLAN.
THERE'S A LOT OF OTHER PUBLIC.
A FEDERALLY FUNDED MHSAA FUNDED
DIFFERENT SERVICES THAT STILL
SORT OF WORK TOGETHER TO BRAID.
IN A BRAID TOGETHER TO MAKE AN
ENTIRE CONTINUUM OF CARE AND A
CRISIS SYSTEM NEEDS TO BE IN
PLACE FOR EVERYBODY IN THE
COMMUNITY.
REGARDLESS OF WHO PAYS FOR THEIR
SERVICES INTERCEPT WITH LAW
ENFORCEMENT THE JUDICIAL SYSTEM
SCHOOLS.
IN A JUVENILE DETENTION SAID
SAID EXTRA COMPLICATION WHEN YOU
THINK ABOUT CARVING AND SERVICES --
BUT WASHINGTON HAS HAD --
INITIAL --
POSITIVE SUCCESS FROM ITS --
PROCESS OF OUR GREAT GREAT WELL
THANK YOU AGAIN I I KNOW BECAUSE
IT WE WHAT WE LIKELY HAVE FOLLOW
UP QUESTIONS WHICH WILL REACH
OUT TO YOU ALL AGAIN SO THANK
YOU VERY MUCH REALLY REALLY
CRESCENTA.
WE GET A MOVE ON TO PANEL TH BE
OF PART --
THREE OUR NEXT OUR NEXT SPEAKERS --
PLEASE PLEASE COME ON UP BUT
DOCTOR SHANNON SU --
WHO'S FROM UC DAVIS SCHOOL OF
MEDICINE.
MIKE DISHONORABLE IS THE CEO FOR
SIERRA VISTA HOSPITAL.
AND KAREN SAVAGE SAYING ONE
WHO'S THE DEPUTY DIRECTOR OF THE
CALIFORNIA PAN HAVE THE PAN
ETHNIC HEALTH NETWORK SO.
PLEASE COME ON A GOOD AFTERNOON --
I'M SHANNON SO AS YOU SAID IN
FROM UC DAVIS I'M ACTUALLY HERE
ON BEHALF OF THE CALIFORNIA
PSYCHIATRIC ASSOCIATION IS CO
CHAIR OF THE COMMITTEE ON
INTEGRATED CARE --
I ALSO WEAR A NUMBER OF OTHER
HATS --
THAT'LL EXPLAIN JUST TO GIVE YOU
SOME CONTEXT OF WHY AND I'M HERE
TODAY AND WHY I'M PASSIONATE
ABOUT THINGS THAT WE'RE TALKING
ABOUT -- I
AM ALSO THE CO DIRECTOR FOR THE
UC IRVINE UC DAVIS STREET NEW
TRAINERS PRIMARY CARE PSYCHIATRY
FELLOWSHIP.
WHICH TRAINS PRIMARY CARE
PROVIDERS PHYSICIANS NURSE
PRACTITIONERS AND PHYSICIAN
ASSISTANTS IN PROVIDING MENTAL
HEALTH CARE IN THE PRIMARY CARE
SETTING.
THIS IS SEEKING QUALIFIED
MEDICAL --
WHAT THEY'RE ALREADY RUNNING
INTO AND WHAT THEY FEEL
INSUFFICIENTLY PREPARED --
FOR I'M ALSO THE PROGRAM
DIRECTOR FOR THE UC DAVIS FAMILY
MEDICINE PSYCHIATRY RESIDENCY
TRAINING PROGRAM WHICH TRAINS TO
RESIDENTS PER YEAR OVER A FIVE
YEAR PERIOD --
TO BE DAHLE BOARDED IN FAMILY
MEDICINE AND PSYCHIATRY IS I AM.
UC DAVIS IS ONE OF ONLY TWO
INSTITUTIONS IN THE COUNTRY THAT
HAS BOTH IN INTERNAL MEDICINE
PSYCHIATRY PROGRAM ANY FAMILY
MEDICINE PSYCHIATRY RESIDENCY
PROGRAM.
AND THEN FINALLY I AM THE
MEDICAL DIRECTOR OF SACRAMENTO
COUNTY'S ONLY MENTAL HEALTH
URGENT CARE WHICH OPENED IN
NOVEMBER OF TWO THOUSAND
SEVENTEEN AND HAS SERVED OVER
FOUR THOUSAND CLIENTS TO DATE.
I'M I WANTED TO TALK TODAY ABOUT --
WOULD REITERATE A LOT OF POINTS
OF COURSE THAT OTHER PEOPLE HAVE
I AM NOT GOING TO TRAIN DELIVER
THOSE BUT JUST TO LEND OUR
SUPPORT AS WELL.
OF COURSE WE TALKED A LOT ABOUT
INTEGRATING SUBSTANCE USE
PHYSICAL CARE WITH MENTAL HEALTH
CARE.
AND THAT'S AN AREA THAT'S VERY
NEAR AND DEAR TO MY HEART
BECAUSE AS A COMBINED TRAINED
PHYSICIAN.
THAT'S WHAT I WANT TO DO THAT'S
ONE OF ONE OF THE SERVICES THEY
WANT TO PROVIDE THE PEOPLE I
WANT TO PROVIDE A ONE STOP SHOP.
I ALSO REALIZE THOUGH THAT NOT
EVERYBODY CAN PROVIDE EVERYTHING
IN ONE BODY.
AND SO THEREFORE WE WANT TO
SUPPORT OUR FQHCS ESPECIALLY
THAT WANT TO PROVIDE THE
SERVICES IN ONE STOP FOR CLIENTS.
BUT ARE BARRED FROM DOING SO
BECAUSE OF THE CURRENT BILLING
STRUCTURE AND THE CALIFORNIA
REALLY NEEDS AN EXEMPTION TO
ALLOW FQHCS TO BE ABLE TO BILL
FOR MORE THAN ONE SERVICE IN ONE
DAY --
OFFERED BY DIFFERENT PEOPLE --
ALSO THE TRANSITION BETWEEN.
DIFFERENT SYSTEMS OF CARE WE SEE
THIS DAILY IN THE MENTAL HEALTH
URGENT ARE PEOPLE ARE
DISCHARGED FROM HOSPITALS
DISCHARGED FROM PRISONS AND
JAILS. TO PRETTY MUCH NO CARE --
THEY WIND UP IN MY URGENT CARE
BECAUSE THEY DON'T KNOW WHERE
THEY'RE SUPPOSED TO GO OR THEY
DIDN'T GET CONNECTED WHERE THEY
WERE SUPPOSED TO LAND.
ON THEIR OUT OF MEDICATIONS
THEY'RE FACING POTENTIALLY A RE
HOSPITALIZATION --
OR FUTURE INCARCERATIONS SO WE
REALLY NEED TO DO BETTER IN
TERMS OF LINKING THESE PEOPLE OF
OUTPATIENT SERVICES AND
PREVENTING THE NEXT RECURRENCE
[inaudible]
AS THESE --
SPECIALTY MENTAL HEALTH --
AND MANAGED CARE ORGANIZATIONS
NEED TO BE ABLE TO SEAMLESSLY
TRANSITION PATIENTS BACK AND
FORTH --
RIGHT NOW WE'VE WE'VE TALKED A
LOT ABOUT OF THE DAY.
THE SILENCE ESSENTIALLY THAT
EXISTS BETWEEN THOSE DIFFERENT
AGENCIES.
AND THEN OF LOTS AND LOTS OF
TALK ABOUT THE BILLING
REGULATIONS DOCUMENTATION THAT
MAKES IT VERY DIFFICULT FOR ALL
OF US IS AS PROVIDERS. TO DO OUR
JOBS TO SERVE CLIENTS TO WORK
TOWARDS BETTER OUTCOMES.
AND YOUR HEALTH CARE PROVIDERS
AND I'M NOT JUST SPEAKING HERE
ABOUT PHYSICIANS BUT ALL HEALTH
CARE PROVIDERS ARE ARE FACING
INCREASING DEBT LOADS.
THEY'RE GOING INTO --
JOBS WHERE THEY CAN MAKE MORE
MONEY.
AND PSYCHIATRY OR MENTAL HEALTH
IS NOT NECESSARILY SEEN AS ONE
OF THOSE SPECIALTIES.
ON SO THERE'S SEND FINANCIAL
STIGMA THERE SOMETIMES SUN --
SOCIAL STIGMA THAT GOES ALONG
WITH GOING INTO MENTAL HEALTH WE
HAVE TO OVERCOME.
