Mental health service management is set to be consolidated further, with a merger to take 10 existing Managed Care Organizations (MCOs), including local Eastpointe, and grouping them into four such organizations across the state.
During a recent Sampson Board of Commissioners meeting, Eastpointe CEO Ken Jones reviewed the state and local initiatives of a proposed Local Business Plan encompassing 2013-16, discussing anticipated changes in the structure of mental health services and what that will mean for Sampson County locally.
Local Management Entities/Managed Care Organizations (LME/MCOs) like Eastpointe offer around-the-clock access to care, review of service requests and care coordination, while managing Medicaid for its 12-county region.
“We really feel like we have good customer service and local presence,” said Jones, pointing to targeted goals to improve that service.
In managing service, the average wait time in the emergency room for a patient with a mental illness, across the state, is two to three days, Jones noted.
“Not two to three hours, two to three days,” he remarked. “For every 15 minutes that person is in that hospital it is costing us, it’s costing the taxpayers, it’s costing Eastpointe. One of our biggest goals this year is to reduce the crisis and ER wait times and reduce the number of ER visits.”
Jones said that can be done by Eastpointe staff working with local magistrates and law enforcement. Those who are deemed involuntary commitments must automatically go through a process that involves an ER visit. Working with law enforcement, Eastpointe might be able to ensure those deemed “IVCs” are truly in need of such treatment.
Removing people from the state waiting list by seeing that they receive treatment, while decreasing readmission rates into hospitals, are chief among other goals.
In recent years, Eastpointe has transformed from a service provider for the indigent population to an organization that now manages mental illness, intellectual/developmental disability and substance abuse services, as well as Medicaid.
“Our budget has gone from $30 million (in indigent funding) to more than $300 million funding,” said Jones, noting the $270 million difference is the Medicaid that is being managed. “We have been through many years of change,” said Jones. “In a couple more years, we will have change again.”
That will come in the form of consolidation.
MCOs like Easpointe and others have saved the state a great deal of money in past mergers and management and the next consolidation is seen as another step toward efficiency.
“Over the past year, these Managed Care (Organizations) have saved the state of North Carolina somewhere around $150 million by managing the service and collapsing from 22 down to 10 entities,” said Jones. “One of the secretary of Health and Human Services’ goals over this next year is to collapse 10 down to four MCOs. This is really based on efficiency, standardization and stabilization. We’ve got many providers who deal with 10 MCOs and they all do business differently. It is very complicated and it has been a struggle this year.”
Jones said Eastpointe is about a year away from making an official request to the board.
“In the near future, we will be coming to all the counties and asking for your support in signing off for the consolidation,” said Jones. “The consolidation date will probably be somewhere around July 2016, and we are in the early stages of that.”
That means Eastpointe MCO’s current status as a dozen-county entity would grow to cover about one-third of the state’s counties — the entire eastern portion — through a merge with East Carolina Behavioral Health and CoastalCare.
“Out of those MCOs, Eastpointe is probably double the size of the other two,” Jones pointed out. “There is no leader at this point in this merger. That has not been determined, but I will say this is two very good partners. I will say, at least two of the partners, Eastpointe and East Carolina Behavioral Health, are in financially good shape. We feel like we will be a good organization once we do come together.”
The Sampson County Board of Commissioners approved the Easpointe LME Local Business Plan for 2013-16.
Commissioner Albert Kirby lauded Jones and his staff for “enduring and surviving” so many obstacles in providing mental health and substance abuse services and now managing that care, weathering and thriving through past consolidation.
“The reason why the name is still Eastpointe is because (Jones) and others had the wisdom and the dedication to continue to get ahead of the game, so we could exist as Eastpointe but larger,” Kirby noted.
Chris Berendt can be reached at 910-592-8137 ext. 121. Follow us on twitter @SampsonInd.