The NorthSTAR Service Delivery The NorthSTAR Service Delivery SystemSystem

Publicly funded, managed care program for 7 counties in Publicly funded, managed care program for 7 counties in the Dallas area that provides mental health and substance the Dallas area that provides mental health and substance abuse services in one integrated service delivery systemabuse services in one integrated service delivery system

Combines services/dollars provided by former HHSC Combines services/dollars provided by former HHSC legacy agencies TDMHMR, TCADA, TCOOMMI, legacy agencies TDMHMR, TCADA, TCOOMMI, traditional Medicaid as well as local dollarstraditional Medicaid as well as local dollars

Public-private partnershipPublic-private partnership

Eligible individuals include most Medicaid recipients in Eligible individuals include most Medicaid recipients in service area, as well as medically indigent (<=200% FPL) service area, as well as medically indigent (<=200% FPL) who reside in service area and meet clinical criteriawho reside in service area and meet clinical criteria

Organizational DesignOrganizational Design DSHSDSHS contracts with, funds, and oversees ValueOptions. contracts with, funds, and oversees ValueOptions. DSHS contracts with DSHS contracts with NorthNorth Texas Behavioral Health Texas Behavioral Health

Authority.Authority. NTBHA is the behavioral health authority for NTBHA is the behavioral health authority for the NorthSTAR service area. This includes local input and the NorthSTAR service area. This includes local input and planning, local oversight of ValueOptions, delegation of planning, local oversight of ValueOptions, delegation of many local authority activities to ValueOptions, in addition many local authority activities to ValueOptions, in addition to serving as a local problem solving resource for to serving as a local problem solving resource for consumers (ombudsman services). consumers (ombudsman services).

ValueOptions’ ValueOptions’ requirements includerequirements include developing a network developing a network of qualified, credentialed providers, managing care for all of qualified, credentialed providers, managing care for all eligible individuals, adjudicating claims for services, and eligible individuals, adjudicating claims for services, and responding to NTBHA and local stakeholder needs.responding to NTBHA and local stakeholder needs.

Organizational DesignOrganizational Design

Oversight Oversight

RelationshipRelationship

DSHS

ValueOptions

Enrollees

NTBHA

Stakeholders

Provider Network

Agreement

CMS

HHSC

LBB

SAMHSA

CSATTCOOMMI

NorthSTAR Counties

FY11 Annual funds for NorthSTARFY11 Annual funds for NorthSTAR

 

FUNDING SOURCE Funds

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 PurchasingPooled Purchasing

Transformed separate, disparate systems of care and Transformed separate, disparate systems of care and funding sources into one system of care.funding sources into one system of care.

Reduced State and provider administrative costsReduced State and provider administrative costs

Provides comprehensive benefit package for eligible Provides comprehensive benefit package for eligible Medicaid and medically indigent individualsMedicaid and medically indigent individuals

Access to services determined by clinical need, not Access to services determined by clinical need, not funding sourcefunding source

Continuation of services regardless of Medicaid statusContinuation of services regardless of Medicaid status

Other features of NorthSTAROther features of NorthSTAR

Open access system. No waiting list for services or medicationsOpen 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 providersConsumer choice of providers Expansive provider network, with competition among providersExpansive provider network, with competition among providers Services are regularly reviewed/authorized by licensed care Services are regularly reviewed/authorized by licensed care

management staff to ensure appropriateness management staff to ensure appropriateness High level of accountability-rigorous contractual requirements, High level of accountability-rigorous contractual requirements,

managed by routine site reviews and analysis of comprehensive managed by routine site reviews and analysis of comprehensive service level dataservice level data

Universal access for crisis/emergency servicesUniversal access for crisis/emergency services Comprehensive Quality Management Strategies (BHO, DSHS, Comprehensive Quality Management Strategies (BHO, DSHS,

NTBHA, provider and stakeholder involvement)NTBHA, provider and stakeholder involvement) Stakeholder input is the centerpiece of the programStakeholder input is the centerpiece of the program

Other features (cont.)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 Service Array includes all DSHS-funded MH and SA/CD

services, Medicaid funded behavioral health services, services, Medicaid funded behavioral health services, and value added servicesand value added services

Federal Medicaid waiver to include Medicaid servicesFederal Medicaid waiver to include Medicaid services Network includes SA/CD Treatment Facilities/Clinics, Network includes SA/CD Treatment Facilities/Clinics,

Hospitals, MHMR Centers, Hospitals, Psychiatrists, Hospitals, MHMR Centers, Hospitals, Psychiatrists, LCSWs, LPCs, Psychologists, LCDCs, and Private LCSWs, LPCs, Psychologists, LCDCs, and Private Agencies similar to Community CentersAgencies similar to Community Centers

DSHS data warehouse contains all paid and denied DSHS data warehouse contains all paid and denied client-level service and medication encounter data, as client-level service and medication encounter data, as well as clinical assessment datawell as clinical assessment data

What has NorthSTAR Accomplished?What has NorthSTAR Accomplished?