IN ORDER TO ATTRACT PEOPLE INTO
DOING THIS WORK THAT IS SO
DESPERATELY NEEDED --
AND THEN FINALLY AS THE FEDERAL
I AM THE WAIVER THAT'S SOMETHING
THAT AS MENTIONED EARLIER --
BUT IS ANOTHER AVENUE BY WHICH
WE CAN CAPTURE SOME FEDERAL
MONEY TO BE ABLE TO HELP PAY FOR
SERVICES THAT COUNTIES ARE
ALREADY HAVING TO PAY.
FOR BUT THEY'RE HAVING TO PAY
FOR IT IN AN IN AN UNPLANNED WAY --
AND THEN NOT BEING ABLE TO USE
THEIR OWN DOLLARS TO PERHAPS
PERCENT HOSPITALIZATIONS.
SO APPLYING FOR THE FEDERAL ANTI
WAIVER AND AND DRAWING DOWN SOME
OF THOSE FEDERAL FUNDS WOULD BE
HELPFUL AND IN.
HELPING OFFSET SOME OF THESE
COSTS THAT WERE LIKE I SAID ARI
EXPENDING [inaudible]
CELL.
THANK YOU.
BY USING THIS.
ONE GOOD AFTERNOON X..
THANK YOU FOR THE OPPORTUNITY TO
PRESENT TO YOU TODAY MY NAME'S
MIKE'S HONOR AND CEO IS HERE
MISTER HOSPITAL IN SACRAMENTO
WHERE --
HUNDRED SEVENTY ONE BAD
FREESTANDING PSYCHIATRIC
FACILITY.
WE WERE SEVENTY TWO BEDS WE
OPENED IN NINETEEN EIGHTY SIX SO
WE'VE SEEN SIGNIFICANT GROWTH
OVER THE LAST REALLY THE LAST
TEN YEARS OR SO --
WE ADMIT ABOUTSIX THOUSAND
PATIENTS A YEAR BOTH ADULTS AND
ADOLESCENTS 90% OF THOSE ARE
MORE ON A FIFTY ONE FIFTY SO
WITH THE SERVICE WE PROVIDE
FALLS INTO THAT SEVERELY.
GENERALLY SEVERELY MENTALLY ILL
SPECIALLY MENTAL HEALTH --
WE EMPLOY ABOUT THREE HUNDRED
FIFTY FULL TIME AND PART TIME
STAFF WE CONTRACT WITH TWENTY
FIVE PLUS PSYCHIATRIST AND AND
MEDICAL DOCTORS.
AND ABOUT.
AVERAGE LIKE TO STAYS ABOUT TEN
DAYS WHICH I'VE BEEN AT THE
FACILITY SINCE TWO THOUSAND AND
TEN IT WAS CLOSER TO SIX OR
SEVEN WHEN I GOT THERE SO IT'S
REALLY EXTENDED.
OVER THE OVER THE LAST EIGHT OR
NINE YEARS.
WHAT'S WORKING WELL WITHIN THE
pWANT TO SAY I DID READ THIS
BEFORE I CAME THIS WAS AN
EXCELLENT OVERVIEW --
IS REALLY INFORMATIVE AND I AND
I THOUGHT ILLUSTRATED.
SOME OF THE CHALLENGES THAT WE
FACE BUT ALSO THE OVERALL SYSTEM
SO THAT WAS THAT WAS NICE WORK
WHAT'S WORKING WELL WITHIN THE
SYSTEM I I THINK THE FACT THAT
THAT MEDI CAL --
COVERS THIRTEEN MILLION PEOPLE
ON THE FACT THAT THE ACA IN THE
COVERAGES.
AT THE FEDERAL LEVEL WERE
EXTENDED AT THE STATE LEVEL NEAR
EVERYTHING THAT THE STATE IS
DONE.
TO MAINTAIN THAT COVERAGE AND
EXTEND IT.
TO AS MANY PEOPLE AS IT HAS I
THINK IS A WONDERFUL THING --
THE OTHER THING I THINK IS
WORKING WELL FROM MY PERSPECTIVE
IT IS.
THAT WANT SOMEBODY IS ADMITTED
TO MY HOSPITAL --
THE SERVICES THAT THEY RECEIVE
WHETHER THEY HAVE.
KAISER.
ANTHEM AT NASA OR MEDICARE.
IT'S IT'S EXCELLENT CARE THE
SERVICE IS CONSISTENT.
IT IS --
EACH PATIENT IS TREATED THE SAME
REGARDLESS OF FUNDING SO IN THAT
SENSE MEDI CAL IN THE ACCESS
THAT IT'S OPENED UP. TO
PROVIDERS --
IS IS GOOD IT'S JUST.
GAINING THE ACCESS TO THE CARE
WHICH IS WHERE THE RUB IS --
I'M GONNA PRESENT THEM OR MY
EXPERIENCE IS FROM THE LENS OF A
HOSPITAL THAT HAS ADMITTED
PATIENTS IN TWO THOUSAND AND
EIGHTEEN FROM THIRTY EIGHT
DIFFERENT COUNTIES OF THE FIFTY
SIX OR FIFTY EIGHT COUNTIES
FIFTY SIX HEALTH PLANS SO.
WE WE LITERALLY HAVE.
A WITH A WIDE RANGE OF
EXPERIENCE IN DEALING WITH THE
INCONSISTENCIES THAT YOU HAVE
HEARD MUCH TESTIMONY ABOUT.
SO WHAT IS NOT WORKING WELL
YOU'VE GOT A A DISJOINTED
FRAGMENTED SYSTEM --
YOU ALSO HAVE A SISTER THEY
LEAVE.
A HOSPITAL SETTING AGAIN COMING
TO US IN A FIFTY ONE FIFTY
SITUATION.
THEIR POST DISCHARGE SUPPORT AND
SERVICES AVAILABLE TO THE MEDI
CAL BENEFICIARIES.
IS LACKING.
BOTTOM LINE AND THEN MAINTAINING
ELIGIBILITY --
I THINK THERE'S WORK TO COULD BE
DONE FOR FOLKS FOLKS WITH MENTAL
ILLNESS --
AND FOLKS ENROLLED IN MEDICARE
ON SOME OF THE CHALLENGES THAT
GO.
HAND IN HAND WITH BOTH REALITIES.
THE REQUIREMENTS TO MAINTAIN
COVERAGE IN MEDI CAL IN THE
PAPERWORK IT NEEDS TO BE DONE IN
THE QUARTERLY TIME LINES AND
WHAT NOT.
IT'S IT'S IT'S IT'S INHERENTLY --
GONNA BE HARDER FOR SOMEBODY TO
MAINTAIN THEIR MEDICAL COVERAGE
VERSUS THOSE I THINK WITHOUT
CHRONIC MENTAL ILLNESS --
THE DELIVERY SYSTEM BEING
FRAGMENTED AND CHALLENGING.
AT BEST IS REALLY A REFLECTION
OF THE COUNTY BY COUNTY I CAN GO
INTO SPECIFIC EXAMPLES BUT
BOTTOM LINE IS WE DEAL WITH EACH
COUNTY DIFFERENTLY.
IN IN HOW PATIENTS ARE ADMITTED --
IN HOW PATIENTS ARE UTILIZATION
REVIEW THAT WE DO WITH THE
COUNTY IS AN ON GOING BASIS HOW
WE BUILD THE COUNTIES.
HOW WE --
THE FORMS THAT WE USE MAY BE
CONSISTENT FROM ONE COUNTY TO
THE NEXT BUT ONE COUNTY MAY SAY
WE WANT THIS OVAL FILLED IN IN
THE NEXT COUNTY SAYS NO YOU
DON'T FEEL AND THAT ALL VOTES
LITERALLY DOWN TO THAT LEVEL OF
DETAIL -- IN
IN THAT LACK OF CONSISTENCY AS A
PROVIDER.
WHERE I'VE GOT?
HELLO TWENTY TO TWENTY FIVE FULL
TIME EMPLOYEES IS DEALING WITH
IT.
IS IS DIFFICULT IS ALMOST
IMPOSSIBLE I COULD IMAGINE WHAT
IT'S LIKE FOR THE CONSUMER.
SO SO THAT'S A REAL PROBLEM THAT
LACK OF CONSISTENCY FROM COUNTY
TO COUNTY --
THE POST DISCHARGE SERVICES.
IN SUPPORT --
WE DO HAVE THE OPPORTUNITY --
TO TO OF VALUE EIGHT IN
CONJUNCTION WITH THE COUNTY
PATIENTS THAT.
