Alachua County Fiscal Year Ending June 30, 2011 Maggie Labarta, PhD President/CEO

Among the most prevalent disorders

By the numbers: mental illnesses and substance use disorders Brain disorders, highly treatable 60-80% improvement, compared to 40-60% for heart disease Mental illnesses cause more premature death and disability than most other conditions, second only to heart disease Account for 25% of disability recipients Cost over $317 billion annually for lost productivity, health care and disability payments Impact of mental health and substance abuse in Alachua County One in four are affected by a mental illness = 7,392 One in 17 has a serious, potentially disabling illness = 1,739

Return on investment Return on investment Community Treatment Without Community Treatment Crisis Stabilization per Day $300 Emergency Room visit $2,887 Detox per day $274 Hospital per day $2,000 Average annual cost – substance abuse treatment $2,400 Average Annual prison Cost $55,000 Average annual cost – mental health treatment $1,551 Average State hospital bed $112,000 per year $28,000 for 3-month admission

The system of care capacity is inadequate Florida ranks 50 th in funding for mental health, 37 th for substance abuse Un-met need: 58% of adult mental health 82% children’s mental health 85% children’s substance abuse 93% adult substance abuse of disorders Only 46% of the care being provided is covered through private insurance Last fiscal year, Meridian provided $1.7 million in uncompensated care and despite this, we currently have 188 on waitlists

Our role in the community Meridian is a non-profit community mental health and substance abuse treatment provider Part of the safety net providing Emergency and crisis support services The region’s only public receiving facility Collaborative solutions to community problems Emergency room and hospital overutilization Jail diversion Homeless services Services to the uninsured

Our role in the community Part of the area’s high quality healthcare system Accredited Council on Accreditation of Rehabilitation Facilities American Association of Suicidology Licensed Agency for Healthcare Administration Department of Children and Families Drug Enforcement Agency

Meridian’s community impact Served 26,154 across 11 counties 13,581 in treatment programs 12,573 through outreach and prevention services On trend for 4% increase this year, 10% last year Part of the area’s economy Employ over 541 individuals, 331 in Alachua County Provide $20.5 million in salaries and benefits Purchase goods and services totaling $8 million in the local communities

Finding Solutions Finding Solutions p Jail Diversion Homeless Educational Success Uninsured Employment

Leveraging Resources Forensic Services

Effective use of resources

Year-to-Date Alachua Services FYE2012 4,967 seen year to date Compared to 4,803 at the same point in FYE2011 (a 3.4% increase) 204 homeless served Turned away 533 with most because the insurance or payer does not cover Meridian Alachua County Waitlist (as of 5/20):Typically increases as state funds are depleted in 3 rd & 4 th quarters Detox -7 Residential Substance Abuse – 48 Outpatient – 37 Medical – 45 Case Management - 51

Economic Status Of Clients 83% of those seen are at or below Federal Poverty 97% are at or below 200% Federal Poverty and receive discounted fees

Age of Individuals in Treatment

Program Number Served Case Management1,068 Outpatient Services2,086 Psychiatric Services3,647 Outreach & Prevention422 Acute Inpatient (CSU / Detox)2,007 Supported Housing73 Crisis / Emergency Screening1,443 Residential Treatment312 Day Treatment210 Psycho-educational Intervention488 Rehabilation & Employment166 Opioid Treatment637

How we are funded Ability to braid funds maximizes county, state, federal and private revenues Ability to braid funds maximizes county, state, federal and private revenues Each piece is essential to maintaining the whole Each piece is essential to maintaining the whole Federal State Insurance Client Fees Donations Medicaid Medicare Contracts Count y

