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Sonoma County, a diverse county of over one million acres, is famed for its agriculture industry and recreation boasting a booming economy and a unique lifestyle for its citizens described by the famed Luther Burbank as the chosen spot of all the earth. Sonoma County is the place

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to live, work and play as we move into the 21st century. Led by the forward looking philosophy of its governing bodies. Sonoma County's 340,000 residents are a harmonious, successful blend of ethnic and economic backgrounds. We invite you to take a closer look at Sonoma County in

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the nineties with your host Rich McGlinchey. How you doing everybody? Welcome to this edition of Sonoma County in the nineties, We're gonna be talking to Alan Roland and Allen is the mental health services director of Sonoma County. Fairly recent addition to the Sonoma County staff, we're

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gonna be talking about California's managed medical, mental health medical plan. But before we do that, Alan, welcome to Sonoma County. I know you've been here before, but uh, your new, with the county government staff. Uh, how about a little background about Alan Roland. Where are you

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from? What you do before you became our mental health services director. Thank you. Rich, thank you for inviting me here and having the opportunity to talk to you about medical and managed care in in California and specifically in Sonoma County. I'm a transplant from southern California.

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I've been up here about three years and both my wife and I are very excited. Uh, this is a beautiful community, a beautiful county and we've got a home and Windsor. My wife teaches in the Windsor school district as a vice principal. And and most recently

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I've been appointed the mental health services director for Sonoma County. I've been actually consulting with the county for the last couple of years helping uh mr ju the former director and and marge film in in in regards to some program development and contract management. Prior to

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that. Um I was in southern California. I was assistant professor of social work at cal state Long Beach for a couple of years and was the assistant director of mental health for Los Angeles County. And uh deputy director with the Orange County had a chance to

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kind of do something different. And when we moved up here, we opened up a small business mom and pop business and Windsor um and uh enjoyed that for about a year and a half and missed our professions and went back into the field. So we're very

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excited about being up here in Sonoma County. It's great to have you, let's get into this medic al managed care like this. What is medical managed care, mental health services. Yeah, that's kind of a large term. It is and nobody's come up with an appropriate acronym

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yet. So um what it is is as everyone is well aware that nationally and locally and statewide. We're looking at health care. We're looking at cost. We're looking at access to services. We're looking at trying to provide care for many people who are without care in

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Sonoma County and mental health managed care. And specifically for the medical population is really to try to develop a more integrated coordinated system of care. It's to increase access to services for people to bring together both the public and the private sector into one system that

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is coordinated and managed by a single authority and the purpose is to increase access and at the same time to control cost. I understand there right now there are two medical systems that provide mental health care in California. Can you clarify those for us? Yes, we

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have actually medical, which is really the federal Medicaid program and it provides health care and mental health services for population who are on medical, who are on medical because of disability or because of uh loss of employment or other types of factors. And in California, we

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have a system where a person on medical can go to the private sector can see private psychologist or psychiatrist or mental health services or they can come to the public sector, which is the Sonoma County mental health services and its various contractors. So we have two

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systems that operate independent and are not coordinated and providing services in some sense to the same individual. Well, how did the two systems operate here in Sonoma County itself? In Sonoma County, Sonoma County mental health services is the public short doll medical system. And we basically

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provide uh mental health services to about 70% of the medic al uh recipients who seek out mental health services. The private sector which is called the fee for service um is uh primarily psychologists and psychiatrists. Uh and it's they provide primarily outpatient services and some inpatient

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services. The county system provides other types of services. Date treatment services, rehab services, vocational services. We are the psych emergency program. People may be familiar with that up at community hospital and an oak crest. And that is the primary differences of the two systems. All right,

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what would be the difference say? Programmatically or as far as the dollars are concerned? Um presently, uh about $8 million is spent in Sonoma County for medical mental health services. Uh The county provides about $5 million of those services. The private sector around two million of

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those services. Of the two million that's provided in the private sector, which is the fee for service. Um It's primarily inpatient services for adolescents outside the county. Uh because Sonoma County does not have an adolescent inpatient acute program and out patient type of services. People who

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are seen for various life crisis problems, depression, other types of mental health programs. In the public sector. Again, we provide other types of services, residential case management, rehab day treatment. Those type of services. Very, very interesting. We're gonna pause right here for our station break and

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we'll be back right in a moment or so. Talk more with Alan Roland about the mental health. Many cattle plan first. This message, We women have always given a lot of thought to matters of the heart, but not always to the health of our hearts. Last

