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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

WAT1

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.

WAT2

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:

WAT4

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.

WAT5

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

41 responses so far ↓

  • 1 CMM // Feb 18, 2016 at 10:09 pm

    This is a great opportunity to recreate the behavioral healthcare system, with the person receiving services, their recovery and their right to a self-determined life being the focus of the design, not dollars and dogma.

  • 2 Ben // Feb 18, 2016 at 10:54 pm

    Way to lead!
    Keep the focus on service- not profits
    Let consumers, families and advocates lead the way

  • 3 Silvia // Feb 18, 2016 at 11:51 pm

    Thoughtful commentary.
    I hope the broader media picks up on this issue.
    These issues impact too many families to turn over to private hucksters attempting to make money off of misery .
    You ever notice how the private sector bashes government– while profiting off of it?
    Be wary
    Hope this is real and not just a sham to con advocates

  • 4 Fred Silver // Feb 19, 2016 at 3:48 am

    Reasons to be skeptical of anything the State says:
    Audit cites lack of staff, false records at vets home
    http://www.freep.com/story/news/local/michigan/2016/02/18/draft-audit-michigan-veterans-home/80556304/

  • 5 Joe Nathan // Feb 19, 2016 at 5:53 am

    Once again, Watkins proposes positive steps to meet important, real needs. Thanks, Tom.

  • 6 Sharon // Feb 19, 2016 at 8:34 am

    The sky has already fallen. The real issue the core issue here is the trust has been severed. Very few in the state of Michigan trust Governor Snyder. It takes years to repair that trust if indeed it can be repaired. There would be no need asking people to not run for “torches’ and pitchforks” if there was trust in our Governor. Simply put we need a new Governor. The trust in him is destroyed beyond repair.

  • 7 Marc Craig // Feb 19, 2016 at 9:26 am

    Great article Tom.
    Clearly there is a need/opportunity for improved efficiency and effectiveness, while maintaining a system of care that is, to a great degree, working for our state’s most vulnerable citizens.

  • 8 Jim Dehem // Feb 19, 2016 at 10:03 am

    Very good article Tom. We must also be careful in defining what integration of healthcare and behavioral health including long term care for people with intellectual and developmental disabilities really means. We can all likely agree that integration means better communication and sharing of information that improves our ability to support people. However, integration does not have to mean the merging of the two systems. Long term supports including housing, employment, inclusion into the community, developing life aspirations are far different from basic health care objectives but clearly are needs of those in the behavioral health system to prosper. Any new plans must not put those support needs at risk.

  • 9 Dian Wilkins // Feb 19, 2016 at 10:29 am

    Excellent article — very thoughtful, sensible. Yes, let’s reimagine how we wish to structure these essential and life-saving services!

  • 10 Provider // Feb 19, 2016 at 12:39 pm

    Tom’s comments reflect true leadership. I like that he is not endorsing scare tactics like others are doing. We have contracts with both the public system and HMOs. The payer is less important than the people’s experience with the providers delivering the services. I believe in a strong public system, but I am not sure that I believe in the one that exists today.

  • 11 Elizabeth // Feb 19, 2016 at 1:28 pm

    Be ware of a bait and switch. It is good that consumers, providers and advocates are at the table– perhas there is an opportunity to develop meaningful reform that places people over a quick buck for those that feed off of human misery.
    Proceed with great caution!

  • 12 Bob Stein // Feb 19, 2016 at 1:55 pm

    Thanks Tom for urging a thoughtful approach to the future of behavioral health and developmental disability services. The opportunity clearly exists to enhance services to people with disabilities. The next few months should be devoted to an open and thorough discussion on the integration of services.

  • 13 Linka J. // Feb 19, 2016 at 2:03 pm

    Tom, although I like your message and you have good reason to be proud, I don’t believe that you actually operate your crisis help line. It would help your credibility if you didn’t take credit for the work others have done or are doing.

  • 14 Kari Walker // Feb 19, 2016 at 2:09 pm

    Tom – thank you for posting your thoughtful article. One of the strengths of the public mental health system in Michigan has been its Person-Centered approach and willingness to address unique needs that individuals and families have. Person-Centered plans are by their very nature larger than the Medicaid benefit. We have braided funding, local support and philanthropy that extend and expand on what is in the Governor’s budget. Preserving Person-Centered values and service innovations and taking them to the next level are what’s needed now.

