Bringing Innovation (& Risk) To Public Behavioral Health

Bringing Innovation (& Risk) To Public Behavioral Health

Toby Ewing, newly appointed Executive Director of California’s Mental Health Services Oversight and Accountability Commission, opened the institute with...

Executive Briefing | by Monica E. Oss | August 26, 2015

openminds.comMonica E. Oss

Greetings from sunny San Diego and The 2015 OPEN MINDS California Management Best Practices Institute! Toby Ewing, newly appointed Executive Director of California’s Mental Health Services Oversight and Accountability Commission, opened the institute with his presentation, Innovation, Integration & The Future Of Mental Health Services In California. He provided the executive attendees with a future view of how the Commission will bring innovation to California’s public behavioral health system.

openminds.comToby Ewing

The purview of the Commission is California’s Proposition 63 dollars, about $1.8 billion per year or about 20% of overall government mental health spending in the state. These dollars are gathered through a “millionaire tax” and distributed to the California counties for spending on mental health initiatives (for more on Proposition 63, see California’s Proposition 63 Passes with 53.4% of Vote and California’s Mental Health Services Act (MHSA)).

Mr. Ewing’s presentation focused on the Commission’s plans to use the Proposition 63 dollars to bring more innovation to mental health service delivery in California. He said that Proposition 63 has been in place for ten years and “requires innovation and learning with a dynamic expectation that we will get better over time.” Dr. Ewing laid out a four-part plan for accomplishing the path to innovation in the public mental health system:

    1. Clear goals and metrics for California’s mental health system – A first step in fostering innovation and then learning from the innovation that works, is to establish clear goals and metrics to measure those goals – a difficult challenge  in mental health. Dr. Ewing noted, “The state came out with performance measures twelve years ago, but those measures are not being used. The Commission is embracing this challenge and development is underway.” (For more on performance measurement initiatives in mental health, see Most State Medicaid Agencies Using HEDIS Measures For Behavioral Health Performance, Oregon Medicaid Releases Performance Baseline Data For Coordinated Care Organizations, and NQF Endorses 10 Behavioral Health Measures.)
    2. Investing in analytics – Dr. Ewing spoke to the power of “open data initiatives” – making information gathered by public agencies widely available. Open access to public information brings many benefits including transparency in spending and outcomes; reduced administrative costs by making data easily and automatically available; and facilitating data-driven innovation. Dr. Ewing noted, “The $3 million a year in the Commission’s budget for analytics is small, but we hope to leverage public interest with an open data initiative that makes public mental health data widely available.” (For more on data transparency and analytics, see Big Data In Action and Transparency Doesn’t Only Benefit Consumers.)
    3. Embracing innovation and risk taking – A key role of the Commission is stepping up its work encouraging counties to invest in innovative programs. California counties have $95 million a year available for innovations in mental health services – and to measure the impact of those innovations. Dr. Ewing noted, “We have been doing ‘innovation light’ for the past decade. We need more disruptive innovations that bring positive change to the system.” To facilitate this role, the Commission is working on an innovation calculator to calculate how much money is available for innovation. (For more on innovation, see Innovation, California Style and Does Size = Innovation?).
    4. Seeking out nontraditional partnerships – To foster innovation, Dr. Ewing noted that there needs to be engagement by both traditional partners in the mental health system, and nontraditional partners, which he defined as organizations in business, education, labor and law enforcement. Why? Nontraditional partnerships can build broad agreement about goals, and increase public support for Prop 63 and its initiatives. He also pointed out that the public sector is not good at innovation. Why? He noted, “Because innovation requires failure and risk, and failure is not an option for government agencies. What bureaucracy is good for is stability and not change. We need nontraditional partners in this process who have the ability to take risk – and to be a cheerleader for change.”

I think Dr. Ewing’s conceptual framework for opening up the mental health system to new service approaches and to new levels of transparency about spending and performance is a big step toward “activating” the experience and ideas within and outside of the mental health system. The transparency of spending and performance measurements at the Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and other performance tracking organizations (see What Is Your Quality Ranking?) has already changed the discussion (and management attention) in health and human services. Moving the needle in the mental health space would be another great step forward.

Tomorrow we’ll continue our live coverage from California as we discuss the policy and financing issues that are shaping the California market – and the implications of these changes for the rest of the country (see California As A Bellwether).