Funding Sources Medicare Medicare Psychiatric Treatment Psychiatric Treatment Counseling Counseling Commercial Insurance Commercial Insurance Psychiatric Treatment Psychiatric Treatment Counseling Counseling CSU – some companies only CSU – some companies only Detox - seldom Detox - seldom Medicaid Medicaid Psychiatric Treatment Psychiatric Treatment Counseling Counseling CSU – managed care only CSU – managed care only Rehabilitation services Rehabilitation services Case Management Case Management Peer Supports Peer Supports State and County State and County Psychiatric Treatment Psychiatric Treatment Counseling Counseling CSU (public receiving facility) CSU (public receiving facility) Rehabilitation services Rehabilitation services Case Management Case Management Vocational Vocational Peer Supports Peer Supports Housing Housing

Braided funding Most clients need more than one service, often not all reimbursed by the primary payor Once a client is admitted, they are offered all medically necessary services regardless of availability of funding Typically results $1.5-2 million per year in uncompensated care Medical Housing, Forensic Rehab, Detox, Jail Diversion

How we prioritize who is billed Fees/ Insurance/ Medicaid/ Medicare StateCounty Comprehensive Care

Sources of Program Revenues

County Match State and federal funds require local match Meridian’s match amount is specified within contract with DCF Varies year-to-year depending on how state and federal dollars are allocated to us from DCF “Local match” Local fee and county funds Counties responsible

County Match Apportion required match Calculate catchment area population Calculate each county’s percent Distribute share of match accordingly Project funds from all eligible sources = “earned match" Client fees Insurance Contracts County special service contracts School contracts Request County Commission funding Match required less earned match Any remaining amount to be asked of county BOCC

Alachua BOCC-Meridian: Partners in Community Wellness

Service Areas Supported by BOCC Funds

Alachua County Community Support Services Fiscal YearNumber Served % changePer Capita Funding Total Funding FYE 2008$3.58$904,929 FYE2009$3.54$883,956 FYE20104,860$ ,561 FYE20115,33410%$3.07$695,913 GR /$100,000 (CHOICES FYE2012 Estimate 5,5474%$3.07 $695,913 GR /$100,000 (CHOICES)

Alachua County Match FYE2012 required match: $2,694,235 Alachua County 50% of catchment area, $1,175,185 in match Helps draw down $11.3 M in state/federal funds, 49% of which is expended on Alachua services Current BOCC match eligible contribution $795,561 Community Support Services contracts $280,806 Court Services Contracts (eligible for match) Total County match eligible funds: $1,076,367 Thank you!

Focus on Evidence Based Practices

Evidence Based Practices Co-occurring treatment Solution focused therapy Group treatment Medication Assisted Treatment for substance abuse Opioid Treatment Jail Diversion Parenting and Adolescent prevention programs Trauma informed care Wellness curriculum for those with serious mental illness

Outcomes Diversion from high cost out-of-community placements for Adults with Serious and Persistent Mental Illness Meridian clients spends 95% of the days in a year in their home and community Meridian serves the highest number of these clients in a region that includes Jacksonville and Daytona (5,612) Children with Severe Emotional Disturbance Meridian children spend 95% of the days in a year in a home or community placement Serving the 3 rd highest number of children in this category, many of whom have child protective services involvement (1,446)

Children with Emotional Disturbances Meridian children spend 96% of the days in a year in a home or community placement We serve the highest number of children in this category in the region (1,295) Forensic Clients Meridian Incompetent to Proceed and NGI clients spend 81% of the days in a year in a home or community placement Serving the 2 nd highest number of clients in this category in the region (188)

Employment and School Days of Work for patients with Severe and Persistent Mental Illness – 30 (State target) Days in School for Severely Emotionally Disturbed Children – 91% Perception of Care 86.9% of consumers report problems “somewhat” or a “great deal” better 92.9% of consumers would recommend us to others "I really appreciate Meridian and their services. I don’t have private care, but I feel like I am treated like I have private care when I am at Meridian." Client from Outpatient "Meridian has helped me out in my times of need, and it’s the best out there." Client from Med Services "I am very thankful for everything Meridian has done" Client from Residential Services

Jail Diversion Services

Thank you! Questions ?