The NorthSTAR Service Delivery System Publicly funded, managed care program for 7 counties in the Dallas area that provides mental health and substance abuse services in one integrated service delivery system Publicly funded, managed care program for 7 counties in the Dallas area that provides mental health and substance abuse services in one integrated service delivery system Combines services/dollars provided by former HHSC legacy agencies TDMHMR, TCADA, TCOOMMI, traditional Medicaid as well as local dollars Combines services/dollars provided by former HHSC legacy agencies TDMHMR, TCADA, TCOOMMI, traditional Medicaid as well as local dollars Public-private partnership Public-private partnership Eligible individuals include most Medicaid recipients in service area, as well as medically indigent (<=200% FPL) who reside in service area and meet clinical criteria Eligible individuals include most Medicaid recipients in service area, as well as medically indigent (<=200% FPL) who reside in service area and meet clinical criteria

Organizational Design DSHS contracts with, funds, and oversees ValueOptions. DSHS contracts with, funds, and oversees ValueOptions. DSHS contracts with North Texas Behavioral Health Authority. NTBHA is the behavioral health authority for the NorthSTAR service area. This includes local input and planning, local oversight of ValueOptions, delegation of many local authority activities to ValueOptions, in addition to serving as a local problem solving resource for consumers (ombudsman services). DSHS contracts with North Texas Behavioral Health Authority. NTBHA is the behavioral health authority for the NorthSTAR service area. This includes local input and planning, local oversight of ValueOptions, delegation of many local authority activities to ValueOptions, in addition to serving as a local problem solving resource for consumers (ombudsman services). ValueOptions requirements include developing a network of qualified, credentialed providers, managing care for all eligible individuals, adjudicating claims for services, and responding to NTBHA and local stakeholder needs. ValueOptions requirements include developing a network of qualified, credentialed providers, managing care for all eligible individuals, adjudicating claims for services, and responding to NTBHA and local stakeholder needs.

Organizational Design OversightRelationship DSHS ValueOptions Enrollees NTBHA Stakeholders Provider Network Agreement CMS HHSC LBB SAMHSA CSAT TCOOMMI NorthSTAR Counties

FY11 Annual funds for NorthSTAR FUNDING SOURCEFunds DSHS Allocated Funds $ 37, 507,304 Medicaid $ 64,718,126 Substance Abuse Block Grant $ 10,252,716 Local County Funds $ 3,379,575 Interagency Receipts (TCOOMMI est.) $ 2,000,000 Crisis Funding $ 9,915,711 State Hospital Bed Day Allocation $ 34, 282,511 FY11 NorthSTAR Funds $ 162,055,943

Pooled Purchasing Transformed separate, disparate systems of care and funding sources into one system of care. Transformed separate, disparate systems of care and funding sources into one system of care. Reduced State and provider administrative costs Reduced State and provider administrative costs Provides comprehensive benefit package for eligible Medicaid and medically indigent individuals Provides comprehensive benefit package for eligible Medicaid and medically indigent individuals Access to services determined by clinical need, not funding source Access to services determined by clinical need, not funding source Continuation of services regardless of Medicaid status Continuation of services regardless of Medicaid status

Other features of NorthSTAR Other features of NorthSTAR Open access system. No waiting list for services or medications Open access system. No waiting list for services or medications Service array is broad and flexible (evidence based) Service array is broad and flexible (evidence based) Consumer choice of providers Consumer choice of providers Expansive provider network, with competition among providers Expansive provider network, with competition among providers Services are regularly reviewed/authorized by licensed care management staff to ensure appropriateness Services are regularly reviewed/authorized by licensed care management staff to ensure appropriateness High level of accountability-rigorous contractual requirements, managed by routine site reviews and analysis of comprehensive service level data High level of accountability-rigorous contractual requirements, managed by routine site reviews and analysis of comprehensive service level data Universal access for crisis/emergency services Universal access for crisis/emergency services Comprehensive Quality Management Strategies (BHO, DSHS, NTBHA, provider and stakeholder involvement) Comprehensive Quality Management Strategies (BHO, DSHS, NTBHA, provider and stakeholder involvement) Stakeholder input is the centerpiece of the program Stakeholder input is the centerpiece of the program