  • 15 Tom // Feb 19, 2016 at 3:15 pm

    Links J.
    We find and contract out our crisis and access line — as we do for the overwhelming majority of services provided. I continually promote this # so those in need will know where to call for help.
    We have an exceptional number of quality providers that add value and make a difference in then lives of the people we serve.
    Thanks to the quality providers for all you do.

  • 16 Robert White // Feb 19, 2016 at 3:25 pm

    I would ask that as Lt. Gov Calley develops the “steering” committee to work on the redesign of the CMH system that he consider having members of one or more “Parent Advocacy Groups” participate as members of this “steering” committee as we represent stakeholders in the CMH system that are closest to the consumers of behavioral health services.

  • 17 Tom // Feb 19, 2016 at 3:45 pm

    Robert–it was clear the process will be driven by the consumer voice — primary and secondary/families. NAMI IS represented by the statewide director and the Metro Director
    ARC has two representatives and there are other as well.
    We want and need this important voice.

  • 18 Janet Smith // Feb 19, 2016 at 4:25 pm

    Thanks Tom for putting the voice of reason in to this conversation. Hoping everyone involved in conversation takes time to read this..

  • 19 Ann J. // Feb 19, 2016 at 4:25 pm

    Compelling column…..

  • 20 Clint Galloway // Feb 19, 2016 at 5:00 pm

    Yes! Section 298 in the FY 2017 budget created quite a stir! Thanks for articulating the high road in addressing the anxiety, fear and anger it has precipitated. You have recognized an opening, seizing it as an opportunity. You are providing focus by framing the question: “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?” The implication is clear, “No”. Then what would it be? This invites a time for reflection and coming together, (probably in that order) acknowledging that, “we cannot continue to behave as though nothing has changed in health care when everything is changing around us.” This change long preceded the budget announcement. Finally, you accomplish some significant bridge building in thanking Lt. Gov. Calley for pulling people together. Everyone’s voice needs to be at the table. While recognizing some of the great accomplishments achieved in the public sector of behavioral health, I am very excited about the possibilities of having authentic Integral Care in Michigan, care that transcends and includes the very best that is present. We don’t have the option of avoiding anxiety, it comes with change and change is a constant. We do, however, have a choice of how we respond along with the knowledge of how to evaluate those responses. (Thanks to George Vaillant) Thanks again for articulating a path that calls out the very best in us. This is leadership, a capacity available to everyone.

  • 21 Bob // Feb 19, 2016 at 6:37 pm

    Here is a partial list of persons who attended the meeting with the Lt Gov.
    From all I have heard from numerous sources there the focus was on:
    Consumers and families driving the process
    Not-/ on supporting or protecting any particular system if care
    Desire to better integrate care– but agreement that where the money resides does not equal integrated care”
    Goal to set an agreed upon set of values amongst the parties– using the visions and values document signed by PIHP’s/CMH’s and DHHS as a starting point
    Agree on a set of facts– everyone is entitled to their individual opinions– but a joint agreed upon set of facts will drive the work
    General consensus the current boilerplate language was unacceptable to most if not all participants– agreed to look forward– not back
    Goal to ultimately replace the existing boilerplate language with consensus language developed by the group below with additions of more primary consumers and a few other undisclosed associations
    mails:

    Alan Bolter (ABolter@macmhb.org); Robert Sheehan ; msrmha@aol.com; ‘tjungel@misheriff.org’; ‘Dana Gill’ ; ‘kfischer@namimi.org’; ‘sherri@arcmi.org’; ‘dhoyle@arcmi.org’; ecerano@mpas.org; ‘roanne@mymdrc.org’; ‘agorelick@epilepsymichigan.org’; ‘Tom Watkins’ ; ‘l.judd@comcast.net’; ‘jpatton@kazoocmh.org’; ‘lisah@wmcmhs.org’; ‘brooksw@occmha.org’; ‘john.kinch@mccmh.net’; ‘jdelay@dwmha.com’; ‘wward1@dwmha.com’; ‘Carmen McIntyre’ ; ‘rstein@miassistedliving.org’; Priest, Chris (DHHS) ; Zeller, Lynda (DHHS) ; Lyon, Nick (DHHS) ; Grijalva, Nancy (DHHS) ; ‘rmurdock@mahp.org’; Renwick, Thomas J. (DHHS) ; Becker, Timothy (DHHS) ; ‘wallen9569@comcast.net’; ‘bpeters@mha.org’; MDHHS-DD-Council ; ‘pweaver@hopenetwork.org’; Daniel Cherrin (dcherrin@northcoaststrategies.com); acmhjane@sbcglobal.net; ‘ndelisle@mymdrc.org’; Hertel, Elizabeth (DHHS) ; Zaniewski, Jamie (GOV) ; ‘johnsons@krkm.com’; ‘David Finkbeiner’ ; ‘Laura Appel’

