Transcript Annual Report to the Board of County Commissioners

Alachua County
Fiscal Year Ending June 30, 2011
Maggie Labarta, PhD
President/CEO
Among the most prevalent disorders
By the numbers: mental illnesses and
substance use disorders
 Brain disorders, highly treatable
 60-80% improvement, compared to 40-60% for heart disease
 Mental illnesses cause more premature death and
disability than most other conditions, second only to
heart disease
 Account for 25% of disability recipients
 Cost over $317 billion annually for lost productivity, health
care and disability payments
 Impact of mental health and substance abuse in Alachua
County
 One in four are affected by a mental illness = 7,392
 One in 17 has a serious, potentially disabling illness = 1,739
 Return on investment
Community Treatment
Without Community Treatment
Crisis Stabilization per Day
$300
Emergency Room visit
$2,887
Detox per day
$274
Hospital per day
$2,000
Average annual cost – substance
abuse treatment
$2,400
Average Annual prison
Cost
$55,000
Average annual cost – mental
health treatment
$1,551
Average State hospital bed
$112,000 per year
$28,000 for 3-month admission
 The system of care capacity is inadequate

Florida ranks 50th in funding for mental health, 37th for
substance abuse

Un-met need:
 58% of adult mental health
 82% children’s mental health
 85% children’s substance abuse
 93% adult substance abuse of disorders
 Only 46% of the care being provided is covered through
private insurance
 Last fiscal year, Meridian provided $1.7 million in
uncompensated care and despite this, we currently have
188 on waitlists
Our role in the community
 Meridian is a non-profit community mental
health and substance abuse treatment provider
 Part of the safety net providing
 Emergency and crisis support services
 The region’s only public receiving facility
 Collaborative solutions to community problems
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Emergency room and hospital overutilization
Jail diversion
Homeless services
Services to the uninsured
Our role in the community
 Part of the area’s high quality healthcare system
 Accredited


Council on Accreditation of Rehabilitation Facilities
American Association of Suicidology
 Licensed



Agency for Healthcare Administration
Department of Children and Families
Drug Enforcement Agency
Meridian’s community impact
 Served 26,154 across 11 counties
 13,581 in treatment programs
 12,573 through outreach and prevention services
 On trend for 4% increase this year, 10% last year
 Part of the area’s economy
 Employ over 541 individuals, 331 in Alachua County
 Provide $20.5 million in salaries and benefits
 Purchase goods and services totaling $8 million in the
local communities
Finding Solutions
Jail Diversion
Employment
Homeless
p
Educational
Uninsured
Success
Leveraging Resources
Forensic Services
Effective use of resources
Services vs Population by County
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
% Services
% Catchment popn
Year-to-Date Alachua Services FYE2012
 4,967 seen year to date
 Compared to 4,803 at the same point in FYE2011 (a 3.4%
increase)
 204 homeless served
 Turned away 533 with most because the insurance or
payer does not cover Meridian
 Alachua County Waitlist (as of 5/20):Typically increases as
state funds are depleted in 3rd & 4th quarters

