Be sure to check out a fantastic op-ed in this morning’s edition of Raleigh’s News & Observer by Durham clinical social worker Barbara Smith. In “Managed care failed, now rebuild N.C.’s mental health care system,” Smith does a great job of telling it like it is when it comes to North Carolina’s failed, decades-long privatization scheme in the provision of mental health services. Here central thesis: abandoning a system of publicly-run, brick and mortar community health centers throughout the state in favor of a system of regional, privately-run “managed care” operations (like the one run by the greedy money grabbers at Cardinal Innovations) has been a disaster that has put money-making above serving people in need. As Smith explains:
North Carolina had a good community mental health system, built in the 1970s and 1980s as a product of a progressive movement in the state. Every county had its own mental health center, or joined forces with neighboring counties. Brick and mortar buildings served anyone who needed help. The community mental health centers were part of one public mental health system. They could share information with each other and with the state psychiatric hospitals and UNC Hospitals.
Then, she explains, came the transition to privately run “managed care.” Soon, she notes, hospital “emergency rooms overflowed with people who needed behavioral health services.”
Here’s her fine conclusion:
“Here’s what managed care does: It makes it harder to get care. It sets up hoops for providers to jump through, first to become a provider in a closed network, and then to complete the paperwork needed to get authorizations for services. Cardinal Innovations wielded considerable power – it controlled the flow of funding to treatment and service providers.
Frontline mental health workers – the people who actually deliver mental health care – saw their salaries go down. Many lost benefits and job security. The first workers to be let go in the streamlined private agencies were clinical supervisors – experienced psychologists, clinical social workers and psychotherapists who trained new workers and provided ongoing supervision. The drive for productivity in the private agencies is relentless; it’s the only way to make the business model work.
Unlike the community mental health system, which served all comers, the new system is only for Medicaid recipients, with paltry funding for those with no insurance. It’s not easy to get Medicaid, especially in a state that did not accept the expansion under the Affordable Care Act. Many with great need are left out entirely.
So what’s next? Gov. Roy Cooper, the Department of Health and Human Services and the General Assembly have a responsibility to do right by our most vulnerable residents, and by taxpayers. We have considerable expertise in this state around best practices in behavioral health. Let’s hope that in the aftermath of the unraveling of Cardinal Innovations, we can rebuild a behavioral health system that is truly person-centered, is integrated with the broader health system, and is guided by proper oversight of public resources. The private sector does many things well – but is it the right vehicle for providing care to our vulnerable citizens?”