COMMUNITY MENTAL HEALTH
AFFILIATION OF MID MICHIGAN
In December, 1999, the Community Mental Health Board of Directors reviewed a number
of potential partnerships that Community Mental Health could pursue, criteria for
the formation of partnerships, by CMH, and the types of partnerships that could
be created. In the fall of 2000, DCH, released the REVISED PLAN FOR PROCUREMENT
OF MEDICAID SPECIALTY PREPAID HEALTH PLANS, in which was specified the minimum size
that a Community Mental Health must be to obtain a Specialty Health Care Services
contract with the Department. Community Mental Health of Clinton-Eaton-Ingham signed
an agreement forming an affiliation with Gratiot, Ionia, Manistee-Benzie, and Newaygo
counties forming the Community Mental Health Affiliation of Mid Michigan.
The Affiliation’s Vision and Values
The Affiliation’s vision and values are central to its formation and day-to-day
operation. The Affiliation’s formation, in fact, was driven by the similarity of
values, among the Affiliation members. The Affiliation exists to ensure and promote:
- Consumer choice and empowerment
- Sound service and support provision; sound clinical operations
- Best value in the services and supports that it provides, to consumers, as well
as administrative and PHP services. Best value is defined as the highest quality
services and supports at competitive costs.
- Local community-driven, local control and responsiveness
- Outcome and data based decision making
- Fiscal soundness
- Proven capacity to manage risk
- Sound care management capabilities
- Regulatory compliance
- The public good, public equity, social justice
Structure and Methods Used to Carry out Vision and Values
The Affiliation carries out this vision, adheres to these values, and capitalizes
on the strengths of its members (strengths honed over three decades of community-based
practice) through a number of means:
- The use of a locally-driven federation-style affiliation. This model, virtually
transparent to consumers and other stakeholders, retains the longstanding relationship
of each CMH with its community, strong local participation and decision making,
strong consumer and community stakeholder involvement, ability to rapidly respond
to local community need and variations, alignment of interests of provider and care
manager via its integration in each Affiliate.
While CEI is the specialty PHP in the Affiliation, contracting, on behalf of the
Affiliation’s members, directly with the Michigan Department of Community Health
(DCH) for the provision and management of Medicaid specialty services, each member
of the Affiliation will carry out the administrative functions of the PIHP, via
contract with and under the supervision of CEI, the PIHP. These functions are described
in both the Affiliation Agreement and the Medicaid Subcontract as is the method
by which CEI will monitor the fulfillment of these functions. Additionally, each
CMH in the affiliation will retain its state General Fund and local funds, to ensure
the autonomy and local relevance of each affiliate.
- Integrated care manager and provider: Additionally, all of the members of the Affiliation
will fulfill both care manager and service provider roles in the fulfillment of
the contract with DCH. The care management model being used by this Affiliation
is akin to a provider sponsored plans/organizations, in that the four CMH affiliates
will:
- Be responsible for managing a population-based rate (the population being the Medicaid
eligibles within the community served by each Affiliate)
- Employ a range of risk management methods in managing the benefit to the Medicaid
recipients in their community
- Make decisions as to whether to directly provide or purchase services, for the Medicaid
eligibles within its community, based upon consumer choice, quality, and cost considerations.
- Be able to capture and reinvest savings created by sound clinical, fiscal and risk
management approaches
This model is a hybrid of the best of provider-sponsored organizations/plans (PSO,
PSP), staff model HMOs/PHPs, and network model HMOs/PHPs and applies a growing body
of research, by the Robert Wood Johnson Foundation and others, regarding the use
of tight-knit provider and payer/care manager systems to ensure the highest total
quality care at the lowest total cost for persons suffering from chronic health
conditions, such as serious mental illness and developmental disabilities.
- The legal structure of the Affiliation, works to ensure local representation and
participation, accessibility, accountability, and collaboration in that it is an
affiliation of locally-responsive CMHs tied together by functional integration and
three legal documents:
- Affiliation Agreement (among all affiliation members)
- Medicaid subcontract (between the PHP and each affiliate)
- Purchase of service agreements between affiliates, for the sale of services to provide
shared expertise and efficiencies
These agreements promote functional integration, efficiencies (through the sharing
or resources, economies of scale, and expertise), and increased effectiveness and
sophistication, without losing local representation and stakeholder participation
- The multi-party, cross-expertise Affiliation Core Group and multiple Work Groups,
which guide the Affiliation, under the authority of the Board of Directors of the
PHP (CEI), consists of representatives from each local CMH and its community.
- The affiliation-wide Consumer and Stakeholder Advisory Council which ensures that
the work of the Affiliation is guided by the voice of the consumer. This Council
reviews and recommends Affiliation policies and procedures, reviews and analyzes
performance indicator data and utilization/service authorization data, promotes
and monitors consumer empowerment efforts, and serves as the communication link
between the consumers, throughout the region and the Affiliation.
- Each CMH continually communicates, and seeks guidance, about the work of itself
and the Affiliation via a number of locally-based venues: its local Board of Directors
(consisting of 1/3 consumers), local consumer advisory councils, and the on-going,
day-to-day dialogue with local consumers, local community collaborative partners,
and stakeholders.
- The strategic use of centralization, standardization, and autonomy in the carrying
out of PHP and provider functions and to ensure that all Affiliation members meet
industry standards and achieve functional integration. The Affiliation, through
the operation of cross-affiliate work groups, draws on the best of what each Affiliate
has to offer by:
- Identifying areas of potential functional integration by examining industry standards
and best practices
- Analyze the current practices of each affiliate against those standards/practices
- Determine the goal of integration. The goals can be any one or a combination of:
- reduced total cost/increased efficiency
- increased effectiveness or sophistication to meet industry or contractual standards
- improved ability of hub/PIHP to ensure compliance with contractual requirements,
improved or retained local responsiveness and/or uniqueness.
- Determine the best course of action to achieve integration
- centralization of function and responsibility;
- standardization via the application of affiliation-wide best practices and standards
to functions carried out locally, by each Affiliate; or
- autonomous functions, carried out locally, by each Affiliate.
The decision, as to which approach to pursue is made on the basis of effectiveness,
efficiencies and total cost (via economies of scale or economies of autonomous parties/small
scale), capacity for synergy, nimbleness of action, value of uniform approach, and
the existence of unique local characteristics.
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