January 25, 2011 Georgia Behavioral Health Caucus Community Care Joseph Bona, MD, MBA Chief Medical Officer DeKalb Community Service Board

January 25, 2011 Georgia Behavioral Health Caucus Community Care Outline Large number of individuals in Georgia with mental illness and substance abuse who are uninsured. Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement. Service capacity and budget planning should be population based. Successful community providers will need to be integrated, complex organizations with specific core competencies. Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011 Georgia Behavioral Health Caucus Community Care Segmenting Georgia’s Uninsured Population Uninsured Georgians By Segment Percent Estimated Number Uninsured, Not Needing Financial Assistance30%510,000 Uninsured, Needing Financial Assistance35%595,000 Uninsured, Eligible for Gov’t Programs20%340,000 Uninsurable15%255,000 Total100%1,700,000  This group of uninsured Georgians represent the target population for the DBHDD under State Contracted Services (SCS).  Census estimates Georgia population growth of 10% per 5 years.

January 25, 2011 Georgia Behavioral Health Caucus Community Care Serious Mental Illness (SMI) among Georgian Adults Aged 18 or Older, by Age and Gender: 2009 In 2009, there were an estimated 310,000 adults aged 18 and older in Georgia with SMI in the past year (4.4 % of all adults in the state) Percent with SMI in the Past Year GenderAge Group 18 or Older 4.4% 18 to % 26 to % 50 or Older 2.3% Male 3.0% Female 5.6%

January 25, 2011 Georgia Behavioral Health Caucus Community Care Substance Dependence or Abuse in the Past Year, among Georgia Adults 767,000 Georgians with substance abuse illness 767,000 Georgians with substance abuse illness 230,390 without insurance 230,390 without insurance Population in Thousands Both Alcohol and Drugs Alcohol Only Illicit Drugs Only Total Substance Abuse Georgia

January 25, 2011 Georgia Behavioral Health Caucus Community Care Uninsured Georgians With SMI: 310,000 With Substance Illness: 230,390 With Dual Diagnosis: 115,000 Total at Risk lives DBHDD: 655,390 *DOJ Settlement specifically focuses on the 9,000 most acute

January 25, 2011 Georgia Behavioral Health Caucus Community Care The Unmet Need Substance Use Treatment Only Mental Health Treatment Only Dual Diagnosis Treatment 39.5% 45.2% 3.7% 11.4% No Treatment 259,000 uninsured adults in Georgia have never accessed care

January 25, 2011 Georgia Behavioral Health Caucus Community Care Outline Large number of individuals in Georgia with mental illness and substance abuse who are uninsured. Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement. Service capacity and budget planning should be population based. Successful community providers will need to be integrated, complex organizations with specific core competencies. Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011 Georgia Behavioral Health Caucus Community Care DOJ Settlement: Service Enhancements Crisis Line Crisis Stabilization Programs Mobile Crisis Assertive Community Treatment Housing Supports Supported Employment Peer Support Services Targeted Case Management

January 25, 2011 Georgia Behavioral Health Caucus Community Care Community Service Delivery Spectrum

January 25, 2011 Georgia Behavioral Health Caucus Community Care Characteristics of a Well-Organized Community Delivery System Services are organized into a simple, local network of care Network services are available through multiple entry points Formal linkages exist between mental health, substance abuse and primary care Local networks are responsible for coordination of client services Case management is identified to coordinate care Stakeholders have direct and meaningful input

January 25, 2011 Georgia Behavioral Health Caucus Community Care Outline Large number of individuals in Georgia with mental illness and substance abuse who are uninsured. Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement. Service capacity and budget planning should be population based. Successful community providers will need to be integrated, complex organizations with specific core competencies. Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011 Georgia Behavioral Health Caucus Community Care Uninsured Georgians With SMI: 310,000 With Substance Illness: 230,390 With Dual Diagnosis: 115,000 Total at Risk lives DBHDD: 655,390 *DOJ Settlement specifically focuses on the 9,000 most acute

January 25, 2011 Georgia Behavioral Health Caucus Community Care

January 25, 2011 Georgia Behavioral Health Caucus Community Care Focus for the Delivery System Coordination of Services Access and Availability of Services Effective Services and Supports Adequate Oversight of Service Delivery Sufficient Funding for Services

January 25, 2011 Georgia Behavioral Health Caucus Community Care Core Competencies For Community Behavioral Health Provider Groups 1. The full spectrum of Specialty Behavioral Health Services 2. Strong and deep clinical staff 3. A well defined Assessment Process and Level of Care System 4. A solid approach to Prevention, Early Intervention, and Recovery 5. The ability to Coordinate Care across the spectrum of services 6. Demonstrated use of evidence-based Clinical Guidelines 7. Measurement Systems and Tools to measure Outcomes 8. A robust Electronic Health Record that includes Patient Registries 9. Quality Improvement Processes and supporting Data Systems 10. Financial Systems to manage Risk and Case Rate Payments 11. Ability to market services in response to increased competition

January 25, 2011 Georgia Behavioral Health Caucus Community Care Outline Large number of individuals in Georgia with mental illness and substance abuse who are uninsured. Community-based services are essential to a stable delivery system and to successfully discharging the DOJ Settlement agreement. Service capacity and budget planning should be population based. Successful community providers will need to be integrated, complex organizations with specific core competencies. Provider groups, advocates and consumers should have an essential role in planning the community system of care.

January 25, 2011 Georgia Behavioral Health Caucus Community Care Meaningful Community Planning Wealth of Expertise, Experience and Local Relationships State and Regional Level Strategic and Tactical Counsel Assist with Resource Allocation Decisions Implementation Support