Mending a broken system

For many years, New Mexico residents who suffered mental health and substance abuse problems also had to struggle to navigate the state’s complicated public health system. Likewise, the state labored to track patients and control costs. However, over the last few years, New Mexico has consolidated its behavioral healthcare system to better coordinate services.

In 2003, New Mexico’s health system included three managed care organizations that provided separate medical and behavioral managed health contracts across the state. But, the system left gaps in some services and duplications in others. Certain geographic areas, for example, might have four case managers available but no psychiatrist, psychologist or licensed counselor. That system was “siloed and cookie-cutter,” where mental health, substance abuse, homelessness and physical health issues were addressed separately, says Donald Hume, a peer counseling specialist and 30-year veteran of the behavioral health system.

To correct the problem and save money, New Mexico Gov. Bill Richardson pushed for a statewide consolidated and coordinated mental healthcare program. As a result, 15 state departments and agencies — including the Human Services Department; Children, Youth and Families Department; Department of Health; Indian Affairs Department; and the State Public Defender’s Office — formed an Interagency Behavioral Health Purchasing Collaborative to set policy and direction for a single behavioral health system in 2004. The collaborative inventoried the state’s existing behavioral health services, finding significant fragmentation at the state and local levels in addition to administrative duplication and clinical gaps. Different departments, funding streams, data systems and oversight existed for different consumer segments, such as Medicaid and non-Medicaid adults and children.

To simplify services, the collaborative contracted with Norfolk, Va.-based ValueOptions in April 2005 to be the New Mexico statewide entity (SE) to develop local behavioral healthcare services, contract with behavioral health providers, determine client eligibility, manage finances, oversee billing and funding sources, establish regional compliance, and ensure quality management and extensive reporting. Within 90 days, the SE had to serve more than 350,000 clients, pay 1,000 providers, collect data, and maintain system performance, outcomes and quality through one system.

The company established six service locations throughout the state — each with a regional director, a field care manager, a provider liaison and peer counseling specialists — and hired and trained nearly 200 administrative and clinical staff. Because mental health and substance abuse clients might receive services from several state agencies, the SE hired population-specific liaisons (i.e. substance abuse liaison) rather than agency-specific liaisons (i.e. Children, Youth & Family Department liaison) to improve interagency communication and problem-solving. The substance abuse liaison, for example, now coordinates information and direction from the Department of Health’s Behavioral Health Service Division’s Substance Abuse Section, helps the agency work with communities on their prevention needs, and assists consumers. The same liaison works with providers to enroll substance abuse clients and to define information they must collect from them for federal grant reporting.

Ultimately, residents will receive a more comprehensive and accessible system of publicly funded behavioral healthcare. “As a result of the statewide collaboration, behavioral health services across New Mexico can become more responsive, consumer-focused, recovery oriented and family friendly,” says Pamela Hyde, co-chair of the New Mexico Behavioral Health Purchasing Collaborative and secretary of the Human Services Department. “The administrative and structural changes are important, but what really matters are the real outcomes for real people that can only exist with a system focused on recovery: jobs, housing, health and safety, school success and social supports.”

Leslie Tremaine, New Mexico’s behavioral health czar