Beltrami PACT Collaborates to Succeed in Implementing the Affordable Care Act

Recently I purchased a plain wooden microwave cart for the lake cabin from IKEA. The item came in a box with several descriptive charts, lots of little pieces and a baffling array of hardware.  I waded into the task trusting the directions and the accuracy of the assembler’s count of screws and bolts. I can say the project was a success and I am reminded how unlike an IKEA package, other things are in life! The directions for implementing the structure that supports participation in the Affordable Care Act have not always been very clear.  In Beltrami County, providers have had a slow start. While other parts of the state have large behavioral and health care organizations that have successfully applied for grants and help, we were largely unaware of the scope of the change. It became obvious to the 11 agency members that we needed to collaborate in order to share the financial benefits associated with the new payment models for Medicare and Medicaid.

The ACA goals also known as the ‘Triple Aims’ of increased health, reduced cost and happier patients are not new ideas any longer, but seemed like lofty goals without a list of tools to be used to attain them. For Beltrami County, our challenges were even greater as our school district is roughly the size of Rhode Island. We also have an isolated, poor population, without central transportation, poor access to services, low wages, high rates of incarceration and crime and suicide as well as high rates of drug and alcohol abuse. In addition, Red Lake Nation, Leech Lake and White Earth Reservations are effected by historical and complex trauma, racism and social exclusion, poverty and high unemployment. In short, the demand for services remains unrelenting and routinely overwhelms the agencies in the area. While mental health providers have had a history of competition and little integration, there has long been the belief that we would likely be better off if agencies collaborated in order to meet the overwhelming needs. The area agencies are often underfunded, with huge demand for services. Perhaps because we are not in competition for business, it made collaboration, despite our history of niche market providers, highly desirable.

After being encouraged by Dr. Trisha Stark, Ph.D., L.P., to apply for the Minnesota Department of Health grant, 11 Beltrami County Area Behavioral Health Practice Alignment and Collective Transformation (Beltrami PACT) agencies including the Beltrami Area Service Collaborative, the Bemidji Area Program for Recovery, Evergreen Youth and Family Services, Great River Psychological Services P.A., Hope House, a community support program, Northern Psychological Services, NorthHomes Children and Family Services Incorporated, Stellher Human Services Incorporated, Tamara Mason MSW LICSW, Upper Mississippi Mental Health Center, and Jay Wilimek of Wildgen Wilimek and Associates, signed a memorandum of understanding (MOU) and applied to MDH for 2 grants.  This MOU asserts our collective willingness and interest in forming an organization that collaborates to fulfill the ACA goals. Getting to the point of consensus was not as simple as building my IKEA cart.  However, as we had to work through a lack of trust, disbelief, and grief, we were awarded a grant after the second attempt and life changed.

Learning the terms for health information exchange and the endless list of acronyms for functions and groups has been an alphabet soup of the murkier sort. In the end, it helped to identify the four key tasks that would support our ACA compliance. 

  1. We had to identify who sends us patients and who we send patients to, when we can’t serve all of their needs. These are our natural collaborative partners.
  2. How were we going to check on patients who we send to others for service because otherwise they will keep us awake at night with concern? We needed a professionalized Facebook style page where we can check and see where ‘at risk’ patients were served and when. This is web-based care coordination.
  3. How were we going to send client files to each other through computers that might have different software programs? We needed a way to send a record from our EHR program and get it to the other provider fast and through a method more secure than a FAX.  This was answered through direct secure messaging (DSM)! This is a system that does not let people into our records, as we send only that for which we have client consent. It is also extremely secure.
  4. The data that will prove that our patients are happier, healthier and cost the system less is buried in the billing data. In order to prove we have put forth our best effort and made real change we need to look at the de-identified numbers for the larger population of patients. This information will likely be provided to us through collaborations with insurance groups, providers and CMS. Our local five county public assistance insurance group has developed a committee that has identified the “Healthcare Effectiveness Data and Information Set (HEDIS)” for the local area.  If this does not prove we are all in this together, nothing will! The effect of all of our good work is lumped, for good or ill, with the work of all of our colleagues. We will share the rewards or the costs.

The good news is that the tools are packaged for us by companies that help with Direct Secure Messaging, Care Coordination, Health Information Exchanges, Health Information Service Providers and Electronic Health Records. Sorting through them is harder than putting together the IKEA cart, so you might need to gather your colleagues and make friends with the providers you secretly believe are not as good, conscientious, or smart as you are, and form a collaborative. Apply for a grant, or pool some money, hire a consultant and listen.  The good news for us has been that the agency down the road we thought was a sketchy provider is someone we now trust, because we know they care about our mutual clients just as much as we do.  We are continuing our struggle to succeed and are sending each other files through DSM, practicing the acronyms we remember with each other and ready to start working on Care Coordination. In many ways this seems to have nothing to do with my career as a psychologist, but in the end it will help us all reach our goals of really helping people live better lives. We hope the data proves it!

Jean A. Christensen Psy.D., L.P., LICSW, has worked a majority of her career in Bemidji, MN first as a counseling program director for Lutheran Social Service for ten years, 14 years in community mental health at Upper Mississippi Mental Health Center, of which nine of those years were as Clinical Director.  In 2009, she began Great River Psychological Services, a private practice for doctoral level psychologists.  She has been a MPA member for several years and in 2014 brought the first members of Beltrami PACT together. 


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