  • 22 Elaine // Feb 19, 2016 at 6:52 pm

    I have worked in Michigan’s behavioral health system most of my career and for the last three years within for profit health plans specifically on integrated care projects and I can tell you this- Working within an integrated system for health care and all social services, I have been able to help the most vulnerable people in ways I never could in the siloed traditional behavioral health system. And for those that fear for profit health plans remember this- even if the health plan only cared about profits, and many do not fall into this category, the biggest expense of care falls into two primary categories: admissions and medicine. If a health plan can save money on those two high cost areas by increasing social supports they will do this- I have experienced it. Health plans will leverage social service supports that are best practice (person centered and self-directed) to improve health outcomes it is a win win for all people affected by this change. Siloed, seperate systems are the way of the past. the ACA and integrated care the way of the future.

  • 23 Jill // Feb 19, 2016 at 7:10 pm

    Tom – it has taken so long to get people to be a part of the community and I really want people with intellectual and developmental disabilities to continue with choice, Self-Determination and a part of their own community life! I understand that changes ARE going to be made but never, ever at the expense of people with IDD. Going to a Profit system will not necessarily see individuals as individuals but dollars signs. There needs to be language protecting and giving choice. Do I want to get the pitchfork – no but I do want what is deserving to individuals with IDD as they have already fought a fight of freedom!

  • 24 Robert White // Feb 19, 2016 at 10:08 pm

    No disrespect intended as the DWMHA under Tom’s leadership and as referenced in this article has accomplished and continues to accomplish many positive things. I do think it is worth noting that one of the enablers benefiting DWMHA is the $40.3 m increase in Medicaid funding DWMHA will receive from MDHHS between Oct. 1, 2015 and April 1, 2017 as the result of ongoing re-basing by MDHHS when during this same time frame MDHHS will reduce funding to Macomb and Oakland Counties by $27.1m and $15.4m respectively.

  • 25 Richard Osburn aka Oz // Feb 19, 2016 at 10:10 pm

    More questions than comments
    1. The Administrative Service Organization that the
    State of Michigan will contract with seems to be picking up more of functions that the old Dept. of Mental Health was\is doing and thus shrinking down the size of the Dept. If this is correct, who will be left to monitor the ASO?
    2. In reading about the PIHPs, I am not clear if the document is referring to the local PIHPs or the “Super PIHPs? It is not clear as to what the remaining functions of both levels of PIHPs will be outside somehow come up with local match for Medicaid dollars????
    3. Back in 1999, when the Mental Health carve out occurred, the mild to moderate clients were left with the private HMO’s. When a concern was raised about the CHMS having to follow a Medicaid guidelines and rules with all of the forms, processes, and required training, but that the MHOs did not have to do so, the reason given by the DMH was that once the Medicaid dollars were given to the HMOs they were no longer public dollars and that they did not have to follow Medicaid and State Mental Health rules. For example, Recipient Rights Rules did not apply to the HMOs, so with the proposed shift will this ruling still be the same with the private MHOs??
    As a footnote,I was around when the community mental boards were formed in Michigan and have worked 30 years in the CMH and PIHP systems.

  • 26 Tom // Feb 19, 2016 at 11:39 pm

    I hope people will continue to point the strengths and weaknesses of the current system– and what flaws they see with transitioning to the elimination of the PIHP and transferring over $2 billion of public money to the private Health Plans.
    Also, what are the strengths of the Health Plans which would make this transfer of in excess of $2 billion a wise decision.
    What are the hopes and fears?
    What is the best way to serve some of our states most vulnerable citizens?
    Your ideas are most welcome

  • 27 Liz K. // Feb 20, 2016 at 8:24 am

    This is a collection of articles related to Section 298— that scares ALL that care about quality care for their love ones. Please do no harm to the minimal services we now have. Don’t let people take profit off of what we get now.
    Please make things better-not worse!

