By GLYNIS HART
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UNITY — At their Tuesday meeting, the Sullivan County Board of Commissioners heard an update on a state program to reform how Medicaid dollars are spent, with local health care providers advocating for changes in the way services are delivered.
Sueellen Griffin of West Central Behavioral Health, Dr. Peter Mason, a family medicine practitioner based in Lebanon, and Peter Wright, executive director of the Valley Regional Hospital, supported this regional effort to integrate behavioral care with medical care. All three entities are slated to receive funding from IDN-1 to expand or integrate their services.
The term “behavioral care” includes substance abuse recovery and mental health services, as well as patient access to housing, job training and transportation.
“We have to change the way we interact with patients,” said Mason, who described himself as a “foot soldier” on the health care front lines. Mason runs a recovery group for mothers.
“If somebody has diabetes and they have severe depression, or they have transportation issues and they can’t make it to the doctor’s, it’s throwing money away to just treat their diabetes,” said Mason.
However, commissioner Ben Nelson (R- District 2) wondered if the money would be better spent on county programs than on regional reforms. The funds come from the federal government to reimburse the county for Medicaid expenses.
Claremont and Newport have the highest proportion of people using Medicaid per capita in the state, while Sullivan County has the largest Medicaid population by the numbers. In Claremont, 28 percent of the population is enrolled in Medicaid, in Newport 25 percent.
Behavioral issues
Ann Landry, executive director of the Region 1 Integrated Delivery Network (IDN-1), gave the board of commissioners a report on the program. She said addressing behavioral issues in the Medicaid population is critical to make health care dollars effective.
“Our end goal is to take better care of these patients,” said Landry. She said IDN-1 funds will be used to hire alcoholism counselors and train social workers and health care providers to provide mental-health first aid. Another IDN-1 project is to update the health information technology infrastructure statewide; future projects include creating care-transition teams so people coming out of the hospital or detox get help finding housing and job training, and expanding a program for babies born addicted.
Nelson expressed skepticism of the IDN-1 plan, saying that a county program for transitional housing for prisoners may already be serving the need, and sending the money (about $700,000) to the regional IDN means the county loses out.
“I need to be convinced how the community’s going to benefit,” said Nelson.
Under the state’s delivery system reform incentive program, $30 million has been allocated to Region 1 — the Upper Valley-Sullivan County-Monadnock Region — over five years (2016- 2020). Landry discussed projects already underway to integrate behavioral health care and primary care.
Landry said they’ve allocated about $900,000 so far, including about $500,000 to Valley Regional Hospital (VRH) for integrating behavioral health services into primary care. That expenditure covers one full-time care coordinator and will help VRH partner with Dartmouth-Hitchcock’s psychiatric services and other mental health care providers. Another $268,000 will go to an enhanced care coordination project to reduce repeat visits to the hospitals’ emergency departments. Other funds are directed at hiring and retaining people to work in the behavioral health care field.
Peter Wright said, “The concept of all that money addressed to behavioral health is enormous. Every day we have 25 to 60 people trying to get into the hospital to get state care. At the same time we have another 60 to 80 trying to get out into transitional housing.”
Wright pointed out that Valley Regional does not have a behavioral (psychiatric and drug detox) unit of its own. “We partner with West Central so much they have their own room in our emergency department.”
TRAILS program
“We have a program for substance abuse and mental health in our jail,” said Nelson. Sullivan County TRAILS, run by the Department of Corrections, is an intensive treatment program for minimum security prisoners. It’s aimed at changing the behaviors that led them to jail, such as relationship problems, substance abuse and addiction, education gaps, lack of parenting skills and so forth.
“We can take that money and build transitional housing, or spread it over the regional IDN,” said Nelson.
“I don’t believe putting the money toward the IDN comes at the expense of the transitional housing,” said Wright. “I firmly believe we can do both.”
The IDN money, Wright said, is more effective with a broader focus. “If we bring it into the county you’re going to get a fraction of the whole program. It’s like bringing a cup of coffee to a house fire – you’re going to put it out in one corner but it will just start in another. We’ve got to start thinking as a region.”
Nelson said, “This will take money out of Sullivan County, and you guys need to convince me you can spend it better out-of-house than we can spend it in-house.”
Mason responded, “We’re talking about a broader range of problems than substance abuse disorders. Over and over again we spend money to put them through a detox program, and they keep coming back because we’re not addressing the issues that put them there in the first place.”
“They’re trying to change the way care is delivered, not waiting for them to be in crisis before they get help,” said Wright. “Hopefully [with this program] the inmate population will get smaller.”
Landry said the IDN-1 has been allocating the money cautiously because there’s a chance of losing the funding. State health commissioner Jeffrey Meyers has threatened to reduce funding to IDNs whose counties choose not to return monies to the state that can be matched by federal dollars.
“This money will be matched if we spend it,” she said. “[Our contribution] will be doubled.”
After Landry finished her presentation the commissioners said they wanted more details about the IDN-1 expenditures. Sullivan county manager Derek Ferland said he would push her to be more specific at her next report to the board.
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