THEIR SEVERITY LEVEL IN THEIR
NEED FOR OUT PAY ABOUT A THIRD
OF OUR PATIENTS OF THE SIX
THOUSAND I MENTIONED BEFORE THAT
ARE NEEDED. TWO THOUSAND OR SO
WERE MEDI CAL.
THE COUNTY WE WILL EVALUATE THE
NEED FOR FOLLOW UP SERVICES IN
THAT MEDI CAL POPULATION ABOUT A
THIRD QUALIFY FOR THE INTENSIVE
SERVICES A TURNING POINT --
TELECARE THOSE TYPE OF SERVICES
BUT TWO THIRDS DO NOT SO THERE'S
TWO THIRDS OF THE OF THE MEDI
CAL.
PATIENTS ARE ADMITTED TO SERVICE
ARE GOING TO BE DISCHARGED
WITHOUT ACCESS TO IMMEDIATE
FOLLOW ABOUT PATIENT CARE LIKE
PARTIAL HOSPITALIZATION
INTENSIVE OUTPATIENT SERVICES.
AND LIKELY WILL NOT BE SEEN BY
PROVIDER FOR THIRTY DAYS OR MORE --
AND THEN THE LAST PIECE ABOUT
WHAT'S NOT WORKING WELL AS THE
ELIGIBILITY PIECES I MENTION
BEFORE JUST.
BY -- AS WE
SPEAK EVERITT TO PATIENTS AT
THEIR MEDI CAL HAS EXPIRED
FEBRUARYTWENTY EIGHTH MARCH
FIRST THEY'RE NO LONGER ENROLLED
IN MEDICARE NOW --
WE DO EVERYTHING WE CAN TO GET
THEM REINSTATED IN MEDI CAL TO
VARYING LEVELS OF SUCCESS BUT
THEY WILL.
THERE'S A CHANCE THEY WILL
DISCHARGE WITH NO MEDICAL MILK
NO MEDICAL COVERAGE IN A FAX SO
WHAT CAN WE DO.
I THINK A DOCTOR ANY SYSTEM
WHETHER IT'S THROUGH THE ELEVEN
FIFTEEN BE WAIVER --
BUT ANY SYSTEM THAT BRINGS
GREATER ACCOUNTABILITY AND AND
AND REDUCES THE INCONSISTENCY
FROM COUNTY TO COUNTY AND IF
THAT'S DONE THROUGH.
THE COUNTIES GETTING PAID ON A
CAPITATED BASIS ARE USING A
CARVIN SYSTEM THAT ALLOWS YOU TO
TAP INTO THE FEDERAL MATCHING
DOLLARS.
I THINK THAT NEEDS TO BE --
NOT ONLY FINANCIALLY WOULD MAKE
SENSE BUT IT WOULD BRING
CONSISTENCY TO THE TO THE TO THE
SYSTEM AND THIS REPORT MENTIONED
THAT ANY PROPOSAL. TO TO GET THE
WAIVER DAHLE THE FEDERAL
GOVERNMENT CMS NEEDS TO BE
BUDGET NEUTRAL.
I WOULD PROPOSE THAT YOU COULD
INCLUDE IN THE APPLICATION --
THE THE DEVELOPMENT OF CRISIS
INTERVENTION SERVICES ARE MORE --
PARTIAL HOSPITALIZATION OR I'LL
OUTPATIENT SERVICES TO PREVENT
PEOPLE FROM GETTING INTO THE
HOSPITAL WHICH I THINK WOULD
OVERALL REDUCE THE INPATIENT
MISSIONS AND COULD POTENTIALLY
BE BUDGET NEUTRAL --
THE LAST THING I WOULD SAY IS
ANYTHING THAT CAN BE DONE BY THE
STATE IN REDUCING THE THE
REQUIREMENTS TO MAINTAIN
ELIGIBILITY FOR THOSE THE
SEVERELY MENTALLY ILL PATIENTS --
I WOULD APPRECIATE I THINK THEY
SHOULD TAKE A LOOK AT DOING THAT
THANK YOU.
FOR THANKS AT MY NAME'S KAREN
SAVAGE AND WITH THE CALIFORNIA
PAN ETHNIC HEALTH NETWORK WHERE
STATEWIDE MULTI CULTURAL HEALTH
ADVOCACY ORGANIZATION AND WE
WORK ON A NUMBER OF HEALTH CARE
ISSUES --
INCLUDING MENTAL HEALTH THANK
YOU FOR THE OPPORTUNITY TO BE
HERE TODAY.
AND I WANT TO START OFF BY
SHARING SOME DATA --
THAT'S BEING PASSED AROUND SO
YOU HAVE THE VISUAL I'M IN
TWENTY SEVENTEEN WE SPONSORED
LEGISLATION --
BY ASSEMBLY MEMBER ARAMBULA TO
REQUIRE DH CS TO REPORT OUT ON
COUNTY MENTAL HEALTH --
WITH DEMOGRAPHIC INDICATOR SO BY
RACE ETHNICITY LANGUAGE IT
CETERA AND SO THIS IS RELATIVELY
NEW DATA THE DEPARTMENT JUST
RELEASED IT I'M AT THE END OF
TWENTY EIGHTEEN BUT THERE'S A
FEW THINGS THAT WE'VE ALREADY
LEARNED FROM LOOKING AT IT THAT
I THINK ARE IMPORTANT TO KNOW.
SO THE FIRST IS THAT MENTAL
HEALTH UTILIZATION SEC ISLANDER
CONSUMERS HAVING THE LOW IS BY
FAR THE LOWEST UTILIZATION RATES.
AND I MISTER MAC EXPLAINED
REALLY WELL SORT OF THE
DIFFERENCE BETWEEN THE
PENETRATION RATE AND THE
ENGAGEMENT RATE WE ALSO SEE
DISPARITIES WHEN WE LOOK AT SORT
OF THE DROP OFF FROM THE
PENETRATION RATE TO THE
ENGAGEMENT RATE AND THERE'S THE
LARGEST DROP OFF FROM PEOPLE WHO
ARE POTENTIALLY.
JUST AS FAST AND NOT ENGAGED IN
TREATMENT FOR BLACK CONSUMERS SO
WE THINK THAT'S IMPORTANT TO
NOTE.
TO MENTAL HEALTH UTILIZATION
ALSO VARIES BY LANGUAGE AS YOU
CAN SEE BY THE GRAPH YOU HAVE IN
FRONT OF YOU WITH ONLY ABOUT 1%
OF BENEFICIARIES WHOSE PRIMARY
LANGUAGE IS NOT ENGLISH BEING
CAN ENGAGED IN SERVICES.
I'M AND THERE'S OTHER LANGUAGES
THAT HAVE EVEN SMALLER NUMBERS
OF PEOPLE WHO ARE BEING ENGAGE
NUMBER SO SMALL THAT THEY CAN'T
BE PUBLICLY REPORTED.
AND I THINK IT'S ALSO IMPORTANT
TO NOTE THAT WHILE THERE ARE
MANY IMPORTANT EFFORTS UNDER WAY
THERE'S INDICATIONS THAT
DISPARITIES ARE ACTUALLY NOT.
I'M GETTING SMALLER OVER TIME
AND SO YOU CAN SEE WE GAVE THE
EXAMPLE OF LANGUAGE BUT THE
DISPARITY BETWEEN ENGLISH
PRIMARY ENGLISH SPEAKERS.
AND I PRIMARY NON ENGLISH
SPEAKERS IS ACTUALLY REMAINED
FAIRLY CONSISTENT FROM TWENTY
THIRTEEN TO TWENTY SEVENTEEN
WHICH I THINK IT'S DISAPPOINTING.
I'M AND THEN FINALLY WHEN WE
LOOK AT OUTCOMES WOULD JUST
AGAIN GIVEN ONE EXAMPLE --
BUT THE TIME IT TAKES FOR
SOMEONE TO STEP DOWN FROM AN
INPATIENT HOSPITALIZATION TO A
LOWER LEVEL OF KERR VARIES BY
RACE WITH BLACK CONSUMERS HAVING
A CONSIDERABLY LONGER AVERAGE
TIME. TO BE DISCHARGED FROM
INPATIENT SETTING AND ENGAGE IN
FOLLOW UP CARE.
AND I WOULD NOTE AGAIN AT THE
STATE THAT ONLY ONLY LOOKS AT
COUNTY MENTAL HEALTH AND
UNFORTUNATELY WE DON'T HAVE THE
SAME LEVEL OF SPECIFICITY
CURRENTLY AVAILABLE.
