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Tom Watkins

By: Tom Watkins

The Sky Is Not Falling

February 19, 2016

Governor Snyder’s 2017 budget proposal creates a forum to explore ways to enhance care to some of the state’s most vulnerable citizens.

Governor Snyder’s proposed 2017 budget released last week had people talking. It is also a reminder, from Civics class –the Executive proposes, the Legislative branch disposes.

Jay Greene, the respected health care journalist with the Crain’s business publication, quickly reported on the governors budget with a bold headline: “Rick Snyder’s $54.9 billion fiscal 2017 budget calls for privatizing the $2.4 billion public mental health system by turning over state funding to Medicaid HMOs.”

He went on to report, “In what is called “boilerplate” language at the end of Snyder’s 408-page executive budget bill, Section 298 calls for carving in behavioral health benefits to the health plans by the end of fiscal 2017, which ends Sept. 30, 2017.” http://www.crainsdetroit.com/article/20160211/NEWS/160219967/michigan-would-privatize-mental-health-funding-services-under?X-IgnoreUserAgent=1&X-IgnoreUserAgent=1

Rightly or wrongly, a “carve in” is feared to mean by parents and advocates that the valued and progressive Michigan public mental health safety net will be ripped to shreds. Family members and consumers worry about change, losing long term relationships with trusted providers and new rules that limit service. Given the struggles to get what they have, their worries are not ill-founded.

The language and its interpretations sent shivers down the spines of parents and advocates of persons with serious mental illness, substance uses disorders and intellectual and developmental disabilities.

The fear comes from the general interpretation of the language that the administration, in what is feared as a cost shifting/saving move, plans to privatize – or as some parents say “profitize” the public mental health system of care they have fought for decades to help build.

The Michigan Association of Community Mental Health Boards are working with the Snyder Administration and the Michigan Health Plan Association in an attempt to have this “scary” boilerplate language removed from the budget bill or significantly modified.

In the mean time, they have provided “talking points” for Community Mental Health Boards, providers, consumers and advocates to uses in conveying the systems concerns to the Snyder Administration, legislators, and the media. Visit www.macmhb.org

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Pause, Listen and Reflect

Rather than run for the pitchforks and torches, I urge all parties to hit the pause button and use this moment to reflect and find a ways to re-imagine and reinvent our system of care that brings about change –leading to progress for the people we are all charged with serving.

Let’s come together and ask what strengths the various parties (consumers, advocates, family members, the public mental health system, hospitals, health plans and other stakeholders) bring to the table to reduce administrative costs, direct maximum public resources to consumers and produce the best outcomes for people in need of mental health and substance uses services.

Now is a time to “light a candle rather than curse the darkness.”

Let’s move forward, getting past the politics and turf protection considerations and truly place our collective focus on the citizens of Michigan, –our family members and neighbors in need of quality mental health and substance use services.

Governmental programs are human constructs. They can and should be reorganized, reformed, reinvented and transformed when need be. We also need to be careful not to “throw the baby out with the bath water.”

Change never comes easily. As we all know, the only human that truly likes to be changed is an infant. Our goal must be to forge change that leads to progress for the people we serve.

Centuries ago, that great political theorist Niccolo Machiavelli wrote: “There is nothing more difficult to manage, or more doubtful of success, or more dangerous to handle than to take the lead in introducing a new order of things.”

Shared Vision and Common Agenda

In May 2015, after months of collaboration between the Community Mental Health Boards (CMHs), Prepaid Inpatient Health Plans (PIHPs), and the Michigan Department of Health and Human Services (MDHHS) a document that reflects our shared vision and common agenda on how we see quality public behavioral health, developmental disability, and substance abuse services delivered and integrated with the broader health and social services system for children and adults in our communities was drafted and embraced by all parties.

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This shared vision and common agenda document must be the foundation upon which any discussion of a system redesign begins and is built.

The agreement specifically states, “It is intended to be a dynamic document used by us all to find common ground and understanding amidst our areas of disagreement as we work to improve the lives of the individuals we serve. It has at its core a fundamental value and belief that the benefits and services we deliver are unique and specialized for the purpose of improving the lives of Michigan’s most vulnerable citizens.”

Reimagine and Reinvent

Ask: If we had an opportunity to do a “do over” in creating a statewide behavioral health system of care, would any of us create what we have now? I think the answer is obvious.

We need to approach this opportunity as if we just discovered this place called Michigan and we had 300,000 people with disabilities that needed care and support, and each year $2.4 billion washed up on our shores to serve these individuals. Now, design a system around our shared values to help meet their needs.

Clearly we cannot continue to behave as though nothing has changed in health care when everything is changing around us. This is an opportunity to put into action “people over programs and politics”.

There are advocates, consumers and leaders in the community mental health system willing to roll up our sleeves in a true partnership to forge a new beginning that add value and makes a difference in the lives of persons with a serious mental illness, substance use disorders and intellectual and developmental disabilities.

None of us individually has “the answer”, but collectively we can forge a better answer to enhancing the existing system of care. As Einstein once remarked: “We can’t solve the existing problem with the same thinking that helped create it.”

