Commissioners ask about gatekeeping

Rural health care has historically been one of the critical issues that policy makers have had to face. In order to discuss the Behavioral Health Redesign being done by the Wyoming Department of Health, the Board of Carbon County Commissioners (BOCCC) met with Senior Policy Analyst Franz Fuchs on January 2.

This redesign will focus on mental health care in the state of Wyoming. The new system will change how behavioral health services are provided throughout the state. Funding will change to a priority method, with state support being provided to populations with higher need for treatment. The main purpose of the new system will be to reduce recidivism rates for at risk populations.

The BOCCC raised many concerns with the new design. The main issue was with the fact the state would be the one to designate the gatekeeper, with the county having no input. The gatekeeper provides guidance during detention and involuntary treatment for at risk individuals.

Ashley Davis, with the County Attorney’s Office, raised concerns about the ability of the county itself to enforce the contract between the state and the health center, as the county is not a party to the contract.

Chairwoman Sue Jones said her main concern is that “one size does not fit all in mental health care in the state of Wyoming.”

“We all know it’s a mental health care wasteland in the entire state and it’s a complete desert in places like Carbon County. We have, over the years, expended our own money for a gatekeeper because we simply did not receive adequate services in our opinion from our counseling centers,” said Jones. “We care about our people, we want to take care of our people and we need the means to do that.”

She said she would like to know how the department will be monitoring behavioral health centers across the state to ensure needs were being met.

In response, Fuchs explained the current contract has outcomes reporting, but the new system will be making adjustments.

“What we’re trying to do with these new contracts is provide monitoring incentives for success for a certain designated set of people. We’re not taking everybody in the state - we’re taking 900 people. These are people coming out of the state pen that are at high risk of recidivism, people coming out of the state hospital, people going to the state hospital, said Fuchs. “The idea is to monitor their outcomes very specifically, and say ‘Okay, if you’re going to take this person as an outcomes client you’re going to report to us if they’re housed, if they’re employed, if they’re engaged in their treatment. Every month that report translates to dollars that that center receives. So centers are going to be directly incentivized to make people’s lives better.”

Fuchs emphasized that the Wyoming Department of Health wants to be able to address the commission’s concerns about input, but that there’s “no legal or statutory framework to allow that to happen.” He said the state has a specific process of selection for gatekeeping in each county.

“This is a novel approach - we’ll be measuring pretty rigorously, doing random variations in the amounts we’re paying, to see whether paying more for success actually gets success, said Fuchs. “We’ll need about a year to study the effects, to really see if it’s actually paying off, but at the end of the day this is something new that really has the chance to improve the outcomes for the highest need folks in Carbon County.”

Jones expressed her frustration with the current process and lack of county involvement in mental health services.

“We would like to have some say in the process and who it is. If they aren’t working can we get out? Can we fix it? Rather than just tie it to the money - well you didn’t do it so you don’t get paid - that doesn’t help the person that needs the service,” said Jones. “It’s really not about the money so much as it is about getting the job done.”

“The county is very well aware of what’s going on and what kind of services are needed in our community and whether they’re being received or not,” said Davis. “This is a substantial amount of funding that comes to Carbon County and we want to make sure the state’s funds and our community is benefiting from them.”

Fuchs concluded by asking for grace in seeing how the new system works, as there are significant changes happening in the contract.

The next meeting of the Board of Carbon County Commissioners will be at 9 a.m. on January 16 at the Carbon Building - Courthouse Annex in Rawlins.