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year 250,000 American women died of heart attacks. Some were smokers, others had high cholesterol, still others had a family history of heart disease. Please take this heartfelt advice, exercise, eat healthy, don't smoke and have regular checkups. A message from the Will Rogers Institute, white plains New

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York. Welcome back to this edition of Sonoma County in the 90s. Were talking to Alan Roland. He is our mental health services director for Sonoma County. We're talking about California's managed mental health medical plan. We just got into the subject pause for our station announcement and

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now and now we're back. I'm gonna ask you about the question. Have jotted down here, says the State of Mental, the state Department of Mental Health Services in their so called strategic plan for care, calls for a carve out of mental health services. And what are

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they talking about? What they're referring to is that the mental health portion of medical will be uh implemented separate from the physical health care uh medical plan for the last number of years. The state of California has been interested in reforming the medical system and they've

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been working on this plan and they released it in 92 a fall of 92 it was reviewed by various groups and with a tremendous amount of input and they released it officially last spring. And in that plan was a carve out of the mental health portion.

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And the reason for that was to allow the California and the various counties to develop a mental health program that would be consistent with how public mental health is now operating in cal California. However, whatever is developed for mental health needs to work in conjunction with

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the physical health side of Medic al and in Sonoma County, we have a unique opportunity because with the reorganization that's occurring in the county, mental health is now going to be part of the proposed new Department of Health Services. So we'll be working very closely together

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in the development of the physical health care side of medical along with the mental health. Well, what's the timetable for implementing the proposed consolidation in this fee for service, medical and the short door medical California. Um What the plan is, and what has been approved by

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the Department of Health Services and the State Department of Mental Health is the lead agency. Uh part of this carve out, they've been designated as the lead agency and they've been working very closely with the Department of Health Services. So we're talking about actually a five

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year implementation project and it's going to take five years to accomplish the overall objective. Um The timetable is in the first year and what they're planning to do that october 1st of this year, the impatient portion of medical and for our county, it's about a million

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dollar fee for service program primarily for adolescents, acute care needs of adolescents. Uh that on october 1st 94 those services, those dollars will now be consolidated with the short Doyle, impatient FIFA services next year. On july 1st of 95 the outpatient, which is another million dollars

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in the FIFA service will be consolidated so that we will then accomplished the first phase on july 1st of 95 then the next three years after that will be then moving towards a capitation uh model which basically is designed to uh uh provide dollars for each

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beneficiary and medical. And then the counties are then responsible for providing the care within those dollars. Well, how about the medical beneficiaries in Sonoma County? How many of them will be impacted by the changes? We have 38,000 people at the present time receiving that our medical

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that are eligible for medical, who receive a medical beneficiary card. Not all of them receive their services in Sonoma County because according to medical requirements, a person can has the freedom to seek services outside the county go as far as southern California to receive services. So

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we're talking about 38,000 people who will be impacted. That becomes the responsibility under managed care, both the physical and the mental health within that, about 7000 People have been treated in the mental health system either in the FIFA service or the public side. So it's a

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smaller percentage. How but the but the population that could seek services is up to 38,000 people. Will the changes in the way of medical services are being consolidated affect the beneficiaries in meeting their health needs? It will affect because under managed care and the whole point

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of managed care, part of it is cost containment and ensure access. The freedom of choice that is now a federal requirement will have to be waived and it will impact them. There will be uh only able to accept assess or seek services from the providers who

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now will be under contract with the county. So they won't be able to for non emergency services uh choose whatever doctor or whatever clinic or whatever program they will now have to uh seek services from those providers who are part of this new network of medical.

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So that will impact them. Um, in that sense, how will the new quote public health managed care program, How will it operate and how will it look to people? What will we notice that's different about it in the past? Well, I think some of the main

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differences is that it will be one system instead of two systems? It'll be one system. And the real advantages of this whole change is that there will be more services available to people who need mental health care. Uh There will be uh more family involvement, more

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consumer involvement and what types of services will be developed. Uh There will be more monitoring, more quality assurance type of activities. Uh There will be um a network of providers at the present time. The private sector works independent, nobody talks to anybody under the new system

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will be one system, a single system of care and the person actually will have more options and more alternatives, so it's going to look much different. But the advantages are it's going to be coordinated. It'll be uh more collaboration among the various providers. Uh People who

