Ted Simons: Behavioral health care for the poor in Maricopa County is set for an April 1st transition to a new provider, Mercy Maricopa Integrated Care. Mercy Maricopa replaces Magellan, which had managed mental health and substance abuse treatment in the county for the past six years. The switch comes at a time when coverage for the mentally ill will be enhanced by the settlement Arnold v. Sarn, a decades-old lawsuit. Here to talk about all this is Charles “Chick” Arnold, the attorney who represented the mentally ill in that lawsuit, Eddy Broadway, CEO of Mercy-Maricopa Integrated Care, and Cory Nelson, deputy director for behavioral health for the Arizona department of Health Services. Good to have you all here. Thank you so much for joining us. Chick, I want to start with you. You've been on the program before. We've talked about Arnold V. Sarn. From a grand overview, come April 1st, what changes?
Charles Arnold: Well, there's a lot that changes, but primarily it's a reason for optimism. A number of factors have come together to allow this optimism these days in our community. The affordable care act, the passage, the governor's restoration of the Medicaid program, parity in insurance to provide for equal coverage for mental health issues, all of that has helped result in the transition to a new regional behavioral health authority in Maricopa County. That's Mercy Maricopa compared to Magellan healthcare. Mercy Maricopa is local and has embraced the notion of integrated care which means providing for primary care needs in addition to that mental health needs and it's a not for profit company which helps the people in our community.
Ted Simons: Integrated care seems to be a major focus here. What exactly does that mean?
Eddy Broadway: Well, here in this model, integrated care means several things. For the most part, there's several different models. One starts out with number one the member decides on what services they want. But they can choose basically to select to have all their care delivered in one place. Integrated care basically where you bring both behavioral healthcare and the physical healthcare together.
Ted Simons: Was that different than what Magellan was doing?
Cory Nelson: Magellan had the starts of it. They were doing some colocated care and really trying to move the system forward but this takes it a whole nother step, that nobody in the country has embraced the way that Arizona has embraced and we're looking forward to continuing to lead the nation in these developments.
Ted Simons: For those members and there's a lot of concern, a lot of worry, things are changing out there. What do they need to know?
Cory Nelson: The key thing that they need to know is they're still going to be able to go to their same providers, they're going to get the same basic care that they were going to get in the behavioral health world but they're going to get their medical care overseen by that same entity that's overseeing their behavioral healthcare. So at the end of the day, we're going to be able to look at them even more as a whole person and that's what everybody wants to be is treated as a whole person.
Ted Simons: It sounds like collaboration is the key here, integration, collaboration they work together.
Charles Arnold: It's absolutely critical. As we've discussed on this show before, people with serious mental illness in Arizona have a 32 year shorter life span than those without. Often the cause of death isn't a mental illness. It's physical issues that are unattended, largely as a result of a mental disorder. The notion of integrated care gets right to the heart of that issue and provides consumers with an opportunity to get their primary care needs addressed at the same time as their mental health needs.
Ted Simons: Was it again moving a battle ship kind of a change in terms of getting all of this collaboration, all these folks under one tent? Talk about the dynamics there.
Eddy Broadway: I think there's many systems in play and it is almost like moving a battleship. We have to start with small pieces. The first piece is getting everyone to the table and talking and sharing information. So the health information exchange is going to be the first step, which is really key to the underpinnings of this. So you have your physical doctors and providers talking to you, behavioral health, and sharing information. And then there are bigger systems development which will start moving along, such as the fully integrated clinics and the member chooses to go to a PCP or psychiatrist.
Ted Simons: Member chooses or perhaps family members help choose? Again, is that dynamic different than what we've seen in the county in the past?
Eddy Broadway: I think so. Over the years, we've had a smaller selection and, you know, when we had a bifurcated system for physical to behavioral and they were really separated and weren't talking. The behavioral health was definitely less of an opportunity for member choice and members to move around the system like they would want to.
Ted Simons: And as far as again, I know that Magellan has a problem with all of this, they've gone to court and said the system was rigged or something along those lines. Are you fitting this system into something that mercy does as opposed to giving the Magellan, the united, someone else out there a chance to try their hand at this?
Cory Nelson: We went through a competitive bid process, we evaluated all the bids that were submitted and we picked what we believed was the best bid out there to get to the core of the matter, and that was improving people's lives through integrated whole person care with a community based approach.
