Mental health: $150m grant for NH – The Union Leader

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New Hampshire is about to embark on a five-year program to remake its mental health system, with the help of a $150 million grant from the federal government.

The initiative couldn’t be better timed, as holes in the state’s mental health network were highlighted with the shooting of two Manchester police officers on Friday.

The father of the young man now facing attempted capital murder charges in the shootings says his son, diagnosed with schizophrenia, spent years in and out of psychiatric hospitals and each time was released with no follow-up.

“It was just a revolving door,” Russell MacPherson said of the care for his son, Ian MacPherson, 32.

State health care officials are hoping they can close that revolving door by created integrated networks in which psychiatrists, medical doctors, counselors, emergency room staff and community health practitioners can communicate with each other and follow a patient’s progress through the system, making sure no one falls through the cracks.

“We want to improve and transform how we deliver mental health services and substance-abuse disorder services for the people of our state,” says Deb Fournier, who became New Hampshire’s deputy Medicaid director in March. “And we’re going to do this through a regional network of providers called integrated delivery networks.”

The breakdown in communication between medical and mental health care is evident in the state’s opioid crisis, in suicide statistics and in the number of dangerous people left to fend for themselves on the street despite frequent contact with the mental health system.

On average, 45 percent of suicide victims had contact with primary care providers within one month of suicide, Fournier said.

$30 million a year

The new program comes under her jurisdiction because it is administered as part of Medicaid, and in the jargon of government is known as a “transformation waiver.”

“The waiver gives us the flexibility to receive matching dollars from Medicaid that we had not previously received, and we can use those dollars to pay for things in ways we wouldn’t otherwise pay for them in the Medicaid network,” she said.

The state was awarded the $150 million in January, after a lengthy application process that began early last year. The money will be doled out in increments of $30 million a year for the next five years.

“We will be paying providers to build regional networks that transform the way they deliver behavioral health care in New Hampshire,” Fournier said.

Competitive process

When the state Legislature agreed in a bipartisan compromise to expand Medicaid under the Affordable Care Act in 2014, lawmakers included a provision that required the state to apply for the demonstration waiver to “enhance mental health programs and transform the delivery system.”

There was no guarantee that New Hampshire would succeed in such a highly competitive application process, but the condition of the state’s mental health system was so severe that the federal government took notice.

“We have an overly strained mental health system, and a substance abuse disorder and opioid crisis on our hands,” says Fournier. “We have wait lists in the emergency departments; we have weeks-long wait times for treatment for people with substance abuse disorders. And our physical health systems and behavioral health systems don’t necessarily talk to each other.”

Getting those systems to talk to each other is a key part of the transformation effort, just getting under way. The state is now accepting applications from health care organizations that want to be the lead applicant on behalf of a group of providers willing to create what’s called an “integrated delivery network.”

The state is divided into seven regions, with applicants from each region. Catholic Medical Center has reached an agreement with Elliot Health Systems, Dartmouth-Hitchcock and the Farnum Center to serve as lead applicant for the integrated network in the Manchester-Derry region.

“We’ve put together a really impressive group of providers and agencies that have expressed an interest in working together to be part of this network,” said Alex Walker, senior vice president for strategic development at CMC.

Each network in the program will have to select from a menu of projects created by state health and human services officials — some mandatory, some optional. They will then be assigned certain measurable goals they have to achieve in order to get their share of the money in each of the five years.

Once a national model

The projects focus on three major areas — improving care transition from one setting to another, building more capacity (more providers, more beds); and integrating systems across the spectrum.

“Bringing together a vast array of providers and agencies will really make the process of navigating what might otherwise be a fragmented and daunting system a lot easier,” said Walker. “The hope is that folks will ultimately get the care they need in the most appropriate setting.”
Fournier said New Hampshire is the first state to receive Medicaid funding exclusively for transformation of the mental health delivery system.

“Other states like New York and New Jersey have waivers,” she said. “But we are the first to get one for this type of initiative.”

It’s a distinction New Hampshire would rather not have, considering that 20 years ago, the state was considered a national model in mental health, with a robust network of community mental health centers and hundreds of psychiatric emergency beds.

But as costs continued to rise, the state had to cut services, hospitals abandoned psychiatric beds, turnover among practitioners increased, as has the complexity of treating mental illness. In 2013, the state had to settle a major class-action lawsuit over its treatment of residents with mental illness, agreeing to spend an additional $30 million over a four-year period.

Mental health: $150m grant for NH – The Union Leader