ON THE MANAGED CARE SITES THAT
WOULD BE ONE RECOMMENDATION IS
TO MAKE SURE THAT WE CAN DO THIS
KIND OF ANALYSIS ON THE MANAGED
CARE SIDE.
I DO THINK THAT THE ANALYSIS DID
A AT THE BACKGROUND DID A REALLY
NICE JOB OF TALKING ABOUT SORT
OF WHAT WE EXPECT TO SEE IN
TERMS OF UTILIZATION IN COUNTY
MENTAL HEALTH AND SPECIALTY
MENTAL HEALTH.
AND WHAT WE EXPECT TO SEE IN THE
MANAGED CARE PLAN HOW MEMBERS
WHO SHOULD BE ACCESSING CARE
FROM THEIR HEALTH PLAN BECAUSE
OF THE LEVEL.
OF I NEED THAT THE HEALTH PLAN
SHOULD BE ADDRESSING AND YET THE
UTILIZATION READ HER RATES ARE
ACTUALLY FAIRLY COMPARABLE SO WE
UNDERSTAND THAT THE MANAGED CARE
BENEFIT IS STILL SORT OF NEW.
BUT BUT I THINK WE'RE REALLY
CONCERNED ABOUT DO PEOPLE KNOW
THAT THAT'S A BENEFIT TO PEOPLE
KNOW HOW TO ACCESS IT.
AND SO IF YOU RECOMMENDATIONS
THAT WE HAVE I'M ONE IS TO
LEVERAGE THE STRENGTH OF COUNTY
MENTAL HEALTH.
I'M TO MEET THE NEEDS OF
CONSUMERS WHO HAVE COMPLEX
MENTAL HEALTH PHYSICAL HEALTH
NEEDS AS WELL AS THOSE WERE NOT
MEDICAL MEDI CAL ELIGIBLE AND
DOCTOR BUNCH DID A REALLY NICE
JOB SO I WON'T REITERATE OF
TALKING AT SOME OF THE STRENGTH
OF COUNTY MENTAL HEALTH.
BUT I DID WANT TO TO TO SENATOR
DRAWS AS EARLY EARLIER POINT
TOUCH ON THE ACCESS FOR FOLKS
WHO ARE UNDOCUMENTED --
WE'VE JUST CONDUCTED AT A
RESEARCH PROJECT ON THAT WE'VE
INTERVIEWED OVER A DOZEN
COUNTIES AND I THINK THEY ARE
YOU KNOW THERE'S BROAD AGREEMENT
BROUGHT UNDERSTANDING THAT
COUNTIES HAVE FLEXIBILITY WITH
SOME OF THEIR FUNDS TO SERVE
THIS POPULATION THAT IS.
VASTLY UNDER SERVED HOWEVER I
THINK THERE'S SOME REAL
CHALLENGES FOR COUNTIES DOING
THAT AND I THINK ONE IS SORT OF
A POLITICAL PROBLEM OF MOST
COUNTIES WILL TELL US YES IF
SOMEONE GETS TO OUR DOOR WE WILL
SERVE THEM WE HAVE FUNDS TO PAY
FOR THEM.
BUT THERE'S A NUMBER OF COUNTIES
THAT ARE NOT DOING PROACTIVE OUT
REACH TO UNDOCUMENTED
COMMUNITIES BECAUSE THEY'RE
CONCERNED ABOUT THE POLITICAL
RAMIFICATIONS SO SOMEBODY NEVER
FIND OUT THEY CAN GET SERVICES
FROM YOU THEY'RE NOT GOING TO
GET THREE OR DOOR.
I'M SO WE WE DO BELIEVE THAT
COULD BE CLARIFIED SOME
ADDITIONAL BACKING FROM THE
STATE WOULD BE HELPFUL THERE.
I'M WE ALSO THINK THAT FOR BOTH
COUNTIES AND HEALTH PLANS WE
REALLY DO NEED TO MOVE TOWARDS
THE MORE VALUE BASED ON PAYMENT
METHODOLOGIES AND THAT IN
PARTICULAR WHEN WE DO THAT WE
NEED TO LOOK AT DISPARITIES AND
SO WE NEED TO DESEGREGATE OUR
DATE OUT BECAUSE YOU CAN.
MAKE OVERALL QUALITY IMPROVEMENT
BUT ACTUALLY CONTINUE TO WORSEN
DISPARITIES AS WE DO SEE IN SOME
OF THE STATE US SO THAT WE NEED
TO BE REALLY CAREFUL ABOUT THAT.
I'M WE ALSO THINK IT'S IMPORTANT
TO REVIEW THE OUTREACH MATERIALS
THAT GO TO CONSUMERS BOTH FROM
DH CS AND FROM HEALTH PLANS IN
PARTICULAR BECAUSE WE KNOW MOST
CONSUMERS WHO NEED THOSE
SERVICES ARE NOT ACCESSING THEM
SO THERE'S SOME KIND OF
BREAKDOWN IS PROBABLY MULTIPLE
BARRIERS.
I'M AND THEN JUST A COUPLE MORE
THINGS SO ONE IS TO MAKE SURE
THAT OUR OUR CONTRACTED MANAGED
BEHAVIORAL HEALTH ORGANIZATIONS
THAT ARE WORKING WITH MANY OF
OUR HEALTH PLANS.
DO HAVE ADEQUATE NETWORKS ARE
MEETING TIMELY ACCESS AND
PARTICULARLY OUR MEETING TIMELY
ACCESS TO INTERPRETER SERVICES
WHICH IS A PLACE WHERE WE
CONTINUE TO SEE A PROBLEM.
I'M ON THAT END AND WE COMMENTS
ABOUT SCREENING AND MEDICAL
NECESSITY AND WOULD JUST ADD
THAT IT DITION TO MAKING SURE
THAT WE DO THE TRAUMA SCREENING
AND WE BROUGHT IN THE MEDICAL
NECESSITY DEFINITION.
THAT WE NEED TO BE CAREFUL ABOUT
TRANSLATIONS PARTICULAR
PARTICULARLY FOR ASSESSMENT
BECAUSE PARTICULAR TALKING
MENTAL HEALTH NOT EVERYTHING HAS
A DIRECT.
TRANSLATION AND SO WE'VE
ACTUALLY TALKED TO AN
ORGANIZATION THAT HAS TO TRAIN
THEIR MEMBERS ON WHAT THEY NEED
TO SAY IN ORDER TO BE ELIGIBLE
WHICH WORDS THEY NEED TO USE AND
NOBODY SHOULD HAVE TO DO THAT.
AND AND THEN JUST JUST TWO MORE
THINGS ONE IS --
ALL COUNTIES HAVE A CULTURAL
COMPETENCY ASSESSMENT PLAN THAT
THEY PUT TOGETHER EVERY THREE
YEARS AND THIS PLAN IS SUPPOSED
TO BE SUBJECT TO REVIEW AND
APPROVAL BY THE DEPARTMENT OF
HEALTH CARE SERVICES.
BUT THIS IS AN AREA WHERE WE
FEEL LIKE OVERSIGHT IS REALLY
LACKING THAT THAT REVIEW AND
APPROVAL HASN'T HAPPENED I'M IN
MANY YEARS AND COUNTIES HAVEN'T
BEEN SUPPORTED IN DEVELOPING
THESE CRUCIAL PLANS.
I'M AND THEN FINALLY WE THINK WE
NEED AN OVER ARCHING STATE
FRAMEWORK FOR HEALTHEQUITY THAT
INCLUDES MENTAL HEALTH EQUITY
AND REALLY LEVERAGES THE NEW
POSITION OF THE CALIFORNIA
SURGEON GENERAL SO THANKS SO
MUCH FOR YOUR TIME AND LOOKING
FOR TO WORKING WITH YOU.
GREAT THANK YOU THANK YOU VERY
MUCH DOCTOR.
QUESTION --
COUPLE COUPLE THINGS --
MISTERS HONOR ARE USED YOU'RE
TALKING ABOUT WHAT HAPPENS --
WHEN WHEN PEOPLE ARE DISCHARGED
AND WHETHER IT THERE MEDI CAL
PATIENTS?
HE SAID OF DID YOU SAY TWO
THIRDS OF THEM HAVE NO ABILITY
TO FOR FOLLOW UP TREATMENT. TWO
THIRDS OF THEM OF THE MEDI CAL
BENEFICIARIES --
WILL NOT QUALIFY.
