MMHAG Action Teams
Action Team 1: Public Private Partnership Model
Scope
Simply put, this action group will design a model for Minnesota's mental health system that exists to serve individuals and chart a course of action where the system is incented to think and act that way. This group will articulate the vision for a macro-level mental health system model grounded in public private partnerships. The work of this action team will create the foundation for all other action teams to do their work.
In designing the system, the guiding principles must be used to weave together the multiple moving parts. The model of care and services must flexible to meet the different populations, ages and cultures, and provides the right care and services at the right time. Both consumers and providers must easily navigate it because it should operate in efficient and understandable pathways. It will clearly define accountability among all parties. It will have appropriate providers and service capacity to serve consumers. An effective model will acknowledge that social service systems have a major role to play with mental health, especially with regard to earlier intervention and recovery. Lastly, the new model will recognize that mental health issues cannot be addressed in a vacuum. Other major systems, such as schools and the justice system serve these same consumers and must interconnect with the mental health system.
Deliverables
1. Articulate the vision of a new model for the mental health system in Minnesota.
2. Describe the interconnections of mental health care and services, and how they interface with other major systems.
3. Chart of course for getting from the system of today to the model vision of tomorrow.
Chair
David Ewald
Executive Director
MN Association of Resources for Recovery and Chemical Health
Action Team 2: Fiscal Framework
Scope
Similarly, the fiscal framework will support the vision by putting the needs of the consumer front and center. The fiscal framework design will assure that consumers receive the right services in the right settings at the right time. This will be balanced with a fair and equitable method of allocating limited resources. In short, this action team will establish a sustainable and affordable fiscal framework for organizing care and services in a way that creates rational incentives to produce the desired results.
This action team will determine what's not working about how mental health services are currently financed, administered and regulated, or what changes would make things work better to develop partnerships between the public and private health systems. Fully two-thirds of mental health funding comes from the government; therefore, changes to the mental health system will revolve around shaping public policy. Policies will be developed for financing with the right incentives for the right entities to deliver care/services to produce the right outcomes.
This action team is committed not to get stuck on the notion that more money can or should always be the answer. First of all, the sky is not the limit . there is only so much money, no matter how it is split up. Secondly, and more importantly, this action team will recognize and celebrate the fact that some highly effective, pivotal system changes don't cost anything - they are the natural outgrowth of ingenuity and cooperation. Finally, the Action Group recognizes the importance of analyzing antitrust law implications every step of the way so that the action team knows what avenues can and cannot be considered.
Deliverables
1. Describe a rational fiscal framework that clearly shows how money follows the consumer, not the consumer chasing funding through a web of disconnected services and programs.
2. Construct a financial model that provides financial incentives to assure that the right care and services are delivered in the in the right setting and at the right time.
3. Identify key leverage points in the current system that will allow early transformational events for the new model, as well as longer-term financial strategies to complete the reform effort.
Chair
Glenn Andis
VP Public Programs and Behavioral Health
Medica Health Plan
Action Team 3: Coordination of Care and Services
Scope
This action team is charged with constructing an easily accessible care system that changes the complexity of today's fragmentation to the simplicity of a continuum of care for the future. This action team will formalize the linkages and partnerships between public agencies and private organizations and between different entities within each sector to coordinate care and services, as well as identify gaps and fill them in, and eliminate obvious overlaps in care and services.
This action team will take a close look at the public system's existing division between children's and adult mental health services and funding. Experience and logic show that a human is not easily split into the child or adult camps. Not only is there a lot of overlap, but also childhood and adulthood each contain many critical phases. It is also important that the new mental health care system be flexible in order to meet the needs of different populations, at all different ages, and episodic ups and downs of mental illness.
Key areas for development include defining and empowering changes in the scope of practices among the various providers. The current system lacks an infrastructure that supports the rational flow information between the various care and service providers. Lastly, there are a multitude of barriers to systems working together, such as confidentiality issues between educational systems, judicial systems, public safety and the health systems.
Deliverables
1. Articulate a system that clearly coordinates care and services along a full continuum of care.
2. Identify key barriers that exist today to the development of a continuum of care and determine a plan of action to overcome them.
3. Identify and develop a plan of action to build an infrastructure to support care and services for the longer-term development of the mental health system.
