Annual Report to Alachua County Board of County Commissioners

Maggie Labarta, PhDPresident/CEO

April 27, 2011

Mental illnesses & substance use disorders

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 = 61,750

One in 17 has a serious, potentially disabling illness = 22,230

The system of care capacity is inadequateFlorida ranks 49th in funding for behavioral health,

35th for substance abuse

Un-met need:

58% of adult mental health82% children’s mental health85% children’s substance abuse 93% adult substance abuse of disorders Only

46% of the care being provided is covered through private insurance

Last year, Meridian provided $1.6 million in uncompensated care and still had to turn away 815 from all catchment areas, 309 in Alachua County who requested treatment because no payment source was available

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

Meridian: An essential community resource

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

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 almost 30,000 across ten counties

14,574 in treatment programs

16,000 through outreach and prevention services

Part of the area’s economy

Employ over 500 individuals, 387 in Alachua County

Provide $22 million in salaries and benefits

Purchase goods and services totaling $8.3 million in the local communities

Finding Solutions

p

Jail Diversion

Homeless

EducationalSuccess

Employment

Leveraging Resources

Forensic Services

Stewardship

Effective use of resources

Who Meridian cared for

Alachua 39.54%

Brad-ford5.41

%

Columbia15.25%

Dixie4.09

%

Gilchrist

3.44%

Hamilton3.26

%

Lafayette1.31

%Levy

7.57%

Putnam3.05

%

Suwannee8.16

%

Union3.03

%

Other5.91%

Age Data

0-41.31%

5-149.21%

15-176.96%

18-4452.55%

45-6528.34%

Over 651.62%

Alachua

Continuum of Services

Bridgehouse8.77%

Case Management10.71%

CSU7.56%Day Treatment

2.52%

Detox1.85%

Emergency Screening

1.64%

FCIT0.44%

FIS0.42%

CJMSAG2.53%

MIWG9.25%

Group Homes4.07%

Medical Outpatient11.64% OTP

10.18%

Outpatient 11.86% Recovery

Center0.34%

Rehab16.20%

Foster Care)0.01%

Continuum of Services by ClientCSU

10.05%

Fostercare0.08%

Rehab1.03%

CJMSAG2.55%

Outpatient27.21%

Group- Home0.84%

Detox3.60%

Emergency Screening10.93%

FCIT0.48%

FIS0.40%

MIWG2.59%

Medical Outpatient25.50%

OTP2.56%

Bridgehouse2.02%

Recovery Center0.14%

Case Management10.02%

AMH ASA CMH CSA -

400

800

1,200

1,600

2,000

2,400

2,800

3,200

3,600

3,363

1,062 1,241

96

5,762 Alachua County Citizens Served FYE2010

Year-to-date FYE2011 4,569 seen year to date

Comparable to 4,554 at the same point in FYE2010

Most prevalent problems Mood disorders (depression, bi-polar) – 2,335

Psychotic Disorders – 567

Substance Use Disorders - 415

PTSD/Anxiety – 304

ADHD - 333

Turned away 100 due to lack of capacity or lack of payor source Typically increases in last quarter as state funds are depleted

84% are at or below Federal Poverty

98% are at or below 300% Federal Poverty and receive discounted services

Characteristic of Population Served

0.0%

20.0%

40.0%

60.0%

80.0%

21.8%13.4%

6.6%

84.3%

45.4% 42.3%

Alachua CountyAlachua Residents Served by MBH

How we are funded•Ability to braid funds maximizes county, state, federal and private revenues•Each piece is essential to maintaining the whole

Federal

State

Insurance

Client Fees

Donations

Medicaid

Medicare

Contracts

Funding Sources Medicare

Psychiatric Treatment Counseling

Commercial Insurance Psychiatric Treatment Counseling CSU – some companies only Detox seldom

Medicaid Psychiatric Treatment Counseling CSU – some companies only Rehabilitation Case Management Peer Supports

State and County Psychiatric Treatment Counseling CSU – some companies only Rehabilitation Case Management Vocational Peer Supports Housing

Braided funding

Most clients need more than one service, often not all allowed by the primary payor

Once a client is admitted, they are offered all medically necessary services regardless of

availability of funding Typically results $1.6-

$3 million per year in uncompensated care

Medical

HousingRehab

How we prioritize who is billed

Fees/ Insurance/ Medicaid/ Medicare

State CountyCompreh

ensive Care

Funding & Payors

Source50.29%

Medicaid0.42%

Medicare2.72%

Client Fees0.01%

School Board1.07%

Third Party In-surance33.92%

State

3.06%

State -

Forensic 1.31

%

Other4.56%

2.63%

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 MatchApportion 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

2010 required match: $2,638,678 or $5.06 per capita

Alachua County

50% of catchment area, $1,301,640 in match

Current match eligible contribution

$795,561 BOCC contract

$430,000 Court Services Contracts (estimated current year)

Match deficit $76,000

Funding HistoryAlachua County

Fiscal Year Number Served

% change Per Capita Funding

Total Funding

Value of Services

Cost Per Person Served

County Per Person Served

FYE 2007 5,042   $3.62 $899,383 $13,111,158

$2,600 $178

FYE 2008 5,487 8.83% $3.58 $904,929 $13,758,791 $2,508 $165

FYE2009 5,725 4.34% $3.54 $883,956 $14,043,825

$2,453 $154

FYE2010 5,762 0.65% $3.14 795,561 $11,064,884

$1,920 $138

FYE2011 Estimate*

5,935 3.00% $3.09

$695,561 GR /$100,000 (CHOICES)     $134

5% Reduction     $2.93 $755,783      

Effectiveness

Focus on Evidence Based Practices

Evidence Based Practices Co-occurring treatment

Evidence based assessment – GAIN

Solution focused therapy

Group treatment

Trauma informed care

Wellness

Prevention

YTD Outcomes Mental Health

    Meridian Region State

Adult Days in Community 348 353 347

  Days of Work (SMI) 31 28 33

  Days in Community (Forensic) 281 240 295

Child SED Days in Community 352 352 350

  SED School Attendance 91.61% 92.49% 91.49%

  ED Days in Community 357 362 360

YTD Outcomes Substance Abuse

Meridian Region State

Adult Successful Completion 57.14% 57.14% 61.54%

%Change in Employment 7% 9% 15%

Child Successful Completion 46.67% 52.93% 69.11%

Stable Housing 100% 92% 96%

Forensic Services – Forensic Specialist Team (MIWG) Arrests went from 1.93 to .75, on average in the

first year and jail days from 117 to 53 jail days. In year 2, arrests remained lower, .70 on average

and jail days to 48, on average.

0 1 2 3 4 5 6 70.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Frequency of Number of Arrests

Baseline Year 1 Year 2

Baseline Year 1 Year 20.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Frequency of Jail Days

050100150200250300350>350

Forensic Diversion Team (CJMHSAG) – The number of arrests and incarcerations decreased for all groups, though it was the most significant for the clients who successfully completed treatment (42% decrease in arrests and 51% decrease in incarcerations). The number of jail days significantly increased by 86% for the non-engaged group of clients) -

Thank you!Questions?