FOR THE MENTAL HEALTH PLAN OR
THE COUNTY BASED SERVICES WHICH
INCLUDE SOME OF THE INTENSIVE
SERVICES THAT.
JUST ABOUT ALL OF OUR PATIENTS
REQUIRED BUT THOSE TWO THIRDS
THAT DON'T QUALIFY DON'T.
DON'T I GUESS SCORE AS BEING
SEVERELY MENTALLY ILL ENOUGH TO
ACCESS THOSE SERVICES.
WILL NOT.
THROUGH THE HEALTH PLANS ARE THE
MANAGED CARE MEDI CAL THE PLANS
AVAILABLE AS MY DISCHARGE PEOPLE
TELL ME THERE'S NOT A THERE'S
NOT ANY DAY TREATMENT OUR
INTENSIVE OUTPATIENT SERVICES
AVAILABLE FOR THOSE PATIENTS.
SO THE COMBINATION OF OF THE
LACK OF SERVICES AVAILABLE AND
THEN THE WHETHER THEY CAN
QUALIFY EVEN QUALIFY FOR THE
SERVICES.
CLINICALLY QUALIFY YEAH IF
THEY'RE IF THEY'RE ILLNESS IF
THEY ARE SICK ENOUGH ESSENTIALLY
FOR THE LEVEL OF CARE.
SO IN YOUR OPINION AFTER BEING
RELEASED AFTER SIX TO TEN DAYS
OF TREATMENT OR THEY THEY WELL
ENOUGH LET LET ME --
LET ME JUST GIVE YOU --
TECH A COUNTERPOINT AND FOR
KAISER --
ANTHEM BLUE CROSS AT AND THE
EXPECTATION IS THAT THEY HAVE AN
APPOINTMENT WITHIN SEVEN DAYS.
AND IT'S OFTEN CLOSER TO FIVE
DAYS FOR SOME FORM OF FOLLOW UP
CARE MANY ARE REFERRED TO OUR
OUTPATIENT SERVICES WE DO OFFER
DAY TREATMENT IOP THERE'S OTHER
PROVIDERS IN THE COMMUNITY TO DO.
PRIVATE PROVIDERS --
I THINK THAT I DON'T KNOW IF
THEY'RE WELL ENOUGH OR NOT --
BUT MY BASED ON A READMISSION
RATES I WOULD GUESS THAT THEY'RE
NOT.
SO WHAT IS THE READMISSION RATES.
FREEDOM OPULENT XIN.
WE RUN OVERALL A READMISSION
RATES OF ABOUT. 10% THERE'S THAT
WE LOOK AT IT WITHIN THREE DAYS
IN WITHIN THIRTY DAYS WITHIN
THREE DAYS IT'S MUCH LOWER THAN
THAT BUT WITHIN THIRTY DAYS IT
IT'S IT'LL RUN ABOUT 10%.
KAISER CONVERSELY WHICH IS --
YOU KNOW WE'LL HAVE IT DOES HAVE
SOME MEDICARE ON IT THROUGH ITS
MANAGE BUSINESS BUT ESSENTIALLY
A NON MEDICARE BOOK OF BUSINESS
THEIR READMISSION RATES HER.
OVER THIRTY DAYS MAYBE ONE OR 2%.
SO THOSE READ MISSIONS ARE
PRETTY COSTLY.
I WOULD SAY SO YES.
AND THAT FROM DOING THE MATH
HERE THAT'S ROUGHLY THIS
POPULATION AMERICA PUBLISHES
ROUGHLY.
THAT THAT IS RELEASED TWO THIRDS
THAT THEY CAN'T GET FOLLOW UP
THAT'S LIKE 25%.
OF ALL OF YOUR PEOPLE IN A YEAR.
THAT ARE IT NEEDED A 90% OF
WHICH ON A FIFTY ONE FIFTY SO
THEY'RE THEY'RE PRETTY.
EITHER EPISODICALLY ARE
CHRONICALLY MEN IN A IN A CRISIS
YES.
THE STAGGERING ISN'T THE AND
YOU'RE JUST ONE HOSPITAL. ONE
HOSPITAL YES --
BOB OKAY --
DOCTOR SEWER --
ONE OF THE ISSUES WE'VE SEEN IN
IN NEARLY ALL THE COUNTY MENTAL
HEALTH PLANS --
IS THAT THEY'RE HAVING
DIFFICULTY WITH NETWORK
[inaudible]
ADVOCACY --
FOR ADULT AND CHILD PSYCHIATRY --
DO YOU HAVE THOUGHTS ON THIS
[inaudible]
THERE'S SEVERAL STAGES TO THE
PROBLEM --
ONE BOTTOM LINE IS THAT WE
SIMPLY WON'T HAPPEN OF
PSYCHIATRISTS.
OF I THINK THERE'S BEEN A COUPLE
OF REPORTS THAT COME OUT OF THE
LAST COUPLE MONTHS THAT HAVE
PROJECTED EVEN IF WE GRADUATED.
YOU KNOW ALL THE PSYCHIATRY
RESIDENCY SAID AT MAXIMUM
CAPACITY WE WOULDN'T HAVE ENOUGH
PSYCHIATRIST --
AND SO THAT'S WHAT'S LED TO
INITIATIVES LIKE THAT THE T. AND
T. PRIMARY CARE PSYCHIATRY
PROGRAM --
TO TRY TO TRAIN PEOPLE WHO.
ARE DOING.
MENTAL HEALTH WERE THE PRIMARY
CARE SETTING --
SO THAT'S ONE INITIATIVE THAT
WE'VE DONE --
AND THEN TRYING TO ATTRACT THE
PEOPLE THAT WE DO HAVE THAT ARE
TRAINED AS PSYCHIATRISTS
INSTALLED IN ADOLESCENT OR ADULT
PSYCHIATRIST. TO STAY IN THE
WORK FORCE --
BECAUSE UNFORTUNATELY WE HAVE A
LARGE NUMBER OF PEOPLE WHO OPT
OUT OF MEDI CAL.
AN OPT OUT OF MEDICARE --
SO WE TRADING COURAGE OUR
MEMBERS TO PARTICIPATE BUT
THAT'S DIFFICULT ONE PAYMENT
STRUCTURES ARE SO CUMBERSOME.
WE HEARD YESTERDAY IN OUR BUDGET
SUBCOMMITTEE --
THAT THE DEPARTMENT STATE
HOSPITALS.
SO ARGUABLY THAT'S OF SOME
PRETTY PRETTY ILL PEOPLE IN THAT
THE STATE HOSPITALS --
THE PSYCHIATRY --
VACANCY RATE FOR PSYCHIATRISTS
IS FORTY POINT 6% [inaudible]
AND SO.
WE'RE DEALING YOU'RE DEALING
WITH A VARIETY OF PEOPLE HERE I
THINK THIS --
THIS IS BEYOND A CRISIS I THINK
IT'S A IT'S IT'S PRETTY A PRETTY
OVERWHELMING YEAH AND AND THERE
WERE YOU KNOW WORKFORCE --
REPORTS THAT ARE SUGGESTING WE
NEED TO INCREASE CAPACITY IN
PSYCHIATRY RESIDENCIES --
FAST TRACKING MEDICAL STUDENTS
INTO PSYCHIATRY VARIOUS
INITIATIVES BUT IT'S STILL IT'S
A PIPELINE ISSUE THAT REST BE
SOLVED VERY GRADUALLY
[inaudible]
RIGHT.
AND SO I THINK YOU THINK YOU AND
AND AND SING WHEN I KNOW THAT
YOU SOME OF THE ISSUES YOU
BROUGHT UP I THINK THERE'S A
BILL FLOATING AROUND OUT THERE
WITH HER TO ADDRESS SOME OF
THOSE SO I I THINK THANK YOU FOR
THAT.
SO.
OF ANY QUESTIONS OR CONTENT SURE.
I THANK YOU --
SO FIRST OF ALL I THINK --
FOR MISS A SINGLE MINUTE THE
TERM -- THIS
IS A TIME YOU'RE NOT.
SENDING SOMEONE TO AN MRI OR
DOING TESTS --
CERTAINLY AT THE FOUNDATION OF
ALL.
MEDICAL HEALTH CARE IS
COMMUNICATION THAT PARTICULAR
AROUND BEHAVIORAL HEALTH SO.
HE SPEAK TO THE ISSUE ABOUT
LANGUAGE ACCESS AND MEDICO --
MENTAL HEALTH --
THE THE THE DIFFICULT EITHER
EASE OR DIFFICULTY PATIENTS ARE
HAVING BECAUSE I AM NOT SURE
WHAT A MENTAL HEALTH
PROFESSIONAL DOES.