Chair
Ron Brand
Executive Director
MN Association of Community Mental Health Programs
Action Team 4: Standardized Assessment, Performance Measurement, Evidenced-based Treatments & Outcomes
Scope
Standardized assessment tools and evidence-based interventions and treatments will be promoted to ensure the system is producing the desired outcomes. Many national standards, best practices, and assessment tools exist today; the dilemma is how to assure standard utilization throughout the system. Applying continuous quality improvement to process does not mean simply tracking licensing and accreditation facts-it must include such valuable elements as consumer and provider feedback as well as short- and long-term outcomes.
This action team will recognize that outcomes should be by no means limited to the clinical perspective (i.e., identifying the right medication). The critical pathways identified, based in the science of standardized assessment and performance measurement, must lead to good outcomes in all areas. Anything that mental health can impact should be included. It is important to look at the possible social systems in which an individual lives and works: housing, home care, therapy, employment, school, and corrections, to name several. The action team might find it expedient to convene subgroups to focus on each of the relevant social services in order to effectively consider all of these important life factors.
Deliverables
1. Develop recommendations for key outcomes for the mental health system, including clinical and non-clinical outcomes e.g., fiscal, patient satisfaction, and other education, judicial and social services systems factors.
2. Inventory existing requirements and data systems, and determine the best methods to develop standardized measurements in the entire mental health system.
3. Develop action plan to implement system wide data gathering to measure recommended outcomes.
Chair
Gordon Alexander
President
Fairview-University Hospital
Action Team 5: Earlier Intervention and Secondary Prevention
Scope
Earlier intervention and secondary prevention is most beneficial to clients and reduces the adverse effects on quality of life as well as the costs to the system of intensive treatment and crisis intervention. The action team devoted to this priority will recognize that optimal treatment for the client is often community-based, with appropriate and natural supports, as opposed to institutionalization. Besides the dangers inherent in delaying treatment so long that one must start with emergency room use or hospitalization, it often costs less to treat mental health problems early than to wait until crisis services and inpatient treatment are needed.
This action group will also identify and make recommendations for earlier interventions and prevention strategies for all people across the lifespan. The elderly are often overlooked in regards to mental health services, but clearly could benefit greatly from prevention and intervention strategies. An assessment of social and economic factors might also be considered fertile ground for intervention strategies, e.g., the impact of intensive treatment on a person's ability to develop appropriate social skills. Clearly any scenario for earlier intervention and secondary prevention will naturally lead to a targeted focus on children. This action team is charged to take a close look at the existing children's mental health collaboratives and assess their potential effectiveness in meeting the needs of children in the redesigned mental health system.
Deliverables
1. Articulate clear systemic incentives for earlier intervention and secondary prevention strategies that produces:
a. better outcomes for the clients across the lifespan, and
b. lower costs to the system.
2. Identify key outcomes for earlier prevention and secondary interventions and prioritize key strategies that will produce the greatest benefits to the greatest number of people (i.e., population based strategy).
3. Develop short and longer-term action plans to achieve key outcomes.
Chair
Darcy Miner
Deputy Commissioner
Minnesota Department of Health Department
Action Team 6: Workforce Solutions
Scope
We must assure that there is an adequate supply of qualified workers to provide appropriate care and services. This action team will direct energies to the fundamental source of the problem: not enough trained health professionals and, more distressing, too many trained health professionals who have turned away from the system in frustration. There are opportunities to influence academic institutions and training sites. At the University of Minnesota, for instance, it is important to look at the entire Academic Health Center, not just the psychiatry department. Other possible medical professionals such as nurses, pharmacists, and psychologists, for starters, are all very important to include in solutions to this shortage.
Especially important to this action team will be to explore such new models of care such as "shared care" where the primary care system is engaged to use mental health professionals in a consultative model to serve the patient. Recruitment and training goals must ensure that Minnesota's varied cultures, races, and backgrounds are reflected in its mental health professionals and that all workers are culturally competent. Additionally, this action team through strong leadership may design strategies to coax valuable professionals back into the new, healthier mental health system.
Deliverables
1. Identify and recommend near term strategies to "bolster the pipeline" of trained professionals for the future mental health system.
2. Identify and recommend strategies to alleviate the current shortage of trained professionals, including areas such as scope of practice review; training teachers; and models of cooperation with other trained professionals such as nurses, primary care physicians, and social workers.
3. Articulate plan of action to bring trained professionals back into practice.
Chair
Donna Zimmerman
V.P. of Government Relations
Health Partners