So pulling together thought leaders to reimagine and redesign a system of care is something we should ALL embrace.

Tapping a Reservoir

Lt. Governor Brian Calley "listening and learning"

Lt. Governor Brian Calley “listening and learning”

Lt. Governor Calley who has a deep reservoir of goodwill to draw from given his leadership chairing the Mental Health and Wellness Commission, expanding insurance coverage for autism and pushing for major and significant changes, such as ending the barbaric practice of seclusion and restraining students in our public schools, has pledged to become deeply involved in working through this issue.

The Lt. Governor took to social media and posted two days after the budget proposal was released:

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I have come to respect and trust Lt. Governor Calley when it comes to meeting the needs of persons served by the mental health system. He is accessible and willing to listen and learn and bend public policy in ways that serve people: specifically meeting the needs of persons with mental illness, substance use disorders and intellectual and developmental disabilities.

The Lt. Governor has promised to take a lead in bringing the various stakeholders together around the goal of maximizing taxpayer value and enhancing services to people. I take him at his word and expect an inclusive stakeholder meeting to be scheduled before this article is published.

Together with the department of health and human services and the leadership of its director, Nick Lyon and Medicaid director, Chris Priest and their teams, there is an opportunity to turn lemons into lemonade.

Doing Good, Well

The Detroit Wayne Mental Health Authority (www.dwmha.com), since becoming an Authority in 2013 has made a number of value based decisions which has allowed for efficiencies and cost savings to be redirected towards service.

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As examples we very proud we have:

  • through better data management generated $30 million in new Medicaid resources for Detroit/Wayne County
  • eliminated nearly $30 million in legacy pension and health care costs
  • redirected over $20 million to provide a $1/hour increase to direct care staff who make slightly over minimum wage caring for extremely vulnerable persons
  • consolidated 2 substance use organizations into our existing organization reducing administrative cost and redirecting over $3 million to service.

At DWMHA we have strengthened care, flattened administrative costs and redirected dollars to service. We expect we will have a prominent seat at the table with the Snyder Administration and the legislature as they move forward on a system redesign. There are ways, which we have demonstrated to improve service delivery that don’t place profits over people.

Advocates Speak

Elmer Cerano, CEO of the Michigan Protection and Advocacy expressed the aspiration and fear of many well when he said, “We need to insure the values imbedded in the concepts of “Person Centered Planning”, “Self Determination”, Conflict-free Case Management, Community Inclusion, Least Restrictive, Environments, Home and Community Based Services and all of the other elements of progress that Michigan has made over the past 4 decades in demedicalizing and deinstitutionalizing supports for people with disabilities remain in any system redesign.” His values and insights must be followed.

I am an optimist and believe Henry Ford’s logic when he said:
“Coming together is a beginning.
Keeping together is progress
Working together is success.”

Governor Snyder’s proposed budget is just the beginning of the process. It makes sense to take a step back and have an inclusive, transparent review our system of care, one that does not have predetermined outcome other than enhancing quality and maximizing taxpayers resources.

Moving forward, the dialog around this issue needs to be open, transparent and inclusive with the state, community mental health organizations, Health Plans, hospitals, consumers and advocacy groups. An open and collaborative approach with all stakeholders will produce better results.

Let’s work together to reimagine and reinvent a better tomorrow for persons with disabilities, mental illness and substance use disorders. Nothing we do should diminish the care, support and opportunities for our family members with an illness or disability. Everything we do should create opportunities and a life of dignity and self-determination for our fellow citizens.

We ought to proceed as though our actions will impact someone’s mother, father, sister, brother or son or daughter– because ultimately it will.

Editors Note:

As promised, Lt Governor Brian Calley called a meeting with a broad cross section of stakeholders from the advocacy, consumers, community mental health/ PIHP’s, hospital health care, sheriff, county and various professional associations together with the Michigan Association of Community Mental Health Boards. The meeting was held as we went to press.

As indicated above, the meeting was inclusive, open and is the beginning of a process that can discuss change that will lead to progress for the people we collectively serve.

An opportunity has been created to redesign a system of care in response to the expressed needs and desires of consumers of behavioral health services that improves outcomes, enhances full citizenship, and self determination– while providing value to taxpayers.

Thank you Lt.Gov Calley for pulling people together to imagine how we can dream, plan and reinvent a system of care that begins and stays focused on the needs of the people we serve.

As soon as available the list of persons/organizations that will participate on the “steering” committee will be posted. The first charge from Lt. Governor Calley is to develop a philosophical/vision/ values foundation and a set of “facts” the group can use as framework upon which to build.

Stay tuned.

Tom Watkins is president and CEO of the state’s largest PIHP, the Detroit Wayne Mental Health Authority (www.dwmha.com). He served the citizens of Michigan as state superintendent of schools under Governors Engler and Granholm and was state mental health director, under Governor Blanchard. He can be emailed at: tdwatkins88@gmail.com, or followed on twitter at:@tdwatkins88

February 18, 2016 · Filed under Tom Watkins


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