IF THEY CAN'T SPEAK THE LANGUAGE
OF THE PATIENT AND PATIENTS
UNDERSTAND SPEAK THE LANGUAGE OF
THE PERSON SEEN THEM.
YEAH THANK YOU THAT'S A REALLY
GOOD QUESTION SO I THINK THAT
THERE'S A COUPLE PIECES TO IT
WHERE IT'S DIFFICULT SO ONE IS --
THROUGH THE PHONE CENTERS IN THE
FIRST PLACE TO THE ACCESS LINES
I THINK WE'VE SEEN SOME PROBLEMS
WITH MAKING SURE THAT WE HAVE
INTERPRETERS WERE AVAILABLE ON
THOSE LINES EVEN TELL PEOPLE
HERE'S WHERE YOU CAN GO TO GET
YOUR SERVICES SO THAT WOULD BE
THE FIRST THING.
I THINK THE SECOND PIECE IS THE
ASSESSMENT PIECE THAT I TALKED
ABOUT EVEN EVEN WHEN WE'RE DOING
TRANSLATED ASSESSMENTS THEY'RE
NOT ACCURATELY TRANSLATING AND
SO.
SOMETIMES PEOPLE WILL REFER TO
HOW THEY KIND OF HIT THE BAR FOR
PEOPLE TO QUALIFY FOR SERVICES
SO THERE'S THAT LANGUAGE ACCESS
PROBLEM THAT I THINK.
NEEDS A LOT MORE STUDY IN A LOT
MORE WORK AND THEN LIKE YOU
BRING UP THERE'S ONCE YOU IF IF
AND WHEN YOU ACTUALLY GET INTO
TREATMENT --
THERE ISN'T THAT INTRACTABLE AT
THE CLINICIAN AND YOU KNOW I
THINK YOU'RE RIGHT THAT THAT
DIFFERENT SYSTEMS I MEAN WE DO
FOR A LOT OF AS YOU VERY WHERE
FOR A LOT OF DIFFERENT MEDICAL
THINGS YOU KNOW WE USED
INTERPRETER LINE THOSE KINDS OF
THINGS THAT THEY'RE NOT AS
EFFECTIVE.
IN MENTAL HEALTH AND SO THAT WE
REALLY WHEN WE LOOK AT WORK
FORCE I THINK NEED TO HAVE A
PARTICULAR FOCUS IN MENTAL
HEALTH AND BILINGUAL
PROFESSIONALS --
AND IT'S IT'S ACTUALLY WHEN I
WAS AT UC DAVIS --
MEMBER BUT WE PILOTED TO
ACTUALLY TELL A PRETTY BECAUSE
THE I MEAN IT'S NOT JUST THE
LANGUAGE --
YOU MIGHT CATCH THE TONE OF
VOICE OVER A PHONE LINE WHAT YOU
DON'T SEE THE BODY LANGUAGE
FACIAL EXPRESSIONS.
THAT GIVE NEW WANTS TO WHAT
THEY'RE SAYING AND REASON --
WE DON'T RECALL AN INTERPRETERS
NOT TRANSLATORS IT'S NOT THE
LITERAL TRANSLATION WE NEED WE
NEED INTERPRETATION OF WHAT IS
THE PATIENT TRYING TO
COMMUNICATE.
NOT NOT SAY A WORD BY WORD THING --
AND SO -- TO
BE EFFECTIVE --
I THINK WE NEED TO LOOK ALSO
BEYOND JUST PHONE.
PHONE LINES AS A WAY TO
COMMUNICATE WITH PEOPLE --
A DOCTOR SO --
YOUR YEAH I WAS THE RESIDENCY
DIRECTOR AT UC DAVIS YOU'RE NOT
RESIDENCY DIRECTOR --
SO YOU SEE THE TRAINEES --
WE TALK ABOUT WORK FORCE --
SO WHEN A TRAINEE GRADUATES AND
THEY CHOOSE WHAT PATH THEY WANT
TO TAKE TO PRACTICE AND THEY
LOOK AT I GUESS WORKING FOR
COUNTY MENTAL HEALTH.
WELL WHAT DID THEY SEE I MEAN
COMPARED TO WHAT THE OTHER
OPTIONS ARE SO WE TALK ABOUT THE
PIPELINE BUT I KNOW I SEE THAT
IN THE GRADUATE THE START
TALKING ABOUT THE CAREER CHOICES
AND WHAT'S AVAILABLE TO THEM SO --
AND SO I'D BE CURIOUS TO IS --
TO THAT PART BECAUSE WE CAN
STUFF MORE PEOPLE IN THE
PIPELINE ABOUT SAYING THAT WE
DON'T HAVE ENOUGH BUT IF PEOPLE
ARE HAVE OTHER OPTIONS AND WE
CAN'T BE COMPETITIVE --
THAT'S AN ISSUE AND THEN I THINK
THE OTHER THING IS IS THAT ONE
COULD ARGUE THAT GIVEN THEM OUT
OF OVERHEAD WORK.
WE COULD PERHAPS INCREASE OUR
WORKFORCE INSTANTLY BY 20% OR
25% BY SIMPLY CUTTING THEM OUT
OF OVERHEAD BY HALF.
I MEAN SERIOUSLY RIGHT VERSUS A
LITERALLY --
FOR HIS MEDICAL SCHOOL FOUR
YEARS OF PSYCHIATRIC TRAINING.
TO GIVE FOUR CERTIFIED EIGHT
YOUR PIPELINE.
SO CAN YOU COMMENT ON THAT.
YEAH WELL --
I'M SURE YOU'RE WHERE YOU SEE
DAVIS HAS.
EIGHTY THE THEY CALL ACE PC
THAT'S A XCELERATED PIPELINE OUR
MEDICAL STUDENTS TO COMPLETE
MEDICAL SCHOOL IN THREE YEARS
AND THE ACCEPTED INTO A PRIMARY
CARE RESIDENCY PROGRAM SO.
SUCH AS FAMILY MEDICINE
PEDIATRIC AND STARTED SO --
AT UC DAVIS SECONDS AS SPEAK
FROM MY OWN PERSONAL PERSPECTIVE --
WERE INVESTIGATING WHETHER OR
NOT WE COULD INCORPORATE
PSYCHIATRY INTO THAT AND
SPECIFICALLY INTERNAL MEDICINE
PSYCHIATRY IN FAMILY MEDICINE
PSYCHIATRY --
YEAH WORDY TAKING --
THE WITH THE COMBINED PROGRAMS
WE TAKE SEVEN YEARS OF TRAINING
THE THE PRIMARY CARE SPECIALTIES
THREE YEARS PSYCHIATRY BEING
FOUR YEARS WITH THE PRESIDENT OF
FIVE TO PRODUCE DAHLE BOARD
CERTIFIED PEOPLE SO THAT AGAIN.
WE CAN TRAIN PROVIDE THAT ONE
STOP SHOP A LITTLE THEY GO TAKE
YOUR MEDI CAL PATIENTS ARE TO GO
HAVE OTHER OPTIONS THE MAJORITY
OF OUR GRADUATES FROM UC DAVIS
DO YOU ACTUALLY GO INTO THE
PUBLIC OKAY --
SECTOR SO WE WE TEND TO ATTRACT
TO YOU WE HAD OVER A HUNDRED
APPLICATIONS FOR G. SPOTS THIS
PAST YEAR AND KILLING MEDICINE
PSYCHIATRY.
AND THE VAST VAST MAJORITY OF
MEDICAL STUDENTS THAT I
INTERVIEW SAY HOW THEY WANT TO
WORK IN UNDERSERVED COMMUNITIES
RETURN BACK TO RURAL COMMUNITIES
IT'S IT'S ACTUALLY VERY
ENCOURAGING AND IT SEEMS LIKE --
PART OF THE DRAW FOR DOING
COMBINED IN PARTICULAR IS TO
WORK IN UNDERSERVED AREAS WITH
UNDERSERVED POPULATIONS.
OKAY THANK YOU AND I JUST WANTED
KNOWLEDGE --
MISTER DAR UM I WANT THANK YOU
SO MUCH FOR SO THANK YOU SO MUCH
FOR BEING HERE.
THANK YOU --
THANK YOU VERY MUCH TO ALL OF
YOU AND WE MAY HAVE FOLLOW UP
QUESTIONS I HOPE WE CAN ENGAGE
WITH YOU FURTHER ON THESE ISSUES
SO.
