HEALTH DEPARTMENT: BSAS/BMHS MERGER

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HEALTH DEPARTMENT: BSAS/BMHS MERGER

 

Problem Identification:
The City’s approach to treating and delivering services to mental health and substance abuse clients is fragmented. This system fragmentation limits the City’s ability to maximize treatment opportunities, coordinate services, and improve public accountability.

Recommended Action:
Combine Baltimore Mental Health Systems and Baltimore Substance Abuse Systems to create a unified organization to oversee and direct the City’s behavioral health spending.

Classification:
Cost Savings, Organizational, Service Improvement

Functional/Operational Area:
BMHS and BSAS

Estimated Annual Impact:
$1,000,000 – $2,000,000

Estimated Implementation Cost:
Not Determined

Barriers to Implementation:
Implementation of this recommendation would represent a fundamental change in the delivery of behavioral health services and would necessitate extensive efforts to educate the public, impacted client populations, and State health officials. As the source of funding for this behavioral health service differs, there could be difficulty in retention of funding.

Projected Implementation:
1 – 2 years

Next Steps:
Convene a working group to develop a comprehensive plan to accomplish the merger of these two entities. The working group should include participation from the Department, management and board leadership from BMHS and BSAS, and potentially impacted stakeholders from the provider community. Initiate discussions with State health officials to discuss the objectives of this initiative and solicit technical support to accomplish implementation.

Analysis:
The Baltimore Mental Health Systems, Inc. (BMHS) and the Baltimore Substance Abuse Systems, Inc. (BSAS) are quasi-public, non-profit corporations responsible for administering the City’s mental health and substance abuse programs. The Health Commissioner serves on the board of each organization.

The City’s current compartmentalized approach to treating mental health and substance abuse problems fails to acknowledge the reality that in many instances BMHS and BSAS are treating a shared population of clients (‘dually diagnosed’) with similar service needs. Merging these entities could achieve the following potential benefits:

Better integration of treatment strategies and funding streams;
Improved data sharing;
Consolidation of administrative functions;
Enhanced public accountability; and ultimately
Increased access to treatment.

The City of Philadelphia provides a useful model for the creation of an integrated behavioral health system. Prior to 1997, Philadelphia’s Department of Public Health provided behavioral health care services to its citizens through the Office of Mental Health (OMH) and the Coordinating Office for Drug and Alcohol Abuse Programs (CODAAP). These two entities offered diverse programs, were supported by different funding streams, and operated under separate restrictions and guidelines.

As a result of the State of Pennsylvania’s implementation of a mandatory managed health care program for Philadelphia’s nearly 400,000 Medical Assistance recipients, Philadelphia’s Department of Public Health created Community Behavioral Health (CBH) to compete for the State contract to become Philadelphia’s local behavioral health care managed care organization. CBH has been tremendously successful. During its first year of operation it produced $21 million in savings that were reinvested in a variety of human services programs. In 1999, CBH was recognized by the Kennedy School of Government and The Ford Foundation with one of ten national Innovations in Government awards. (To learn more about this initiative, please consult http://www.phila-bhs.org).

As indicated in the ‘Barriers to Implementation’ section of this recommendation template, the implementation of this recommendation would represent a fundamental change in the delivery of behavioral health services and would necessitate extensive efforts to educate the public, impacted client populations, and State health officials. The range of potential savings included in this recommendation is a conservative estimate based upon the two entities being able to identify approximately $1 million in salary and fringe benefit savings through the consolidation of duplicative organizational functions and a target of an additional $1 million in economies-of-scale that can be achieved in the delivery of services. Ultimately, savings in both areas could enable the merged entity to increase the total level of behavioral health services provided without increasing total costs.