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NAMI-NYC, Managed Care Pilot To Assist Consumers with MI

Mental Health Weekly�� June 17, 2013

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The National Alliance on Mental Illness of ���������� City (NAMI-NYC Metro) and Beacon Health Strategies,

a managed care organization, are embarking on a public/private partnership to provide communitybased

outreach services and education for Beacon plan members with mental illness and to expand their

individualized care plans.

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The year-long pilot program, slated to begin with 50 participants at the end of June, will educate program

participants on mental illness in general and about the importance of accessing community-based services.

Beacon officials will also measure the impact that the NAMI services will have on participating members’ knowledge of dealing with mental illness and the subsequent use and success of community-based services to support independent living.

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“All across the country and in ���������� state, people on Medicaid with high healthcare needs, including

mental health, are moving from a fee-for-service to a managed care environment,” Wendy Brennan, MS, executive director of NAMI-NYC Metro, told MHW. In this environment, managed care organizations (MCOs)

are encouraged to identify services that are low cost but are able to reduce overall healthcare costs and improve outcomes, said Brennan.

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Brennan added, “The health system is beginning to recognize the value of peer-family and consumer education support and involvement. There is little objective evidence to support those beliefs. The NAMI

project is important because it will provide preliminary objective data about the value of consumer and

family support.”

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The program is unique for families and consumers, said Brennan.

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“Generally, no one is looking for partners in managed care. This is a terrific opportunity to look at a program that will impact outcomes,” she said.

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MCOs generally adhere to the medical model, she said. “Beacon is really thinking outside the box and

working with an organization that provides family and consumer support and education,” she said. “Beacon

believes that involving patients and families impacted by chronic illnesses in their own care and that of

their loved ones will enhance wellbeing.”

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Brennan explained that the medical community understands, to some extent, that patients and families

need to be involved in chronic illness management. “Few believe the same is true with mental illnesses,”

she said.

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Education programs

The pilot program will include two of NAMI’s peer-to-peer-led programs for people with families with mental illness or with serious mental illness, said Brennan. One of the programs that will connect participants

to community-based services is NAMI Basics – an education program for parents and other caregivers

of children and adolescents living with mental illness – taught by trained leaders who themselves are

parents and caregivers of children with mental illness.

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The goals of the program include providing basic information for caregiving, helping the parent/

caregiver cope with the impact of mental illness and providing tools to assist in making the best decisions

for the child’s care. The NAMI Basics program lasts for six weeks, said Brennan, adding that the program

also enables parents and caregivers to work with the public mental health system better.

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NAMI’s peer-to-peer program focuses on wellness and recovery and is taught by a team of individuals

who are living with mental illness.

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“We’ve already added two physical health-related sessions that includes information about the importance

of addressing physical health to promote overall wellness and includes practical information about how to talk to your primary doctor, et cetera,” said Brennan.

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“Beacon and NAMI have a long history together,” Alan Boardman, LMSW, ���������� state director of

Beacon Health Strategies, told MHW. “We have sponsored several NAMI walks in ���������� and in Massachusetts. We’re always looking for partners with community-based or peer-led organizations.”

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The partnership, said Boardman, reflects the recovery mission at Beacon. “These services are never

meant to take the place of behavioral health services, but to augment behavioral health treatment,” he said.

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Measuring outcomes

NAMI will administer surveys before and after the intervention to measure the courses’ impact on

knowledge about mental illness, medications, stress management techniques and wellness management

skills. Additionally, Beacon will work with ���������� University’s McSilver Institute for Poverty Policy and Research to assist with data analysis and review of members’ subsequent service utilization.

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Beacon and NAMI will assess any correlation between the use of NAMI services and the improved use of outpatient and preventive services to support community living.

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“We want to take a look at how service utilization may shift after the intervention,” said Boardman. “We’re

hoping to see more use of preventive services through primary care or behavioral healthcare or both and

less on ER services and inpatient services.”

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When a person goes to the ER for treatment for an acute [illness], there is very little follow-up, said

Boardman. “They don’t promote wellness; there’s no continuity of care,” he said. “They don’t see the

same doctor every time, so there’s no relationship with the provider.”

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“We’re making sure that Beacon case managers and utilization managers, discharge planners at the hospital

and other behavioral health network providers are aware of NAMI’s services and weave them into their

care plans,” he said.

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“The mental health field is notorious for not looking for objectives, outcomes and measurement,” said

Brennan. “It’s really held back the quality of mental health services that are available. The world is changing. Services are held up to higher mental health standards.”

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Brennan added, “It’s really rare that an organization like NAMI gets to find a partner in the for-profit

world who’s committed to many of the same goals and understands our mission. I would certainly hope to

continue this effort statewide in the future.”

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