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are seeking services will have different choices. Uh and the uh person will have uh more support um and actually be involved in the planning. What is the local management mental health care plan? How would you describe that for what? That the local manage this is a

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mouthful. We're gonna have to figure out another terminology, but anyway, you're doing very well. The local manage mental health care plan is really um what will have responsibility for administering the medical program as part of the requirements of the state. Uh The county board of supervisors

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has the first right of refusal to determine if they want to be designated as the local managed care health plan and authority. And they will then be responsible administratively for providing those services under the present system and the fee for service people build the state for

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reimbursement for the services provided under the new authority. Uh providers like independent psychologists will be part of the network, will now build the county for for the services and will have to meet credentialing requirements standards, other types of quality of care type of requirements. This may

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be redundant. Question on top of that. But what are the reasons the county should be designated as the local manage mental health care plan Administrator. Well, some of the primary reasons and one is that the strategic plan put out by the Department of Health Services actually

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recommends and feels that the county mental health system and the county board of supervisors should be designated. Part of the reason is that we are the primary providers of, of medical services. We have the larger range of services that are already available. Um We have probably

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the best knowledge of the population who need services. Uh One of the other advantages is that we have the board of supervisors who have responsibility and oversight responsibility. We have a mental health board which can provide input which includes consumer and family involvement. Um And part

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of the medical or part of medical reimbursement requires a local match, a state match. And right now the dollars it's 50 cents on the dollar. So for every 50 cents of state money or local money that's put up, we can then get reimbursed from the federal

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government of fifth 50 cents. And right now the majority of state dollars that could be available to provide the services rest with the county and is under the authority of the county. So it's it's actually administratively programmatically and fiscally to uh the advantages of the county

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to be designated as the as the local managed care plan. That tells us why why you should be. What are the advantages to the county mental health services to be designated as the administrator of this new program? Well, some of the primary advantages of I mentioned

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earlier is that we have the best knowledge of the system and we know the clients, we know uh the programs and we've also, which is one of the primary differences of of the private sector versus the public sector is that we are the safety net. And

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uh when there's emergencies, when their police need somebody to intervene, who do they come to? They come to the county and they come to psych emergency. So we are the safety net. And that's, you know, one of the important advantages. We already have a full array

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of services being provided, a system of care in place from residential to outpatient today. Treatment as I mentioned earlier, we have a mental health board that includes families and consumers uh in the system. And one of the most important parts of managed care in order to

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control costs and to assure quality is that we have in place already utilization review and quality control requirements and monitoring that. The FIFA service sector does not have under short Doyle medical since its existence. County programs have been scrutinized and monitored by the state in the

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FIFA service. It's not that closely monitored and scrutinized. Uh there's authorization for treatment and then there's a limit on that. But there's not the monitoring and the evaluation that's done on the short side. So by integrating them, the taxpayer is going to be assured that accountability

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is much stronger and built into the system. That's right. Alright. We're gonna pause right here for a another public service announcement after which Alan Roland and I will come back and we'll talk more about the managed mental health Medicare medi cal plan. I can't get that

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all out. But we will be back and talk more about this important subject in just one moment everyone gets the blues. Sometimes, usually they go away after a short while, but sometimes they grow worse. Day to day life can feel heavy and hopeless but you don't

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have to let depression ruin your life. You can get help to lift the blues. Let your doctor find out if there's a physical cause. Talk to a counselor or a therapist just deciding to get help can make you feel better to learn more about dealing with

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depression. Right? The Will Rogers Institute White Plains new york. Welcome back to this edition of Sonoma County in the nineties were talking to Alan Roland, the mental health services director for Sonoma County, talking about California's managed mental health medical plan. Got it all at that time.

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That is that is quite a title, isn't it? Alright. The changes you've mentioned now, this new mental health services are going to be provided. How do these changes in the medical, mental health services relate to being what To what's being proposed by county public health. As

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I mentioned earlier, Sonoma County is applying to the state to begin to actually demonstrate a managed care system for medical clients for physical health. And they've put an application into the state to take responsibility for managing the care of the 37-38000 um individuals who receive medical

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and they will receive a dollar amount for doing that managed care. And it relates in the sense that both systems are developing a network, an alliance of providers and by working closely together will be able to treat the person to care for the person, both the

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physical side and the behavioral side. And so there's a natural linkage and relationship by what both um services are are developing right now in Sonoma County right now, we have had two previous medical services. So the question seems to come to mind right now, what are