    http://www.lansingstatejournal.com/story/news/local/capitol/2016/02/18/official-snyder-not-privatizing-mental-health/80566960/

    http://www.thetimesherald.com/story/news/local/port-huron/2016/02/16/snyder-budget-could-shift-mental-health-funding/80441816/

    http://www.voicenews.com/articles/2016/02/18/news/doc56c62d8ac9a7f413246141.txt

    http://www.grandhaventribune.com/State/2016/02/14/Governor-s-budget-proposes-privatizing-mental-health-funding.html?ci=stream&lp=12&p=1

    http://www.michigansthumb.com/news/local/article_8c6d1d74-d571-11e5-881f-73f03acfe113.html

    http://detroit.cbslocal.com/2016/02/12/gov-snyders-budget-proposes-privatizing-mental-health-funding/

    http://www.crainsdetroit.com/article/20160211/NEWS/160219967/michigan-gov-rick-snyders-proposed-budget-would-privatize-mental

    http://www.therepublic.com/view/story/d761bacd0f5543ee8a2bc611c396f998/MI–Michigan-Budget-Mental-Health

    http://thecountypress.mihomepaper.com/news/2016-02-17/News/Lapeer_commission_Dont_privatize_mental_health_car.html

    http://www.heraldonline.com/news/article60042791.html

    http://www.theolympian.com/news/business/article60042791.html

    http://www.myrtlebeachonline.com/news/article60042791.html

  • 28 linda // Feb 20, 2016 at 9:24 am

    298 said what it said. The analysis of many people in the business was not a “chicken little” moment. That they have pulled back in response to public outcry, and once 298 came to light, it is no reason to pat them on the back, and every reason to keep vigilant to their desire to dismantle the public system.

  • 29 Tim // Feb 20, 2016 at 10:24 am

    Trust– but verify!
    This is a good strategic move for the providers, consumers and advocate to “work with” the Administration to get them to back off their end game to privatize and profitize the services to people– but be ware— that is CLEARLY their end game!
    The only thing that will prevent this from happening is if the consumers and advocates stand strong and refuse to go along with ANY plan that deminishes services and supports we have fought hard to get.
    Yet, we need to be honest– all is not well with our current system. So, an honest, thoughtful review that starts with the consumer and family in mind as the author suggests — is a worthy starting point.
    Trust– but verify– and keep your torches and pitchforks nearby!
    Stand strong!

  • 30 Elaine // Feb 20, 2016 at 10:59 am

    Administrative functions should sit with Health Plans who have the technology to authorize and track electronic claims- One plate form for all authorizations- NCQA standards followed to assure HEDIS measures and reporting
    Health plans assure network adequacy PIHP assistance
    PIHP’s should transform to become a provider system and continue to do what they do best: Training; recipient rights; advocacy; quality management of BH services (NCQA standards) and of course all BH & SUD inpatient and outpatient Service provision. I would further suggest the federal government consider merging homeless services and all DHS/Public health services into this integrated approach and use the PIHP network more broadly to offer those services, contracting with the health plans to do.

  • 31 Marlene // Feb 20, 2016 at 12:33 pm

    Lots of finger pointing, pimping and whining going on here.
    Seems there is a blank sheet in front of you to reimagine and rebuild a new system of care– don’t blow it by pointing fingers, casting blame and looking backwards.
    If you have good ideas– place them in the public square.
    The Snyder Administration is a deadman walking. Now is the time to push forward a vision that truly places people at the center of decisions.
    If they don’t listen to advocates, parents, consumers— there will be hell to pay— hopefully, they understand the only thing more unstoppable than an advocate/ parent that feels a politician lied and misled them and the expense of their child!

  • 32 Tom // Feb 20, 2016 at 1:45 pm

    Lt. Gov. Calley to lead effort to find consensus on mental health funding – Crain’s Detroit Business
    “I have an open mind,” Calley said. “I want more money going to people. I don’t have a loyalty to government structures. I have a loyalty to getting more money to consumers.”
    http://www.crainsdetroit.com/article/20160220/NEWS/160229999/lt-gov-calley-to-lead-effort-to-find-consensus-on-mental-health?X-IgnoreUserAgent=1

  • 33 Martha // Feb 21, 2016 at 7:38 am

    Lt Gov– please proceed with caution. Don’t believe big business, campaign donors, people who would like to profit of our families pain.
    We can improve the current system for sure– it is far from perfect. Yet, for the most part, it is driven by compassion and service. Be very careful not to throw human goodness out in a rush to change or believe what people want in the pursuit of profit.
    Not all that glitters is gold

  • 34 Craig Douglas // Feb 22, 2016 at 4:26 am

    Thoughtful writing by an excellent leader. I do share concerns.

