Strategies for Success
Strategies for Success
Given the challenges faced by providers, what distinguishes providers who are thriving in the current system from those who are struggling to sustain? Below are several features of communities with successful programs. Taken alone, none of these is sufficient. In fact, these program features are strongly interrelated. With most or all of these characteristics in place, a programs has a great likelihood of being financially sound, enabling it to continue serving youth and focus on quality implementation.
A strong referral base.
EBIs depend on a strong, steady flow of referrals. A good referral base may be due to a number of factors: a provider’s excellent reputation; strong provider-stakeholder relationships; county stakeholders who are invested in the service; and a well-coordinated intake process within the county. For instance, some county agencies have a designated coordinator whose job it is identify youth appropriate for referral to an EBI. Other counties have a team that meets weekly to discuss new cases with providers and assign youth to the most appropriate service. Referral sources are also motivated to refer when services can begin quickly, funding is easily accessible, and they are confident in the program’s outcomes.
The ability to start services quickly.
The ability for FFT and MST to start services immediately is not only attractive to stakeholders but also promotes implementation quality and enables providers to engage families when they are most receptive to services. Quick initiation of services is facilitated by a BH-MCO protocol that allows pre-certification and/or county funding of services until M.A. is authorized.
Accessible and adequate county funding.
Counties with a generous pot of funding that is easily accessible provide a more sustaining environment for EBIs. County funds can be used to pay for services until M.A. is authorized, fund youth who are not M.A. eligible or whose families refuse M.A., cover the cost of services when M.A. lapses, and pay for service activities that are not M.A.-reimbursable (e.g., court-related activities, time spent assisting a family with M.A. eligibility). This is especially important in communities where many youth do not already have M.A. and in communities where the BH-MCO does not pre-certify services. Furthermore, some counties have made the conscious decision not to require youth without M.A. to apply for it, since the path to M.A. eligibility often requires a mental health diagnosis. These counties instead use Special Grant or other county funds to pay for the youth’s services.
A process to expedite M.A. eligibility.
In some instances, county agencies have successfully worked with the County Assistance Office to develop a plan for expediting M.A. applications for youth referred to an EBI. In addition, some providers have been able to maximize M.A. reimbursement for services by working with their BH-MCO to develop a process for accessing “retro-eligibility,” so that M.A. pays for services from the date the M.A. application is submitted to the County Assistance Office, rather than the date the application is processed. This enables the program to begin serving youth promptly, rather than waiting days or weeks until the service is authorized.
To enable clinicians to focus on clinical work as well as use resources wisely, programs benefit from having support staff to manage administrative and case management tasks such as assisting families with M.A. eligibility, coordinating ISPT meetings, following up with the County Assistance Office regarding applications, monitoring M.A. eligibility throughout the course of treatment, ensuring documentation is completed on time, and so forth. This cost must be accounted for in the program’s budget and rate of reimbursement.
These characteristics can be used to guide policy and support for EBIs at both the state and local levels, creating a climate that better supports EBIs across the Commonwealth.
While many providers have successfully negotiated common obstacles by working closely with county stakeholders, significant challenges remain in many communities. For instance, while one provider was successful in negotiating a better rate after providing the BH-MCO with more information about the evidence-based model, another group of providers has been unsuccessful in convincing their BH-MCO to increase its rate of reimbursement, which has not changed in 7 years.
Download Strategies for Success. (Written in December 2012)
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