Other features (cont.) Direct Service Claims Target (DSCT)-88% Direct Service Claims Target (DSCT)-88% Service Array includes all DSHS-funded MH and SA/CD services, Medicaid funded behavioral health services, and value added services Service Array includes all DSHS-funded MH and SA/CD services, Medicaid funded behavioral health services, and value added services Federal Medicaid waiver to include Medicaid services Federal Medicaid waiver to include Medicaid services Network includes SA/CD Treatment Facilities/Clinics, Hospitals, MHMR Centers, Hospitals, Psychiatrists, LCSWs, LPCs, Psychologists, LCDCs, and Private Agencies similar to Community Centers Network includes SA/CD Treatment Facilities/Clinics, Hospitals, MHMR Centers, Hospitals, Psychiatrists, LCSWs, LPCs, Psychologists, LCDCs, and Private Agencies similar to Community Centers DSHS data warehouse contains all paid and denied client-level service and medication encounter data, as well as clinical assessment data DSHS data warehouse contains all paid and denied client-level service and medication encounter data, as well as clinical assessment data

What has NorthSTAR Accomplished? Increase in number served- more clients receive services now than prior to NorthSTAR Increase in number served- more clients receive services now than prior to NorthSTAR There are no waiting lists for services or medications There are no waiting lists for services or medications Increased integration of all levels of care, including coordination with STAR/CHIP Increased integration of all levels of care, including coordination with STAR/CHIP Larger provider network to serve Medicaid and non- Medicaid populations Larger provider network to serve Medicaid and non- Medicaid populations Jail Diversion Strategies-TCOOMMI funded programs, in addition to Acute Front Door Evaluation Facility Jail Diversion Strategies-TCOOMMI funded programs, in addition to Acute Front Door Evaluation Facility 340B Pharmaceutical Purchasing Program-Reduced cost for medications (UTMB); integration of physical and behavioral health 340B Pharmaceutical Purchasing Program-Reduced cost for medications (UTMB); integration of physical and behavioral health

Numbers Served Number of enrollees served has increased since inception Number of enrollees served has increased since inception

Increased Choice of Providers who can Serve Medicaid and non-Medicaid Public Sector Clients

How are Service Funds Directed? System is needs based, not allocation based. Money is designed to flow to where it is needed The questions to ask are: –Does the provider network consist of providers who are accessible? –Do network providers have capacity? –Do providers provide all services within an authorization? –Are providers adequately reimbursed? –Is there a continuous marketing and outreach effort? –Can individuals file complaints and is that information captured and acted upon? –Are data on other performance tracked?

Various Challenges to the NorthSTAR Program Population and service utilization increases for NorthSTAR service area Population and service utilization increases for NorthSTAR service area System has no waiting lists System has no waiting lists Data collection and evaluation. We have a robust data and information collection system, but analysis takes time and resources. Data collection and evaluation. We have a robust data and information collection system, but analysis takes time and resources. Funding level not commensurate with need. Funding level not commensurate with need. Program is complex at the DSHS administrative level (but simplified at the enrollee and provider level) Program is complex at the DSHS administrative level (but simplified at the enrollee and provider level) Cost shifting from other systems still presents some problems Cost shifting from other systems still presents some problems

Summary NorthSTAR is a unique approach to delivery of publicly funded mental health and substances abuse services NorthSTAR is a unique approach to delivery of publicly funded mental health and substances abuse services Funding for services is designed to be directed where it is needed. Counties have a stake in identifying need. NTBHA, ValueOptions and providers have a stake in addressing this need Funding for services is designed to be directed where it is needed. Counties have a stake in identifying need. NTBHA, ValueOptions and providers have a stake in addressing this need System is designed to be efficient, efficacious, and accountable System is designed to be efficient, efficacious, and accountable Many more clients have been served, without substantial increases in resources Many more clients have been served, without substantial increases in resources Competitive environment has resulted in increased provider choice and client empowerment Competitive environment has resulted in increased provider choice and client empowerment Because of pressures on the system, it has been adaptive and resilient Because of pressures on the system, it has been adaptive and resilient Because NorthSTAR has no waiting lists and funding is finite, maintaining quality is always a challenge Because NorthSTAR has no waiting lists and funding is finite, maintaining quality is always a challenge Other Information and Data: Other Information and Data:

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