Cenpatico increasing pressure on mental health agencies

Tucson behavioral health agencies are feeling the squeeze of new data-reporting requirements, slashed reimbursement rates and quotas imposed by their new payment coordinator, Cenpatico Integrated Care.

But some are hopeful the changes will result in a more streamlined, high-performance behavioral health system.

“I personally believe in the long run, it’s going to make those (agencies) who can survive stronger,” said Dan Haley, executive director of HOPE Inc., an outpatient treatment center serving clients with behavioral and substance-abuse issues.

Last fall, Cenpatico replaced the Tucson-based nonprofit Community Partnership of Southern Arizona, or CPSA, as the regional behavioral health authority (RBHA) for the eight-county Southern Arizona region. The new RBHA coordinates and pays for both behavioral and medical health care for adults with a diagnosis of serious mental illness, and it covers behavioral health care needs for children and adults who qualify for Arizona’s Medicaid program, known as the Arizona Health Care Cost Containment System. The contract runs for three years, plus two options to renew for two more years.

As part of the $612 million contract, Cenpatico administers payments, mostly comprising Medicaid funds, to 117 behavioral health agencies and medical providers in Pima County, ranging from big referral agencies like CODAC Behavioral Health Services to smaller agencies like the National Alliance on Mental Illness (NAMI) Southern Arizona.

The Tempe-based Cenpatico is a subsidiary of the publicly traded, St. Louis-based Centene Corp., which had a net income of $355 million last year.

Terry Stevens, Cenpatico CEO, said fiscal accountability and programmatic efficiency are the new standard for behavioral health agencies in Southern Arizona.

Cenpatico has an army of technical support teams ready to help agencies adjust to the new requirements, Stevens said.

“I see our job being to make them the best providers they can be,” she said.

LOWER RATES

When Cenpatico’s contract began in October 2015, behavioral health agencies saw drastically reduced reimbursement rates compared with what they’d received from CPSA. Reimbursements for NAMI Southern Arizona were cut by two-thirds, said executive director Clarke Romans.

“I know there’s been a steady stream of meetings between agencies of all sizes (and Cenpatico) to try to renegotiate these rates,” he said. “Everybody is still kind of holding their breath.”

New state rules mean Cenpatico has to base their rates on a percentage of AHCCCS’ out-of-date fee schedule, Stevens said. Cenpatico needs state approval to increase rates above recommended levels and is working with AHCCCS to renegotiate rates, she said.

If NAMI doesn’t secure higher rates, the agency will no longer be able to participate in the RBHA contract and will have to scale back services, instead relying on private donations, Romans said.

“We’re not going to go away, but we just couldn’t provide as many classes and support groups and help as many families as we can now,” he said. “We hope to stay in this game at this level.”

DEVEREUX

Stevens said her 30 years of experience as a child and family therapist is guiding some reforms. For one, she doesn’t believe in institutionalizing children, which she says is a traumatic event that doesn’t help children learn to live within a family structure.

That philosophy has resulted in big changes at Devereux Arizona, a behavioral health and social welfare agency for children and families.

In December, Devereux shut down its 10-bed, Level 1 residential treatment center for children in Tucson. Children in crises too severe for community or at-home services could stay at the center for months or even years, Stevens said.

Instead, she wants Devereux to focus on short-term, intensive support services for kids and their families aimed at preventing a crisis that warrants residential treatment.

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That includes 24-hour, wrap-around services in the home, which cost twice as much as residential treatment, Stevens said.

“It isn’t about the money. I don’t want to build these (residential treatment centers) because I don’t believe in them,” she said.

Since Tucson’s residential treatment center closed and shorter-term alternatives have been bolstered, it seems all children have been cared for at the level they need, said Lane Barker, executive director for Devereux Arizona. The agency is tracking outcomes for all kids to ensure there aren’t any gaps in services, she said.

“We believe there’s a place for residential treatment, and some kids will need that level of care for a period of time,” she said, adding, however, “We would agree at end of the day that probably should be the last alternative for a youth having difficulties or a family that’s struggling.”

INTEGRATED MODEL

The state’s new model for its RBHAs includes medical care for adults with serious mental illness. Arizona is at the forefront among states in embracing an integrated care model, which ensures people with mental illness receive treatment for their physical ailments as well, Stevens said.

That’s brought primary care providers like El Rio Community Health Center into Cenpatico’s new contract.

The shift to an integrated model means medical providers here are making more connections with mental health experts and improving communication about their shared patients’ health, said Tracy Murphy, population health administrator for El Rio, which treats about 3,000 patients a year covered by Cenpatico.

“The focus now is on everybody developing relationships with one another for the benefit of our patients,” she said.

ACCOUNTABILITY

Agencies are also facing a new quota system under Cenpatico. Each month, agencies are allotted a block of funding based on how much they are expected to bill for their services. Agencies that don’t bill for at least 75 percent of that funding allocation won’t get paid at all for the month.

Cenpatico wants detailed reports on health outcomes for patients as part of its data-driven accountability system. It has been tracking the 20 percent of patients who have the most severe behavioral health needs to ensure they’re getting treatment.

The RBHA is pushing for improvement in specific performance measures, such as reducing patients’ emergency room visits. Those measures are beginning to get tied to reimbursements.

And it’s focusing on reducing repeat hospitalizations and recidivism among people with mental illness who serve jail time, which Stevens views as “failures in treatment.”

But Romans said the heightened scrutiny of agencies is breeding some resentment.

“It’s a very different ballgame. People have this internal feeling that Cenpatico is more interested in the numbers and the statistics than they are in the people we are serving,” Romans said.

Despite his concerns, Romans said he is inspired by Cenpatico’s ambitious goals, including improving the life expectancy for people with serious mental illness, who in Arizona die an average of 32 years earlier than those without mental illness.

The early deaths are usually due to untreated physical conditions such as diabetes and heart disease, he said. Cenpatico wants to cut that disparity by 11 years.

“At least on paper, Cenpatico has good intentions,” Romans said. “No matter whether they’re playing hardball or not, if they can achieve those goals, that’s a good thing. The people in this state who live with serious mental illness would have a better life.”