Sustainability and Solutions

Federation community based behavioral health and chemical dependency clinics are safety net services operating on razor thin margins. Accordingly:

  • Medicaid APG rates (i.e. government rates of reimbursement) are the minimal rates required by Federation clinics to remain financially viable
  • Such APG rates should be insured for the next decade as the behavioral health field transforms into a value- based, yet undetermined, structure
  • In fact, in order to realistically accommodate rising costs in Personnel and OTPS expenses, APG rates should be adjusted upwardly on an annual basis. (Note: such rates have only been minimally increased twice during their decade plus existence)
  • Federation clinics are staffed by a dedicated, overburdened, and underpaid workforce at a time when severity, intensity, and frequency of serious issues (suicide rates; opioid overdoses; etc.) continue to escalate. This has resulted in a lack of staff retention, and a significant workforce shortage, which impacts continuity of care. Consequently:
  • Such committed staff deserve regular Cost of Living Adjustments (COLA) to allow them to continue to provide these essential services
  • In an effort to attract and engage the full array of experienced, culturally competent clinicians, the licensure exemption which permits the full range of behavioral health disciplines should be extended indefinitely, or until that time when the aforementioned clinical crises cease, and the noted workforce shortage is resolved
  • Federation clinics enjoy high levels of credibility within their communities, and as such, are extremely successful in engaging difficult to reach residents who are frequently suffering with a multitude of severe problems (both behavioral and medical). In fact, research on a core group of our clinics published in the Journal of Contemporary Psychotherapy (McQuade & Gromova), (2015) has empirically documented that the engagement of such clients in outpatient treatment for 31 or more visits reduced hospitalization rates by 62%. Accordingly:
  • Such clinics should receive an annual Community Support Allocation Grant to enhance the fiscal stability of their critical services, and also allow them to continue to treat such suffering individuals, who are oftentimes uninsured, and/or undocumented
  • Federation clinics have complied with NYS’s mandate to form networks (i.e., IPAs) by winning a Behavioral Health Care Collaborative grant and establishing BHNYC, IPA. In so doing, and consistent with the above research, it has already been determined by our partner MCO that the groups in our IPA enjoy significantly lower rates (vs.  NYS averages) of key value- based metrics (i.e. < 2 ER visits; < 2 behavioral or medical hospitalizations, annually) – further illustrating that our community-based providers are not only very good at what they do but are also extremely cost effective.  Consequently:
  • Efforts to compel Federation clinics to engage in value-based arrangements with MCOs should never require assumption of risk – since doing so would further threaten the existence of this extremely valuable, yet economically fragile, community resource. 

An Examination of Treatment Outcomes at State Licensed Mental Health Clinics
James McQuade and Elena Gromova
Journal of Contemporary Psychotherapy
September 2015, Volume 45, Issue 3, pp 177–183

Mental health clinics that are licensed and regulated by their respective states constitute a vast mental health delivery system. Yet these programs, while operating for the last 40 years, have not been subject to systematic review. This retrospective study of archival data investigated the relationship between intensity of clinic treatment and hospital-based treatment episodes and polypharmacy. The sample was comprised of 562 patients with diagnoses of MDD, bipolar disorder, or a schizophrenia spectrum disorder, drawn from four state-licensed community clinics. These clinics provided a relatively heterogeneous model of care consisting of psychotherapy, medication management, and critical case tracking. Subjects with the highest number of treatment visits (31 or more) had a 62 % reduction in the incidence rate ratio of hospital-based treatment episodes compared to subjects with the least visits (15 or less). Subjects with 15–30 visits also fared well with an 82 % reduction in the incidence rate ratio of hospital-based treatment. Secondarily, a diagnosis of schizophrenia or bipolar disorder resulted in a significantly higher incidence of hospital treatment than a diagnosis of MDD. Polypharmacy, measured at the .01 level, was not found to be associated with treatment intensity. The findings lend support to the outpatient clinic treatment model as a viable system that can significantly reduce costly hospital-based psychiatric care. At least for the diagnoses examined, early drop out is detrimental and increases the probability that hospital-based treatment will become necessary. Click to read the entire article