  • 35 Lidia // Feb 22, 2016 at 2:44 pm

    I also believe a steering committee should be started with individuals that can address matters with the different communities. Because the ideal situation would be that services and resources would be available at one site with collaborating organization or services to include resources within communities . Centralized at sites in each part of the state . Focused on Patient needs not profit centered

  • 36 Lclass // Feb 22, 2016 at 6:26 pm

    My concern is that when asked if the people served were at the table, NAMI and ARC were given as examples. These are not primary consumers of the CMH system, as wonderful as they are. Were ANY folks at the table who receive services from the current system? The table should be full of them and the peer support specialists in recovery. are going to give you a clearer picture. Personally, I think this is a terrifying idea. Health insurance companies only care about money, in my unfortunate experience. Sometimes you have to support people without, because it is the right thing to do. Give cmh’s guidelines, for sure The purpose of community mental health is outdated. We certainly see that happening all over the state with integrated care centers that care for the whole person. Please don’t put companies that are already using cost cutting measures in charge of a financially devastated
    state. I am so happy for the author’s efforts on the east side of the state. What about Central MI or the UP? They get a pittance “because there just aren’t enough people” in those areas. If we are going to change things, change the way we spend the Federal Medicaid dollars. Get rid of subcapitation and give all Michiganders equal access to all healthcare

  • 37 Roger // Feb 23, 2016 at 11:03 am

    According to Crain’s, Meridian is number one in growth Top 50 because of Mediciad. Interesting that Mike Ilitch is number 30 with all his developments.
    http://www.crainsdetroit.com/article/20150809/AWARDS1415/150809921/1-meridian-health-plan-inc

  • 38 Bill Smaller // Feb 23, 2016 at 5:44 pm

    Gets stinker and stinker
    House panel expresses concerns about Snyder proposal to use Medicaid HMOs to manage mental health services – Crain’s Detroit Business
    http://www.crainsdetroit.com/article/20160223/NEWS/160229934/house-panel-expresses-concerns-about-snyder-proposal-to-use-medicaid?X-IgnoreUserAgent=1

    Privatization of mental health system is in eye of beholder – Crain’s Detroit Business
    http://www.crainsdetroit.com/article/20160223/BLOG010/160229928/privatization-of-mental-health-system-is-in-eye-of-beholder?X-IgnoreUserAgent=1

  • 39 Michael Hunter // Feb 24, 2016 at 1:16 pm

    I am a fan of lighting a candle instead of cursing the darkness. Tom, your leadership in this regard continues to bring the respect and guidance needed for such a large system of care. The one thing a new and reinvented approach would need, is patience. What has tended to disupt the progress and efficiency is often the abrupt change that is decided and imposed without adequate consideration of all sides. If the system is privatized; we must make sure that the waiver programs and indigent are not left unprotected. That is certainly one aspect that the current system excells at.

  • 40 Tom // Mar 2, 2016 at 9:02 pm

    Grand Rapids veterans home is Michigan’s latest outsourcing disaster

    How many times have you heard this story? Hoping to cut costs, government outsources work to a private contractor who promises to deliver superior service for less money. It doesn’t happen. In fact, things go horribly awry.
    http://www.freep.com/story/opinion/editorials/2016/03/02/michigan-veterans-care/81111468/

  • 41 Reimagine Community Mental Health In A Self Determined Way – Mentally Nutritious // Mar 13, 2016 at 7:37 am

    […] I am joining my colleague and friend, Tom Watkins, the former state superintendent of schools and state mental health director and current visionary leader of Detroit Wayne Mental Health Authority (www.dwmha.com) in seeing this “threat” as an opportunity to reimagine and reinvent the public mental health system in ways that moves more dollars from administrative layers and bureaucracy to service and support for people in need. See: The Sky Is Not Falling, Let’s reimagine and reinvent Michigan’s behavioral health system: http://domemagazine.com/tomwatkins/tw021916 […]


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