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Posted on: March 2, 2020

Transforming Behavioral Health in Pierce County

Essential to developing new, additional resources to successfully transform our region’s behavioral health system is first creating a comprehensive plan.  Funding an array of providers without first developing a comprehensive vision will only perpetuate an already fractured system that underutilizes resources, doesn’t measure results, and fails to build the case for shared saving strategies and additional investments. 

The Pierce County Council commissioned the 2016 HSRI report for the Pierce County Behavioral Health System Study to provide recommendations on filling gaps in service and ideas for areas of growth. In 2018 HSRI updated their recommendations.  I have requested and have been given a progress report from Heather Moss, Director of Pierce County Human Services. 

Pierce County has undergone many changes since the initial 2016 HSRI study so to say we have been sitting on this study is not accurate. 

I was most intrigued by the progress of the Pierce County Integration Oversight Board (IOB) in collaboration with Elevate Health and the Washington State Health Care Authority. 

In 2019 the IOB focused mainly on overseeing the integration of physical and behavioral health in Pierce County.  Now, that integration effort is well underway.  The IOB shifted its focus to creation of the Regional System of Care Committee (RSCC) which was the primary recommendation of both the 2016 HSRI study and the follow up revised recommendations of 2018 to serve as the central coordination body.  The RSCC reports up to the IOB.  It is co-chaired by the IOB and Elevate Health and consist of representatives from key sectors. 

Elevate Health extends across Pierce County.  They contract with 65 health care providers.  They have already distributed $47 million to support transformational change of the Medicaid population or 25% of Pierce County residents.   The RSCC will utilize Elevate Health’s expertise and align its plan with Elevate Health’s performance metrics.  The RSCC and Elevate Health will jointly employ a full time Project Manager.  The Project Manager and RSCC will have access to Elevate Health’s care and social determinants data to measure outcomes and build the case for shared savings and investments.  Elevate Health has set aside $6 million for key community assets.  Additionally, the RSCC will build its plan with an eye to new Elevate Health funding sources to attract new investments into Pierce County, including Elevate Health’s funding arm “One Pierce Community Resiliency Fund”

IOB/RSCC is the only regional government body at the forefront of financial integration with close working relationships with Elevate Health and access to the latter’s data, expertise and resources.  The Council’s HSRI report recognized the enormous advantage to this relationship when the report recommended that the local coordination body be a working partnership of the IOB and Elevate Health.  The RSCC sub-committee will work to develop a comprehensive plan will benefit enormously from that partnership. 

The IOB formed the RSCC in the fall of 2019 and it had it’s first monthly meeting in January 2020.  It is drawing up it’s Charter and has already concluded that the regional plan it is charged with developing must envision an integrated system of care.  That moves the region well beyond the existing, fragmented and difficult to navigate patchwork of providers that struggle to work collaboratively.  Accordingly, it would be premature to make funding decisions prior to the RSCC developing a regional plan and include the population health metrics that will demonstrate that the region is moving in the right direction.  Put another way, budgeters cannot know which provider to fund, nor how much to fund them, until the plan and its metrics are established.

The HSRI report as I read it was not intended to set forth a regional plan to transform the system of care.  It identified obvious gaps in service, some of which have been filled. 

One example is Pierce County’s adult mobile behavioral health crisis response team managed by MultiCare through their Mobile Outreach Crisis Team (MOCT).

Also, Comprehensive Life Resources manages MCIRT which has been a successful and well-used intervention program which I and several of my fellow councilmembers have engaged with ride-a-longs.  Comprehensive Life Resources (CLR) plans to expand this program to Lakewood and the Key Peninsula.  I look forward to seeing a Comprehensive Plan to expand it to all of Pierce County. 

Another example is the Crisis Recovery Center at Parkland-Spanaway which is under construction and due to open in Summer 2020. 

After finding out about the IOB, I asked if I could attend the RSCC February meeting.  I was placed on the agenda wanting to understand more about the direction and capability of the sub committee to deliver a strategic plan.  After a dialogue with members, I believe that the RSCC is well suited to develop a strategic plan for behavioral health system improvements because of its superior access to data, expertise and resources. 

Proposed Ordinance 2020-24s would impose a new sales and use tax prior to having a specific plan for how the money is to be spent, what outcomes are expected, and how performance will be measured.  Imposing a new tax without a specific and fiscally responsible plan undermines public confidence and risks the uncoordinated expenditure of behavioral health resources.

We should request the Pierce County Integration and Oversight Board (IOB) and the Regional System of Care Committee (RSCC) prepare and submit to the Council by October 1, 2020 a strategic plan that if implemented, efficiently and effectively expands revenues projected to be raised by the behavioral health and therapeutic court tax 1/10 of 1%. 

This Strategic Plan will include these objectives at a minimum:

  • Clearly articulate goals, objectives and action steps that prioritize areas for short, medium and long-term change. 
  • Identify relevant performance and outcome measures for specific objects of expenditure with emphasis on accountability, key implementation milestones and measurable results. 
  • Prioritize implementation steps based on cost effectiveness and maximizing the impact of county directed spending by leveraging non-County resources.
  • Identify improvements to system oversight and governance including opportunities for ongoing engagement by Pierce County Council and Pierce County Human Services Department

I have also requested the RSCC to include the Council’s policy goals:

  • Reduce the number, time and rate of avoidable behavioral health crisis
  • Ensure broad access to treatment for Pierce County residents in both urban and rural communities regardless of the type of health insurance coverage or lack thereof.
  • Prioritize especially vulnerable populations, particularly youth and veterans
  • Divert adults and youth with behavioral health needs from costly interventions to more appropriate services
  • Reduce rates of substance use, morbidity and mortality
  • Reduce rates of suicide and other self-harm
  • Leverage and link programs and services
  • Provide trauma-informed, culturally competent services

It is my intent to draft a Resolution for this Councils consideration directing the RSCC to develop a strategic plan including the above stated objectives and Council goals and to receive input from First Responders, Tribal communities, workforce development advocates, long term care providers, justice related service providers, affordable housing developers, federally qualified health centers, peer to peer service providers, parents, medical providers for the developmentally disabled and others. 

As stated previously, we should request the Pierce County Integration and Oversight Board (IOB) and the Regional System of Care Committee (RSCC) prepare and submit to the Council by October 1, 2020 the strategic plan.  Representatives from the RSCC would be requested to provide periodic updates to the Council during the development of this strategic plan.

Here in Pierce County this Council believes in Fiscal Responsibility and Social Responsibility.  Like other Counties and Cities, we do not think “If only we raise more taxes” Pierce County will be able to show it cares.  Pierce County does care.  This Council knows we are growing and what worked 20 years ago may not work now.  Our citizens need leaders to develop smart, sound and sensible policy knowing that we are spending other peoples hard earned money.  They deserve the best we can give.

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