Mental Health and Substance Abuse

I'm seeing a trend of interest in integrating mental health and substance abuse services-- and I'm seeing some implications in the way agencies are approaching the idea.

By "a trend" I mean that it has come up three times in the last couple of weeks.

Talking with a potential customer a few weeks ago I asked about their project ideas. I look for ideas that galvanize key partners, meet a key need, and involve revenue generation. One of their key priorities was to figure out a way to integrate mental health and substance abuse services in a way that makes more sense for clients, makes more sense in terms of efficiency, and looks forward to a time beyond block grants, to a reimbursement model.

To me, this sounds like a great fit for a business plan: priority need, committed partners, revenue generation required.

One week later, I got an email from a Management Academy grad from several years back. They had just received HRSA funding for their business plan, doing similar work in rural Nebraska.

Last week, a group from Maryland presented their final business plan on the same topic. The team really impressed us with their commitment to see the change through, because they really believe that they can provide measurably better care and deliver better outcomes, and also create measurable administrative efficiencies, by doing the hard work of integrating. They are committed to this path even though the reimbursement picture is foggy at best. No one is sure how this work will get compensated. The only certainty seems to be that the funding model will be changing often, and perhaps dramatically, at least for the next couple of years.

You can't plan for everything. It certainly puts you way ahead of the curve to have planned for what you can plan for, though. These teams are being proactive. They are moving with purpose toward a better future state. And they are preparing themselves, as part of their plan, for uncertainty on the revenue side of the equation.

--Stephen Orton

On The Road in Raleigh

We launched four new teams in Raleigh this week! Here's a quick look at the projects going forward from that group:

• A phone app/game to help drive school culture change
• A revenue-supported plan for delivering quality improvement training
• On-line weight loss and lifestyle change program... already piloted, and it works
• Diabetes Education at the local level, sustained by revenues

A key theme for me at this session is this: Public Health agencies are ready, willing and motivated to find partners and revenue streams to support their work. Gone are the days when we had to convince some teams that it was OK to think about generating revenue... now revenue-generation is seen as an important part of the public health portfolio. That doesn't mean *every* project or function needs to be revenue-supported, because some can't or shouldn't. It does mean that agencies need to have the tools to create business plans when revenue-generation is appropriate and will make a product or service better, more effective, more integrated, more sustainable.

-- Stephen Orton

Management Academy On The Road

Here's a quick update on our Management Academy On The Road program. We completed a pilot in Florida with five counties; we launched a new group in Maryland this spring; two more groups launch this summer. The program is two on-site days, supported by webinars and technical assistance before and after (details on the MAPH website).

Here's a short list of business plan ideas in development across these groups.

• An ER Diversion project with hospitals, public health and the Federally Qualified Health Center
• An "Academic Health Department" plan to allow the county to participate in clinical trials, bringing in revenue and expanding treatment options
• A dental clinic add-on to an existing Ryan White organization
• A free clinic to create a bridge for the uninsured until 2014
• A health coaching project
• A project to combine substance abuse/behavioral health in an integrated organization

What ideas are sitting in your community's health improvement plan? What ideas are bubbling up from your community health assessment or your MAPP process? Can we help you push them to implementation?

--Steve Orton

Business Planning On The Road

Yes, we are piloting a program that provides business planning development to communities where they live. We're starting by targeting MAPP communities at the "Action Cycle" end of their process. (MAPP = Mobilizing Action through Planning and Partnership-- check it out at naccho.org/mapp)

Here's how the program works.

• We consult with you in advance to identify the best ideas to develop business plans around, and then form teams around those ideas.
• We come to your community for a one or two-day session; you convene as many members of your MAPP team as is necessary to get one or two or four business plans started.
• At the end of that session, your team or teams will have a good outline of a feasibility plan completed.
• We meet via webinar or conference call with each team as they develop a full feasibility plan.
• If the plan is in fact feasible, we coach them through the full business plan.

I should clarify what I mean by "team" in this context: I mean a cross-community team. For instance, you might have team members from the health department, the hospital, the other hospital, the United Way, the YMCA, the school system, the community health center, the county-- or all of the above.

We're in the middle stages with several teams in Florida right now, and some of the feasibility plans look really good. Two stand-out plans: adding dental services to an existing HIV clinic, and doing ER diversion with at least two and probably three different hospitals across a county.

The lesson for me is this: communities can develop business plans very quickly and efficiently if they already have a good, fresh assessment in hand, and a wide range of partners queued up and ready to go. That defines the MAPP communities we're working with: motivated partners, good data, identified priorities.

-- Stephen Orton

Recovery Act funds for Public Health

It seems that some public health agencies have access to Recovery Act funds to do specific new things.

The challenge is to figure out how to spend that money in a way that makes a difference during the two years you have it, without losing those gains at the end of the time. One way to approach such an opportunity is to think in terms of start-up funding. Spend the money (time, effort) building something that can then go by itself.

Perhaps in two years you can build something that creates more community health and generates sufficient revenue on its own to support itself through user fees. Perhaps you can build something that generates sufficiently impressive results after two years that you can interest some other funder-- one that values the outcomes you are creating. Perhaps at the end of two years, you operationalize your exit plan: your agency steps back and the program is taken over by an external partner who cares about it and can run it sustainably, with the thanks and blessing of your busy staff!

Shovel-ready?

I've been inspired by the term "shovel-ready" in the media reports about the stimulus package. I think that's one of the things we want to foster in public health: organizations that have a set of shovel-ready plans that they would be ready to start quickly.

Maybe some of you have more money than you have ideas-- that's a difficult state of affairs but it can be solved. Innovation is a process you can learn. We've written some about it already.

I'm guessing most of you-- especially now-- don't have lots of extra money to spend. Do you have more ideas than money? Should you?

I think it would be a bad plan to quit brainstorming and quit planning at this point. Because what if someone does offer you some money? What if some stimulus money appears, and needs to be spent in a hurry? What if you wound up with some extra time on your hands, as funding for certain projects dries up?

The answer is this: you will want to have a little folder of "shovel-ready" plans. This is exactly what the business planning structure is about-- getting from the back of the envelope to a fleshed-out, researched, vetted plan with real need, a real chance, a real budget, real partners. A business plan is shovel-ready: ready to get funded and get going.

Let's talk more about developing "shovel-ready" public health ideas-- are you developing plans now? Why or why not? What would constitute shovel-readiness in your organization? Drop me an email or respond here!

--Steve Orton

The Size of the Pie

Thanks for the input on public health challenges-- tell us more!

By the way-- these challenges will likely have to be met by using existing resources more efficiently, or by creating new alliances and generating new revenue. Why? Because it looks like the size of the pie for governmental public health is not going to grow soon.

Jonathan Oberlander, who gave the Foard Lecture at UNC this spring (you can watch the webcast), warned the audience against "irrational exuberance" about the possibility that a new president might make dramatic changes in health care and population health. I heard similar forecasts from several healthcare executives this week. Folks in state and federal public health are expecting cutbacks, not big new expenditures. In many areas, the mortgage crisis is going to slowly deflate tax revenues.

So financial help is not on the way. If you want pie, it is time to start rolling out your own dough!