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
Detox -7
Residential Substance Abuse – 48
Outpatient – 37
Medical – 45
Case Management - 51
Economic Status Of Clients
 83% of those seen are at or below Federal Poverty
 97% are at or below 200% Federal Poverty and receive
discounted fees
Age of Individuals in Treatment
45-64
22.06%
65+
1.74%
0-5
2.43%
6-12
13.64%
Children
27.35%
18-44
48.85%
13-17
11.28%
Program
Number
Served
Case Management
1,068
Outpatient Services
2,086
Psychiatric Services
3,647
Outreach & Prevention
Acute Inpatient (CSU / Detox)
Supported Housing
Crisis / Emergency Screening
422
2,007
73
1,443
Residential Treatment
312
Day Treatment
210
Psycho-educational Intervention
488
Rehabilation & Employment
166
Opioid Treatment
637
How we are funded
•Ability to braid funds maximizes county, state, federal and private revenues
•Each piece is essential to maintaining the whole
Funding Sources
 Medicare
 Psychiatric Treatment
 Counseling
 Commercial Insurance
 Psychiatric Treatment
 Counseling
 CSU – some companies only
 Detox - seldom
 Medicaid
 Psychiatric Treatment
 Counseling
 CSU – managed care only
 Rehabilitation services
 Case Management
 Peer Supports
 State and County
 Psychiatric Treatment
 Counseling
 CSU (public receiving facility)
 Rehabilitation services
 Case Management
 Vocational
 Peer Supports
 Housing
Braided funding
 Most clients need more
Medical
Rehab,
Detox,
Jail
Diversion
Housing,
Forensic
than one service, often
not all reimbursed by
the primary payor
 Once a client is
admitted, they are
offered all medically
necessary services
 regardless of availability of
funding
 Typically results $1.5-2
million per year in
uncompensated care
How we prioritize who is billed
Fees/
Insurance/
Medicaid/
Medicare
State
County
Comprehensive
Care
Sources of Program Revenues
BOCC - Comm BOCC - Ct
Suppt
Serv
4.93%
6.17%
DCF
32.47%
Contract
2.91%
Self Pay
2.49%
Medicare
0.15%
Medicaid
50.88%
County Match
 State and federal funds require local match
 Meridian’s match amount is specified within contract
with DCF
 Varies year-to-year depending on how state and federal
dollars are allocated to us from DCF
 “Local match”
 Local fee and county funds
 Counties responsible
County Match
Apportion
required
match
• Calculate
catchment
area
population
• Calculate each
county’s
percent
• Distribute
share of match
accordingly
Project funds
from all eligible
sources =
“earned match"
•
•
•
•
Client fees
Insurance
Contracts
County special
service
contracts
• School
contracts
Request
County
Commission
funding
• Match required
less earned
match
• Any remaining
amount to be
asked of
county BOCC
Alachua BOCC-Meridian: Partners
in Community Wellness
State/Federal
Grants Via
Court Services
34%
Community
Support &
Choices
37%
Court Services
29%
Service Areas Supported by BOCC
Funds
6.57%
3.23%
19.72%
Psychiatric Services
Child Case Management
Detox
24.41%
Housing Outreach
Jail Diversion
Group Homes
Bridge House
22.54%
16.96%
6.57%
Alachua County Community
Support Services
Fiscal Year
Number
Served
% change
Per Capita
Funding
Total Funding
FYE 2008
$3.58
$904,929
FYE2009
FYE2010
4,860
$3.54
$3.14
$883,956
795,561
FYE2011
5,334
10%
$3.07
5,547
4%
$3.07
$695,913 GR
/$100,000
(CHOICES
$695,913 GR
/$100,000
(CHOICES)
FYE2012
Estimate
Alachua County Match
 FYE2012 required match: $2,694,235
 Alachua County
 50% of catchment area, $1,175,185 in match
 Helps draw down $11.3 M in state/federal funds, 49% of
which is expended on Alachua services
 Current BOCC match eligible contribution


$795,561 Community Support Services contracts
$280,806 Court Services Contracts (eligible for match)
 Total County match eligible funds: $1,076,367
Thank you!
Focus on Evidence Based Practices
Evidence Based Practices

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
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Co-occurring treatment
Solution focused therapy
Group treatment
Medication Assisted Treatment for substance abuse
Opioid Treatment
Jail Diversion
Parenting and Adolescent prevention programs
Trauma informed care
Wellness curriculum for those with serious mental
illness
Outcomes
 Diversion from high cost out-of-community placements
for
 Adults with Serious and Persistent Mental Illness


Meridian clients spends 95% of the days in a year in their home
and community
Meridian serves the highest number of these clients in a region
that includes Jacksonville and Daytona (5,612)
 Children with Severe Emotional Disturbance


Meridian children spend 95% of the days in a year in a home or
community placement
Serving the 3rd highest number of children in this category, many
of whom have child protective services involvement (1,446)
 Children with Emotional Disturbances


Meridian children spend 96% of the days in a year in a home
or community placement
We serve the highest number of children in this category in
the region (1,295)
 Forensic Clients


Meridian Incompetent to Proceed and NGI clients spend 81%
of the days in a year in a home or community placement
Serving the 2nd highest number of clients in this category in
the region (188)
 Employment and School
 Days of Work for patients with Severe and Persistent Mental
Illness – 30 (State target)
 Days in School for Severely Emotionally Disturbed Children –
91%
 Perception of Care
 86.9% of consumers report problems “somewhat” or a “great
deal” better
 92.9% of consumers would recommend us to others



"I really appreciate Meridian and their services. I don’t have private care, but I feel
like I am treated like I have private care when I am at Meridian." Client from
Outpatient
"Meridian has helped me out in my times of need, and it’s the best out there."
Client from Med Services
"I am very thankful for everything Meridian has done" Client from Residential
Services
Change in Days in Jail 12 Months - Total
Sample (N=240)
Jail Diversion
Services
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
Average Pre Days
Change in Jail Days - Successful
Clients (N=177, 74%)
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
Average Pre Days
Average Post Days
Average Post Days
FYE 2010 vs FYE 2011
0.00
-5.00
-10.00
-15.00
-20.00
-25.00
-30.00
-35.00
-40.00
-45.00
-50.00
-55.00
FYE 2010
FYE2011
Thank you!
 Questions?
[email protected]