Ted Simons: Is there enough of an accountability factor here when it's a nonprofit sponsored by the county?
Cory Nelson: There's accountability at all levels. We built in accountability through our contracts with them, the Arizona healthcare cost containment system builds in their accountability, so there's accountability at many, many levels to make sure that there's no underhanded dealings or anything like that associated with it, just like we do with a for profit, a nonprofit, a county based, a private based.
Ted Simons: Okay. Arnold V.Sarn.
Charles Arnold: One of the things that the settlement agreement provides for continuing quality service reviews. So while the case has indeed been settles and resolved in its principle, there's continuing review of the system through the process provided for in the settlement agreement. There will be independent quality service reviews to assure that what the vision of the provider and the department is actually manifested.
Ted Simons: So that is part of the deal?
Charles Arnold: Correct. It's been embraced by the providers and it's part of the contractual agreement that Mercy Maricopa will have with the state.
Ted Simons: As far as Mercy Maricopa and what you are doing here, is it modeled after a program somewhere else in the country or is everyone else in the country looking at this as a model?
Eddy Broadway: That's a very interesting question. I think there are parts of it going on across the nation. This is really more the trend. To the extent and the scope of this contract this is probably the largest undertaking and the first of its kind.
Ted Simons: Wow. Okay. Are you ready for it?
Eddy Broadway: We're ready.
Ted Simons: Do you think they're ready? Healthcare service in Arizona, we've done so many shows on this, there are so many concerns, right, left, in the middle. For those who are in the system for members, if you will, again, how do they see optimism in this? How are they going to see something get better?
Cory Nelson: I think what they can see get better is they are treated like the rest of us want to be treated, as a whole person. They're not left behind. Most of us right now in our own private insurance, you know, we can go to the provider we want whether it's behavioral health, physical health, whatever it may be. Behavioral health in the public system hasn't always been that way. So the fact that they're going to be treated as that whole person equally I think is a huge step for us.
Ted Simons: As far as experience for Mercy Maricopa, what kind of background, what kind of experience do the folks have in terms of the background for integrated care?
Eddy Broadway: Mercy Maricopa is a new company but the sponsors that have been involved in this including Maricopa health systems, dignity health, have been doing integrated care and we come with that experience. And the models that we've really adopted have been tried across the United States, so, you know, we feel that we're set and ready to go for that.
Ted Simons: Is that a concern at all that this is a new beast on the horizon?
Charles Arnold: It's a positive concern. The old beast wasn't necessarily responsive to the needs of the people it sought to serve.
Ted Simons: How so?
Charles Arnold: As Eddie suggests, it was focused on the behavioral health system as a distinctly separate system, that doesn't work for any of us. The big deal, though, is critical to recognize that the Medicaid restoration will, you know, enlarge the universe of people who are eligible for federal reimbursement for the services they receive. The affordable care act will make insurance accessible for another group of people, all of which will help to reduce the cost to the state of Arizona and permit a provider such as Mercy Maricopa to be clever and intelligent in the way it uses the money.
Ted Simons: How do we make sure that Mercy Maricopa isn't too clever or isn't too intelligent in the wrong way? In terms of -- I called it a beast. If things start fraying at the edges, talk a little bit about accountability but again, making sure when you have integration, when you have collaboration, a lot of folks need to work together, can they work together?
Cory Nelson: I believe they can and I believe we have the quality measures at a lot of different levels to make sure they are working together for the right purpose and that purpose is for the delivery of service to the members that improve their lives. I think between all of us and the contractual requirements that we have in place and the monitoring, I think it will continue to drive the system forward.
Ted Simons: So in -- someone watching right now having a family member with problems, needing this kind of service, care, what do they need to know?
Eddy Broadway: If they're involved in the system, that day one, nothing's going to change for them. They can continue seeing their doctor that go to their clinic, their PCP. If they need to access care, they can call when we go live on April 1st and we can get them connected to the right services.
Ted Simons: And you are optimistic correct?
Charles Arnold: I'm feeling really good about it, absolutely. There are still concerns of course, the transition in itself is a cause for concern. There's still obviously going to be a shortage of funds, that's always part of the equation, but the elements we do have control over have been adjusted in a positive way.
Ted Simons: Gentlemen it's good to have you here. Thank you so much for joining us. We appreciate it.
Eddy Broadway: Thank you.
Cory Nelson: Thank you.