These days, the world has seen and heard enough bad news. So Jill Wiedemann-West, CEO of People Incorporated, an Eagan-based nonprofit providing integrated behavioral and mental health services, felt happy to be able to finally be the bearer of some good news.
Right before the winter holidays, Wiedemann-West received an email that was sent to members of the National Council for Behavioral Health, outlining details of the just-approved $2.3 trillion COVID-19 relief spending bill. Major recipients in this package are certified community behavioral health clinics (CCBHCs), nonprofits like People Incorporated that provide a comprehensive range of mental health and substance use disorder services to vulnerable individuals. The new package allotted $600 million in new funding for those programs through Sept. 30, 2021.
In 2017, after an exhaustive application process, People Incorporated became one of six providers in Minnesota awarded CCBHC status by the Substance Abuse and Mental Health Services Administration (SAMHSA). The new spending package extends federal funding for CCBHCs for three more years.
“We are super-excited about it,” Wiedemann-West said of the extended funding. “It will give us the ability to think about what we can do in this space at People Incorporated and expand on our ability to find creative solutions for our community’s most vulnerable people.”
The continued funding for CCBHCs was supported by a bipartisan coalition of federal lawmakers, Wiedemann-West said. For the last several years, bipartisan legislative support for mental health initiatives has become increasingly common on the local and national level.
“At some point,” she said, “everybody realized that they have mental health. I don’t think there’s ever been a time in our history where people have been more aware of their own mental health: The COVID, the social unrest, the political polarization has been extraordinarily challenging for all of us.”
This realization extends to people who used to think that somehow they and their family existed outside of the world of mental illness and addiction, Wiedemann-West continued.
“Even folks who used to say stuff about, ‘Those poor people over there,’ are now starting to say, ‘All of this togetherness with my family and all of this anxiety around COVID is tough on my mental health.’ We are all more acutely aware of how fragile we all are,” and that, she said, is reflected in these new spending priorities.
People-centered philosophy of care
It makes sense that the name “certified community behavioral health center” could give the impression that CCBHCs are stand-alone clinics, where people struggling with mental health and addiction issues could come to get all of their care in one place.
But the reality is different from that. Rather than being in one physical location, CCBHCs are instead a person- and family-centered “one-stop” model of care that meets clients’ needs by integrating chemical, behavioral and physical health services through care coordination, helping to make connections to a range of providers based at multiple agencies or organizations.
At People Incorporated, this care coordination is handled by the central access team, a group of staffers who take calls for about 10 hours each weekday. When an individual calls People Incorporated seeking assistance, the call is answered by a central access team member in the nonprofit’s call center.
With their focus on easing clients’ process through the care system, central access team members make calls to providers and help schedule appointments, Wiedemann-West said.
“They are not only doing intake for all services at People Incorporated but also resourcing for hospitals and other community agencies for individuals and families who are calling in to that line and asking for help.”
Coordinating care requires flexibility and deep knowledge of options that can help individuals on any number of levels, Wiedemann-West said.
“We may be talking to folks who need resources for housing or need a different therapist because their therapist has just has retired. Or maybe it’s a person who’s lonesome looking for resources and programs that could help them feel more supported.”
Jim Olson, People Incorporated CFO, said that in the days before CCBHC funding, the nonprofit provided a range of mental health services, but they didn’t have funding to support programs like the central access team that helps put the pieces together for clients.
“The CCBHC dollars help fund the central access team where a lot of the integration happens,” Olson said. “It helps support the integration of all the services and the continuum of care for the client.” He likes to compare this model to the kind of care that patients usually get in a hospital: “When you go in for open-heart surgery, they have a cardiologist, a physical therapist, a nutritionist all there and you pay in one lump-sum payment for your treatment. We want to be the place people go to coordinate all of the care they need.”
Wiedemann-West agreed, adding that she and her colleagues see the CCBHC approach as “a philosophy of care.” With this approach to care, she explained, “You look at the whole person and meet them where they are at and deliver the services we think are right for their needs with fewer barriers.”
A ‘better fiscal footprint’
Because he’s a numbers person at heart, Olson likes to emphasize his conviction that beyond creating a seamless approach to care for People Incorporated clients, the CCBHC approach also helps nonprofits like his keep an eye on the bottom line. And the impact can be even greater, he added.
“We’re starting to see the savings of what it costs to spend a day with our program and our central access team vs. having a person end up in the ER and then sit there for a day or more not getting the care they need,” Olson said.
Dedicating focused professional time to coordinating care for one individual may sound like an expensive prospect, Wiedemann-West said, but in the long run this approach actually saves money.
“These are the folks that are more expensive over the long term,” Wiedemann-West said. “They are the individuals with multiple barriers, with mental health and chemical health needs, people who are homeless with a lot of trauma, with a lot of barriers to getting on track. They don’t present with one issue. They present with many issues.”
The CCBHC way of coordinating care has better outcomes, Wiedemann-West said. “It creates better access and in the long run a better fiscal footprint.”
The largest percentage of the gross national product is health care, she explained. “We need to find a way to improve outcomes and get the fiscal footprint under control. This integrative model gives us the ability to do that better. If we can create ways for people to be healthier and create better outcomes, it hopefully lowers costs.”
‘On a lick and a prayer’
Before they had access to CCBHC funding, People Incorporated staff often provided specialized care without direct compensation. When they were awarded CCBHC designation, the nonprofit had more wiggle room, with the ability to dream big, create new programs and hire staff to provide continued support for clients.
“We’ve always done this on a lick and a prayer because of the way the funding process works,” Wiedemann-West said. “The CCBHC extension allows us to look at a module and create better things for the people who rely on us.”
The CCBHC program has designated funding streams for services like care coordination that are often not covered by traditional insurance plans.
“It funds the services and the staff we need to be integrated and provide that service to the community,” Olson said. With guaranteed federal funding, “We can hire the staff and provide the services that are not covered under the insurance reimbursement system.”
Those compensated services include programs like home services and mobile support teams that go out into the community and provide assessment services for clients.
“This expansion of this program allows us to continue working in an integrated model and get paid for more of the care that we do,” Wiedemann-West said. “We see this as really a form of reform of the mental health system around these vulnerable folks we’re serving.”
As a nonprofit, People Incorporated continues to rely on philanthropy and grants, but Wiedemann-West explained that CCBHC funding allows her organization to take a step back and clarify organizational priorities, take a closer look at their philosophy of care and “make it stronger and better for the people we serve.”
Before the CCBHC model of care was introduced, Wiedemann-West continued, People Incorporated was moving toward creating an integrated model of service, but the funding the program provides has helped the nonprofit move even closer to achieving their goals. Building the program has meant serious work, but the progress it has allowed has felt heartening and encouraging, two emotions that are in short supply these days.
“It’s been a big lift but a big lift in the best possible way because we are building integration, which I believe is the right and proper philosophy of care,” Wiedemann-West said. With this increased support, “We are really heading in the right direction.”