WE LIKE TO GO AHEAD AND MOVE
INTO PUBLIC COMMENT --
AND TO SEE STATE YOUR NAME AND
ORGANIZATION AND WE COULD KEEP
IT MAY BE A COUPLE MINUTES.
I THANK YOU.
KELLY BROOKS I'M HERE THIS
AFTERNOON ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS.
I JUST WANTED TO TALK A LITTLE
BIT ABOUT THE SUCCESSES OF THE
WHOLE PERSON CARE PILOTS AND THE
LINK WITH BEHAVIORAL HEALTH.
JUST A REMINDER THAT THE WHOLE
PERSON HER --
PILOT PROGRAM IS LOCALLY BASED
CENTS PER THE STATE'S --
ELEVEN FIFTEEN MEDICAID WAIVER --
FIRST WE'RE SEEING EARLY
SUCCESSES IN DEVELOPING
PARTNERSHIPS AND DATA SHARING TO
IMPROVE CARE COORDINATION ACROSS
COUNTY AGENCIES OF OUR COMMUNITY
PARTNERS --
SECOND THE PILOTS ARE BEST
INVESTING IN NEW WORK FORCE THAT
CAN PROVIDE ESSENTIAL PEER
SUPPORT AND NAVIGATION SERVICES.
I'M AN ADDITIONAL PERSON CARE
FUNDING IS BEING USED TO PAY --
FOR AND WE'RE SEEING PROMISE AND
HELPING BENEFICIARIES OF
BEHAVIORAL HEALTH CONDITIONS
STATE OF THE HOSPITAL IN JAILS
I'M PRIMARILY THROUGH SERVICES
SUCH AS RESPITE CARE AND
SUFFERING CENTERS --
COUNTY IS A PUBLIC HEALTH
SYSTEMS HAVE --
ON THE GROUND EXPECT EXPERTISE
TO UNDERSTAND AND DELIVER WHAT
REALLY MAKES A DIFFERENCE FROM
MEDIC HOUSE MOST VULNERABLE IN
COLLABORATION WITH HEALTH PLANS
OTHER WHOLE PERSON HER PARTNERS --
WE LOOK FORWARD TO FOR TWO
OPPORTUNITIES --
TO TO SUSTAIN AND SPREAD THE
WHOLE COURT PERSON CARE WORK
AFTER THE WAIVER ENDS AND TWENTY
TWENTY THANK YOU.
THANK YOU.
GOOD AFTERNOON MR CHAIRS AND
MEMBERS I'M FAIRLY STATE TING ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES
REPRESENT IN ALL FIFTY EIGHT
CALIFORNIA'S COUNTIES.
THANK YOU FOR THE SUBSTANTIVE
HEARING AND THE HEARING LAST
WEEK LOOK FOR TO THE LAST ONE IN
THE BACKGROUND PAPER ONE ECHO
ONE OF THE PANELISTS THAT WAS
AMAZING --
COUNTIES WANT TO DO BETTER WE
WANT TO WORK WITH THE PARTNERS
IN OUR COMMUNITIES WHETHER THEY
ARE THE SCHOOLS.
COMMUNITY BASED CLINICS FQHCS OR
OTHER COMMUNITY PARTNERS ARE
HOSPITALS WE WANT TO WORK WITH
THOSE ENTITIES --
TO MAKE SURE THAT THE PEOPLE
THAT NEED THE CARE ARE GETTING
AT WHEN THEY NEED IT --
WEEK AS YOU'VE HEARD WE RUN UP
AGAINST THE CHALLENGE OF BEING
TREATED LIKE A HEALTHCARE PLAN
WITH ALL THE RULES AND
REGULATIONS IN ADMINISTRATION
AND BILLION IN COSTS.
BUT ALSO SORT OF THE SOCIAL
MODEL WE WANT TO BE OUT THERE IN
THE COMMUNITY AND THE PEOPLE AT
THE COUNTY LEVEL ARE DOING THAT
WORK -- AS
USE HEARD FROM MS LARSON AND
YOU'LL THEY'RE REACHING THE
COMMUNITIES THAT ARE UNDER
SERVED THEY WANT TO SERVE
EVERYBODY IN THE COMMUNITY SO WE
LOOK FORWARD TO CONTINUING TO
WORK WITH BOTH HOUSES ON HOW WE
MOVE FORWARD --
IN MAKING SURE THAT EVERYBODY'S
GETTING THE CARE THEY NEED AND
THAT COUNTIES CAN COMPLY WITH
THE RULES AND REGULATIONS THAT
ARE REQUIRED OF THEM --
AGAIN I WANT TO THANK YOU FOR
HAVING THESE HEARINGS THANK.
GOOD AFTERNOON ADRIN SULTAN WITH
THE STEINBERG INSTITUTE WOULD
ALSO LIKE TO THANK THE COMMITTEE
FOR THE SIGNIFICANT TIME.
I'M DEDICATED TO THE TOPIC OF
MEDI CAL MENTAL HEALTH --
REALLY EXCELLENT WORK BY THAT
NOT BY THE LEADERSHIP IN THE
MEMBERS AND THE STAFF --
WELL THE ISSUES THAT --
WE WORK ON IN THIS FIELD MAY
SEEM.
VACCINE AND COMPLEX WOULD LIKE
TO NOTE THAT THERE ARE PROGRAMS
WITHIN THE SPECIALTY MENTAL
HEALTH SYSTEM THAT ARE WORKING
QUITE WELL --
PREVENTION AND EARLY
INTERVENTION IT HAS BEEN A LONG
STANDING TOP TIER PRIORITY FOR
THE STEINBERG INSTITUTE AND THAT
WILL CONTINUE INTO THIS YEAR WE
LOOK FORWARD TO WORKING WITH THE
BOTH OF THE COMMITTEES AS A WEEK
BRING FORWARD PROPOSALS THIS
YEAR. TO STRENGTHEN AND IMPROVE
THE SYSTEM OF CARE SO WHETHER
THAT'S PROPOSALS RELATED TO
SUICIDE PREVENTION --
PROPOSAL RELATED TO ENSURING
EQUAL ACCESS FOR MENTAL HEALTH
AND SUBSTANCE USE SERVICES AS
THERE ARE FOR PHYSICAL HEALTH
CARE.
ENSURING THERE'S A MORE
COORDINATED STATEWIDE TRAUMA
RESPONSE AND BE IN EMERGENCIES
IN OUR STATE AND ADDRESSING THE
SIGNIFICANT DISPARITIES THAT WE
HAVE IN OUR FIELD.
OF THE IMPORTANCE OF THESE
ISSUES REALLY CANNOT I WANT TO
THANK YOU FOR THE OPEN DIALOGUE
TODAY IN THE PROBLEM SOLVING
THANK YOU.
HELLO AND I WANT TO ALSO THANK
YOU ALL FOR HOLDING TODAY'S
DISCUSSIONS MY NAME IS RORY
O'BRIEN I'M WITH NORCAL MENTAL
HEALTH AMERICA AND THE OUT FOR
MENTAL HEALTH PROJECT.
OF FOR MENTAL HEALTH IS A STATE
WIDE LGBT Q. MENTAL HEALTH
EQUITY INITIATIVE FUNDED BY THE
MENTAL HEALTH SERVICES OVERSIGHT
AND ACCOUNTABILITY COMMISSION.
SOME OF TODAY'S PANELISTS SPOKE
TO THE NEED FOR GREATER DATA
METRICS TO ASSESS ACCESS TO AN
QUALITY OF MEDIC HAL MENTAL
HEALTH SERVICES.
DATA SPECIFIC TO THE HEALTH AND
HEALTH DISPARITIES FACED BY LGBT
Q. CALIFORNIANS IN PARTICULAR IS
SEVERELY LACKING AND THE
LEGISLATURE HAS PREVIOUSLY.
RECOGNIZE THIS AS IN THE PASSAGE
OF ASSEMBLY BILL NINE FIVE NINE
THE L. G. B. T. REDUCING
DISPARITIES ACT.
AS A COMMUNITY BASED RESEARCHER
WITHOUT FOR MENTAL HEALTH I'M
EXCITED TO INCLUDE METRICS
INCLUDING TIMELY ACCESS TO CARE
METRICS IN OUR RESEARCH STUDY
WHICH WE LAUNCHED THIS MORNING.
AS I BELIEVE THAT THIS MAY BE
THE FIRST AND ONLY STATEWIDE
SURVEY TO ASK LGBT Q. PEOPLE
ABOUT THEIR TIMELY ACCESS TO
CARE IN THE STATE OF CALIFORNIA.
