California County Behavioral Health Medical Directors Leadership Training Series Summer Session 2016

Collaborative Leadership: Working Together to Achieve the Outcomes Required to Serve Our Communities A Strategic Dialogue with County Behavioral Health Directors and Medical Directors Framing The Issues

History  Initiated in May 2006  In response to a request from California Mental Health Directors Medical Services System of Care (MS-SOC) and MHSA to provide ongoing training and support for the County Public Mental Health medical directors and their physician staff toward and wellness and recovery vision.

Faculty Program Manager Constance Gustafson MSW- Senior Associate, CIBHS Advisory Committee Allan Edwards MD – Orange Vanessa De la Cruz MD- Santa Cruz William Arroyo MD- Los Angeles Aubrey Eubanks MD- Nevada Celia Woods MD- Ventura Hardeep Singh MD- Sutter- Yuba Teresa Frausto MD- San Bernardino Percy Howard LCSW- CIBHS Funder Department of Health Care Services (DHCS) MHSA

Objectives and Funding Source  Promote physician leadership within system of transformation and the Mental Health Services Act  Apply and embed quality improvement practices within medical services toward a recovery resiliency and wellness vision medical services  Funding provided through state contract utilizing Mental Health Services Act ( MSHA)

Structure  Statewide quarterly conventions 1-1/2 days  Alternate southern and northern venues to maximize attendance.  Evening county to county knowledge exchange and local program update sessions  All day facilitated learning session led by internationally renown physician and leading professionals with specialized content expertise in the area of focus

Outcomes  Established a statewide strong cohesive support network of medical directors and physicians staff that consistently channels information regarding the local impact of new trends, practices and polices county to county.  Consistent in person participation rate from 40% - 60% of California counties - - this # has increased in the last year.  The sessions have expanded to include nursing staff, fiscal leadership and quality improvement managers for specific topics to foster collaboration and innovations for medical services.

Added Benefit Los Angeles County Mental Health provided CME credits for qualifying sessions through a sponsorship agreement with CIBHS.

Series  Focused on The future of Whole Health Care with the Advent of the ACA  Aligned Incentives, funding and data sharing toward Safer more efficient Care What are the tools MDS require to make it happen? Cultural considerations? Community involvement, leadership, intra-department collaboration?

Series Sessions We were on Hiatus

Series Drilled down to specific practice strategies for whole person integrated health care including succession planning, role clarity understanding of funding streams, and collaboration.  Role of the Medical Director (Fall Session)  Behavioral Health Finance 101 (Spring Session)  Value Added Collaboration with Behavioral Health Directors (Summer Session)

Framing The Issues Key Issues

Role of the Behavioral Health Medical Director  The Medical Director is responsible for medical supervision and overall regulation of all medical facets that may affect the organization  The Medical Director is responsible to develop and approve an applicable continuous quality improvement program for medical services to maintain the organizations standards of care on both clinical and programmatic levels.  The role of the Medical Director has expanded over the years to include not only clinical responsibilities but also administrative and leadership duties  Within the organizations culture, MDs promote the client first -- client centered care.

Medical Director Role (cont.)  As the organizations senior clinical leader, the Medical Director informs a broad range of clinical, policy, programmatic, and strategic issues  Contributes to setting the department’s strategic direction  Establishes and promotes the professional, clinical, and ethical values and standards to which all clinical staff are expected to adhere.  The Medical Director’s role can be defined as an inclusive clinical leader expanding beyond physician staff

Medical Director Role (cont.)  Guardians of child/youth behavioral health services for medication prescribing.

Key Issues: Advent of Health Care Integration Community Mental Health Substance Use Disorders Primary Care

Key Issues  Manage care plans  New funding streams and financing Models  Scrutiny of prescribing practices.  New SUD integration  Drug Medi-Cal Wavier  Primary Care Prescribing for mild to moderate  Behavioral Health Care Home  Crisis Services

Sense Of Urgency  Legislation, initiatives and requirements hitting the system at once  Change process start ups  Need to establish strategy and best practices for care  Outcome Measures

Assumptions  There is value added benefits when the Medical Director and Behavioral Health Director work closely and well together Business goals Organizational change Visioning Implementation and oversight of trending policies and practices Outcome: Overall organization success and positive health outcomes.

Assumptions  Medical services are a key focus of new policies and service requirements  Utilizing the best skill sets of your Medical Directors to assist with the implementation quality improvement and practice planning, support smooth transitions, staff buy in and benefit outcomes.

The Rationale for Collaborative Leadership Let’s begin the process

Thank you!