Increase in number served- more clients receive Increase in number served- more clients receive services now than prior to NorthSTAR services now than prior to NorthSTAR

There are no waiting lists for services or medicationsThere are no waiting lists for services or medications Increased integration of all levels of care, including Increased integration of all levels of care, including

coordination with STAR/CHIPcoordination with STAR/CHIP Larger provider network to serve Medicaid and non-Larger provider network to serve Medicaid and non-

Medicaid populationsMedicaid populations Jail Diversion Strategies-TCOOMMI funded programs, in Jail Diversion Strategies-TCOOMMI funded programs, in

addition to Acute Front Door Evaluation Facilityaddition to Acute Front Door Evaluation Facility 340B Pharmaceutical Purchasing Program-Reduced 340B Pharmaceutical Purchasing Program-Reduced

cost for medications (UTMB); integration of physical and cost for medications (UTMB); integration of physical and behavioral healthbehavioral health

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

Number of Individuals Served in NorthSTAR by County

0

10000

20000

30000

40000

50000

60000

70000

80000

FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11

Rockwall

Navarro

Kaufman

Hunt

Ellis

Dallas

Collin

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

Providers That Have Served at Least One NorthSTAR Enrollee by county(Represents individual and facility based providers-numbers of providers are often

represented in multiple counties)

0

50

100

150

200

250

300

350

400

FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11

Collin

Dallas

Ellis

Hunt

Kaufman

Navarro

Rockwall

How are Service Funds How are Service Funds Directed?Directed?

System is needs based, not allocation based. Money is System is needs based, not allocation based. Money is designed to flow to where it is neededdesigned to flow to where it is neededThe questions to ask are:The questions to ask are:– Does the provider network consist of providers who Does the provider network consist of providers who

are accessible?are accessible?– Do network providers have capacity?Do network providers have capacity?– Do providers provide all services within an Do providers provide all services within an

authorization?authorization?– Are providers adequately reimbursed?Are providers adequately reimbursed?– Is there a continuous marketing and outreach effort?Is there a continuous marketing and outreach effort?– Can individuals file complaints and is that information Can individuals file complaints and is that information

captured and acted upon?captured and acted upon?– Are data on other performance tracked?Are data on other performance tracked?

Various Challenges to the NorthSTAR Various Challenges to the NorthSTAR ProgramProgram

Population and service utilization increases for Population and service utilization increases for NorthSTAR service area NorthSTAR service area

System has no waiting listsSystem has no waiting lists Data collection and evaluation. We have a robust data Data collection and evaluation. We have a robust data

and information collection system, but analysis takes and information collection system, but analysis takes time and resources.time and resources.

Funding level not commensurate with need.Funding level not commensurate with need. Program is complex at the DSHS administrative level Program is complex at the DSHS administrative level

(but simplified at the enrollee and provider level)(but simplified at the enrollee and provider level) Cost shifting from other systems still presents some Cost shifting from other systems still presents some

problemsproblems

SummarySummary

NorthSTAR is a unique approach to delivery of publicly funded NorthSTAR is a unique approach to delivery of publicly funded mental health and substances abuse servicesmental health and substances abuse services

Funding for services is designed to be directed where it is needed. Funding for services is designed to be directed where it is needed. Counties have a stake in identifying need. NTBHA, ValueOptions Counties have a stake in identifying need. NTBHA, ValueOptions and providers have a stake in addressing this needand providers have a stake in addressing this need

System is designed to be efficient, efficacious, and accountableSystem is designed to be efficient, efficacious, and accountable Many more clients have been served, without substantial increases Many more clients have been served, without substantial increases

in resourcesin resources Competitive environment has resulted in increased provider choice Competitive environment has resulted in increased provider choice

and client empowermentand client empowerment Because of pressures on the system, it has been adaptive and Because of pressures on the system, it has been adaptive and

resilientresilient Because NorthSTAR has no waiting lists and funding is finite, Because NorthSTAR has no waiting lists and funding is finite,

maintaining quality is always a challengemaintaining quality is always a challenge Other Information and Data: Other Information and Data:

http://www.dshs.state.tx.us/mhsa/northstar/northstar.shtmhttp://www.dshs.state.tx.us/mhsa/northstar/northstar.shtm

Questions?Questions?