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Managing Healthcare OPINION by JIMMY KEEFE undergo a change in how publicly funded mental healthcare is managed. Starting Jan. 1, our state legislators have passed bills requiring that every county in North Carolina cease to operate independently in regards to mental-health services and become part of a larger group of consolidated counties. Cumberland will become part of Alliance Behavioral Healthcare, a four-county managed-care organization that will oversee the spending of federal Medicaid and state dollars allocated for mental health services. While the business model will be that of a large insurance company seeking cost efficiencies, the MCO will remain a public entity responsible to the respective counties. Because the state is not contracting out to the private insurance industry, the public MCO will reinvest cost savings back into services, thereby providing more efficient services and better treatment to our citizens with mental health conditions who need care. With the beginning of 2013, all of Cumberland County's state and federal mental-health dollars will go directly to Alliance headquarters in Durham County. Alliance is a merged entity between Durham and Wake Counties, and Durham is the lead agency for the MCO. This change is certain. It will happen based on an inter-local agreement approved in 2011 by the Cumberland County Mental Health Board and Alliance. Johnston County also signed an agreement to align itself with Alliance. Since our annual planning retreat in February, commissioners have heard The clock is ticking. In just a few short weeks, Cumberland County will with their respective managed care organizations. Had we initially engaged in "merger discussions" when this issue first came about, we would have been in a much better position to negotiate a different board structure with more representation within the MCO. However, the composition in terms of personal characteristics of individuals allowed to serve is still at stake. The legislation that dictates the make-up of MCO area boards is very specific in the categories of membership. However, the Alliance must receive unanimous approval from the commissioners from all four participating counties to allow for a new group of board members that is best suited to represent this business entity. This alternative composition will include individuals who have business, financial, managerial, operational and legal experience, as well as positions for consumers and family members. It will be a board particularly suited to dealing with insurance issues and scrutinizing a large financial budget. Qualified oversight benefits participating counties and their citizens. The current board has 13 of the 16 positions occupation-specific or designated to a specific family or individual circumstance. Although these board members may be passionate about mental health, they may or may not have the experience and insight to ensure from the Cumberland County Mental Health Director, Alliance officials and representatives from the state Department of Health and Human Services that the new managed care structure will operate like a business, with cost benefits and improved services to consumers. The MCO will create savings on the administrative side by combining operations and is required to still maintain a local presence with offices at Executive Place, home to our current Mental Health Department. This will be where we'll find consumer-relations personnel to provide the local point of contact. Financial expertise will be crucial because the MCO will be at risk and accountable for managing the funding it receives from these federal and state programs. If it doesn't perform, the state can pull its contract. The new model also comes with increased reporting on quality assurance and access to care requirements. We've heard terms like "right sizing the marketplace" and "creating a new mind-set." This management entity can limit the provider network based on performance and provide a culture of client benefit and services. In just six weeks, Alliance Behavioral Healthcare begins its operations in our county. Yet, the structure of its 16-member board remains up in the air at this point. The numbers break down to eight slots for Durham; six for Wake; one each for Johnston and Cumberland. The minimum representation of these two counties is because they have elected to contract with Alliance Behavioral Healthcare through an inter-local agreement as opposed to every other county in the state that has merged that a large public entity dealing with hundreds of millions of dollars is providing the best services to all of their clients in the most efficient and financially responsible way. Cumberland County commissioners tabled voting on a resolution supporting the alternate board structure on Nov. 5 because we did not have unanimous consent on this issue. We will take up the issue again on Nov. 19. To be clear, the Cumberland County Mental Health board has already signed an inter-local agreement with the Durham Alliance to manage these services. If it is not passed unanimously, the Alliance board must revert to the state-mandated model where 13 of the 16 positions will be earmarked. It is my opinion that this would not be the best board to serve the clients, to represent the citizens and manage the cash. While my fellow commissioners and I have expressed concern that Cumberland County will only have one slot on the 16-member Alliance board, we were not party to the agreement made between the Mental Health Board and Alliance. We inherited it. There are big decisions ahead for commissioners to make regarding mental health in our community, and we will be tackling local funding issues and others in the near future. These are complicated matters and we will diligently work to determine the best path for us to take. For now, the immediate matter will be before us on Nov. 19. I encourage the board of commissioners to unanimously adopt the resolution supporting the alternative Alliance board structure so that our MCO can move forward without further delay. The days are passing. The clock is ticking. Jimmy Keefe Cumberland County Commissioner Family Friendly! "Kids Eat Free" on Tuesdays (with purchase of adult entree) Open Daily for Breakfast, Lunch & Dinner Banquet rooms available up to 100 guests WWW.UPANDCOMINGWEEKLY.COM 1304 Morganton Rd. Mon-Sat: 6am-10pm Sun: 7am-2:30pm 484-0261 Serving Fayetteville Over 50 Years! NOVEMBER 14-20, 2012 UCW 5