I HOPE TO COLLABORATE WITH AT
THE LEGISLATURE AND WITH STATE
PARTNERS TOGETHER MEANINGFUL
DATA ON ACCESS TO SERVICES AND
TO INFORM EFFORTS TO CLOSE
HEALTH DISPARITIES FACED BY LGBT
KIA CAT.
OF THE BT CUTE CALIFORNIANS
THANK YOU SO MUCH THANK YOU.
WELCOME GOOD AFTERNOON MISTER
CHAIR AND MEMBERS CONNIE DELGADO
ON BEHALF OF THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION WANT TO THANK YOU
FOR THE HEARING AND THE GREAT
DISCUSSION WE LOOK FORWARD TO
WORKING WITH ALL THE STATE COURT
HOLDERS GOING FORWARD TO ADDRESS
THESE ISSUES THANK YOU
[inaudible]
THANK YOU [inaudible]
WELCOME.
JANET FRANK UCLA CENTER FOR
HEALTH POLICY RESEARCH.
AND I WANT TO THANK YOU FOR YOUR
LEADERSHIP IN THESE AREAS --
WE'VE BEEN WORKING WITH THE
STATE THE LAST FEW YEARS LOOKING
AT A PUBLIC MENTAL HEALTH IN
OLDER ADULTS.
I WANT TO THANK YOU FOR
INCLUDING A SPEAKER ABOUT DUAL
ELIGIBLES THESE ARE PEOPLE WITH
THE MOST VULNERABLE KINDS OF
ISSUES.
AND SO WE THANK YOU FOR HAVING
MISS ALTMAN SPEAK --
OUR OWN RESEARCH ARE REALLY
SUPPORTS THE EFFORTS THAT YOU'RE
PUTTING FORTH INTEGRATED CARE
IT'S IS ARE IMPORTANT FOR ALL
AGE GROUPS AND ESPECIALLY OLDER
ADULTS WHO OFTEN HAVE.
MOBILITY AND HEIGHTENED STIGMA
ISSUES WE AGREE THERE NEEDS TO
BE A MINIMUM DATA SOFT OF DATA
ACROSS ALL THE COUNTIES.
WE ALSO AGREE THAT THE JURY IN --
ARE REALLY INAPPROPRIATE AND WE
SHOULD NOT BE GIVING SERVICES
BASED ON ZIP CODE LOTTERY.
AND FINALLY WE AGREED THAT --
WORKFORCE ISSUES ARE CRITICAL
AND ESPECIALLY AROUND
SPECIALIZED WORK FORCE TRAINING
FOR GERIATRIC BEHAVIORAL HEALTH
THANK YOU [inaudible]
WELCOME.
GOOD AFTERNOON TO MADDEN REPS IN
THE CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS WHO ARE TO THANK THE
COMMITTEE FOR ITS ATTENTION ON
THIS ISSUE.
AND AS WE'VE HEARD TODAY ALL THE
PROBLEMS THAT WE'VE BEEN
DISCUSSING.
THEY LIED A LOT OF THESE
INDIVIDUALS TO COME INTO THE
MARIN SAID APARTMENT AND ONCE
THEY COME IN IN THE MARIN CITY
APARTMENT THEY TEND TO STAY IN
THE EMERGENCY DEPARTMENT AS WAS
HIGHLIGHTED THE BACKGROUND PAPER
AND THAT'S WILL REFER TO THE
BOARDING.
AND THEN ONCE WE GET TO A PLACE
WHERE WE CAN TRANSFER THEM TO TO
GET THE CARE THEY NEED AS WAS
DISCUSSED AND LAST MAN A LOT OF
TIMES THEY'RE DISCHARGED TO A
SITUATION WHERE THERE ARE COME
RIGHT BACK TO THE MERCY
DEPARTMENT.
IN THIS PROBLEM HAS A MUCH
BROADER IN FACT AND JUST ON THE
PATIENT THEMSELVES AS A BIG
IMPACT ON THE SYSTEM IN GENERAL
SO ANYONE WHO'S TRYING TO ACCESS
THE EMERGENCY DEPARTMENTS GOING
TO BE IMPACTED BY THIS BECAUSE
WE HAVE PATIENTS.
WHO STAY MEMBERS WHO DEPARTMENT
FOR LONGER TAKING UP --
RESOURCES COULD BE USED FOR
OTHERS.
WHO ARE HAVING AN EMERGENCY
MEDICAL CONDITION?
I'M SPECIFICALLY A COUPLE THINGS
WE ARE FROM OUR MEMBERS TO COULD
BE HELPFUL IS AROUND THE ACCESS
TO INFORMATION IF WE COULD HAVE
BETTER ACCESS TO A PATIENT'S
TREATMENT PLAN WHO'S COMING IN
HE'S BEEN A PART OF THE SYSTEM.
WE HAVE A BETTER UNDERSTANDING
OF HOW TO HANDLE THE CRISIS THAT
THEY HAVE.
SIMPLY YOU IF WE UNDERSTOOD WITH
THE MEDICATIONS WERE WE MIGHT BE
ABLE TO GET IN TO THAT PLACE AND
I'LL GIVE US OTHER OPTIONS IN
TERMS OF GETTING BACK INTO THE
SYSTEM.
GETTING BACK TO THEIR CARE
PROVIDERS SO THAT ON ITS OWN
COULD HAVE SOME REALLY BIG HELP
FOR US IN THE MERCY DEPARTMENT.
ON THE WHOLE PERSON CARE PILOT
IS SOMETHING THAT WE SEE A LOT
OF BENEFIT AS WELL SO EXCITED
ABOUT THAT.
BUT WE WILL LOOK FORWARD TO
WORKING WITH YOU AND TALKING
[inaudible]
THANK YOU.
WELCOME.
GOOD AFTERNOON LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY AGAIN THANK YOU. FOR
HOLDING THIS SIZE THIS HEARING
AND AND THE PAST HEARING ON ON
THIS ISSUE --
WE'D WE AGREE WITH MANY OF THE
COMMENTS ON STRONGER DATA I
NEEDED CARE COORDINATION AND
REFERRALS AND AND WHICH IS ADD
ONE OTHER CONSIDERATION RELATED
TO THE DISPUTE RESOLUTION.
I'M HAVING A DISPUTE RESOLUTION
PROCESS FOR WHEN --
THERE IS A DISPUTE BETWEEN
WHETHER THE SERVICE IS A MILD TO
MODERATE OR A A SPECIALTY MENTAL
HEALTH SERVICES SO THAT
INDIVIDUALS ARE NOT --
BOUNCING BACK AND FORTH AND CAN
ACCESS THE CARE THAT THEY NEED
THANK YOU [inaudible]
THANK YOU.
OKAY SAYING NO ONE ELSE AT THE
MICROPHONE I WANT TO THANK
EVERYONE FOR PARTICIPATING --
ETHNICALLY STINKER SPEAKERS --
I'VE REALLY APPRECIATE PEOPLE
COMING AND SPENDING TIME SHARING
WITH US --
THEIR EXPERIENCES.
WE HAVE A LOT OF WORK TO DO
AROUND MENTAL HEALTH --
I THINK THAT --
IN THE SPACE WE A LOT OF PEOPLE
DOING WE ARE HELPING PEOPLE SAME
TIME WITH --
FOR FROM MANY SPEAKERS ABOUT
ISSUES OF FRAGMENTATION OVERHEAD
SOME OF THIS YOU KNOW MAYBE FROM
THE FEDERAL GOVERNMENT AS WELL --
DEL CHALLENGES THE WORK FORCE --
YOU KNOW AT DAIS.
METRICS AND PERFORMANCE --
ACROSS THE BOARD --
SO -- THINK
ARE WE HAVE A LOT WORK CUT OUT
FOR US --
TOGETHER AND I I THINK THIS
HEARING AND ALSO THE PREVIOUS
ONE IS AS MUCH OF LUNCH POINT AS
IT IS CERTAINLY.
AT THE CONCLUSIONS HEARING DOES
NOT REPRESENT SENT THE
CONCLUSION OF OUR INTEREST AND
THIS ISSUE AND DID DELVING MORE
IN DEPTH IN THE FUTURE AS WELL.
SO WITH THAT I DON'T THINK
EVERYONE FOR BEING HERE SENATE
HEALTH CAN HEARING ON PRE THE
HEALTH OF THE RESEARCH NOW
ADJOURNED THANK