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the risks inherent in assuming responsibility for consolidation of those two plans? Well, one of the the obvious one is and this was communicated to the board of supervisors by myself and mr. Costello of the acting director of health services at any time. You take on a

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state program uh you know, you're always concerned about. Is there something that we don't know? Is there something hidden? And obviously the board is very sensitive to that. Uh The other risk uh in regards to uh taking on medical and managed care is that the overall

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plan to be accomplished the next five years is the capitation which is designed to give you a certain amount of dollars. And with those dollars you're then to manage the care of the individual. So you have to be very careful to assure that the rates that

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you establish the standards, the utilization controls and the authorization process for care is um well thought out and well developed. And that's how the private sector managed care companies, the large companies have been successful. So we're basically adopting some of the same principles and some of

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the same procedures that the private sector in order to control costs and to control the amount of treatment. Because if you do not do that then you're going to bankrupt the system. So that some of the, you know the major risk in regards to providing uh

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medical managed care. Another major risk is to assure that when this agreement is put in place that growth and the amount of growth because we do know that population in Sonoma County is growing. There will be more people receiving medic al over the years and we

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have to make sure that the state dollars do follow the individual and that we have the necessary funds to to to provide the services. You mentioned earlier the National Health uh scene, so to speak. How does this relate to what's happening under the national national scene

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in regard to health care reform in this reform of the mental uh mental health services, How does it fit into the national organs? Is it part of the national plan? Well, it is part of it. And there is some concerns by the mental health directors in

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the state of California has been very aggressive in pro providing some input into the dialogue that's occurring at the national level regarding health care reform. In fact, California is seen as kind of way out in front and compared to other other states regarding national health care

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reform. Our major concern is that whatever is developed at the national level, the population that we're concerned about, the seriously and persistently mentally disabled and seriously emotionally disturbed Children receive benefits. And there's a lot of dialogue at the federal level to exclude them from the benefit

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packages that the benefit packages are designed around, um the general population and not the population that needs a full array of services. So we're providing significant input at the national level, working with the major uh federal people who are designing the packages. And California is actually

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being considered on the cutting edge of of what we're doing in regards to managed care and trying to develop a single system of care in California, Mental health services are so vitally important. That's why this program I think is extremely important to the public in general,

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is to get out this information about the consolidation of the plans. What are some of the specific outcomes that will be expected from an implementation of this kind? Well, there's a lot and I and uh being in the field for the last 25 years, I think

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this is a very significant change and having the experience of, of working in systems where creativity and innovation was not necessarily fostered. Um what this gives us an opportunity is to develop alternative programs to develop local options and to design a system that meets the needs

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of our residents in Sonoma County because we'll basically be in charge of the dollars, will be in charge of the planning, will be in charge of the program. So it's transferring the responsibility for providing this services to the local level, but also transferring the dollars to

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go with it and and the authority to be able to develop those programs, will be able to be more innovative, will be able to be more creative, We can develop options to acute care. Uh a lot of mentally ill people once they're stabilized, once medication uh

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is appropriate for their symptoms. What they need is support services. They need quality of life support services. They need housing. They need supportive employment. Uh They need recreational pre vocational. I mean, a person who's mentally ill does not need to be locked up for long periods

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of time. We're not talking about major physical type of problems. We need the medical attention in the first few days, but once that's over, they can be treated in less or or residential type of programs uh programs in the community that's going to provide support for

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them. So this some of the outcomes that we expect our more creativity, more innovation, more options for people, cost, containment, Accountability, better quality control. And most importantly, consumer involvement in the decision making. We're rapidly running out of our time. A couple of things. I want to

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ask. What does capitation mean? And how does that relate to medical managed care within the next five years? Um if we're successful with this implementation by they figured July of 98 um uh The dollars that will be available will be distributed to the counties and within

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that dollar amount were to provide managed care and were to provide health care if we can do it for less than what we have. That means more money that can be put into the system for new programs. The time has escaped. Thank you for coming down

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and talking with us. And I'd like to have you come back in a few months if you would tell us this is all progressing. All right, thank you. Ladies and gentlemen, we're talking to Alan Roland, the mental health services director for Sonoma County. Our subject has

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been California's managed mental health medical plan. And he told you how these two plans have been combined and what is going to be in our future? As far as mental health treatment programs to Sonoma County is concerned. My name is Richmond, the program at Sonoma County

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United. I'll be back with you next week with another member of the county government family or a related agency till then. Good night. Good luck and good health to each and every one. Mhm.