Better Behavioral Health for Maricopa

Judge: State ignored mental-health reform

The Arizona Republic
by Casey Newton - May. 18, 2009 08:42 PM 

A Superior Court judge chastised the state Monday for failing to improve mental-health care in Maricopa County, saying officials had essentially ignored a January audit that declared the system in crisis.

Judge Karen O’Connor, who is presiding over the class-action lawsuit Arnold vs. Sarn, criticized the Department of Behavioral Health Services for its latest response to a lawsuit that was filed in 1981.

“The bottom line is the department did not add- ress their non-compliance,” O’Connor said. “Nor did they offer any realistic solutions.”

O’Connor ordered the status conference in response to an audit from the case’s court-appointed monitor, which found that the system had worsened under its latest managed-care provider and needs a complete overhaul.

The judge asked the state to address the system’s historic instability, its lack of local controls and whether its shift to a for-profit provider needlessly took money out of the system.

In its response, the state argued that there was no crisis, only “room for improvement.”

“They had no realistic basis for taking that position,” O’Connor said.

O’Connor ordered the state to issue a new progress report on the lawsuit by Sept. 3, with a status conference to follow a week later.

State law requires Arizona to provide treatment for Maricopa County’s 19,000 people with serious mental illnesses. Deficiencies in care sparked a successful class-action lawsuit against the state, and the plaintiffs and state officials have been working on a solution since the first “blueprint” for improvement was developed in 1991.

Magellan Health Services won a three-year, $1.5 billion contract to overhaul the system in 2007. The January audit argued that care had deteriorated under Magellan, which promised to make vast improvements over its predecessor, ValueOptions.

In one key measure, the percentage of seriously mentally ill people who have a stable living situation and job or “meaningful day” declined from 44 percent under ValueOptions two years ago to 14 percent under Magellan. The 2008 target was 80 percent.

Magellan officials say the audit does not accurately reflect the strides they have made in several areas. They say they are in the midst of a large-scale transformation and need more time to complete it.

“We’ve been working over the last 19 months to bring the system out of its low point,” said Richard Clarke, CEO of Magellan of Maricopa County. “And I think we’ve been making very good progress and steady progress on all the issues that the court is concerned about.”

Clarke said employment figures have improved dramatically and that the number of vacant case-manager positions is at an all-time low.

Joe Kanefield, an attorney representing Gov. Jan Brewer and the state, said a plan for improving the system could not be developed until after the state resolves its budget crisis. Brewer has convened a task force to issue recommendations on whether and how to overhaul the system.

Steven Schwartz, an attorney representing the plaintiffs, said further delays would be unacceptable.

“People have been waiting for years,” he said. “And the situation has been regressing, not improving. Something’s got to change.”

Another Example of Magellan's Failure to Care for Mental Health Patients and Residents in Maricopa County

I wish to remain anonymous, but I work for a Crisis company in Maricopa county and I was just told that we could no longer see patients without some form of insurance because magellan refuses to pay us to see these people.

So, many of the people I see are already in the system, but many  more are not, and due to psych issues and lack of any coping skills, they are unable to get through the complicated process of getting on AHCCCS (takes 45+ days assuming they can come up with all the necessary paperwork) and then must navigate the Magellan system to get into treatment.

As a provider, I find this process daunting at times due to limited guidance and information along the way and spend a good deal of time with uninsured crisis patients explaining the process and promoting patience and advocacy.  So now, if a person does not have any form of health insurance, for whatever reason, our regular crisis workers are not able to get paid to help these people.  And where does this leave the person in crisis?  Up a creek and offered very brief snippets of information by caring individuals who do not have to rely on a paycheck to survive.  (A paycheck that is ever decreasing due to Magellan not wanting to pay us a decent wage for our services)

This is just another example of Magellan’s failure to care for mental health patients and residents in Maricopa county.  The way the providers are treated is in direct relation to how the patients and residents of Maricopa county are treated.  We are not respected and valued and neither are the patients and residents.

Anything to maximize profits that get funneled out of our state.

Governor to spearhead mental health investigations

By Anjanette Riley, Arizona Capitol Times
March 4, 2009

Gov. Jan Brewer has indicated to at least two Republican lawmakers that she intends to spearhead all efforts to reform state-run mental health services in Arizona.
Reform efforts are expected to focus on the implications of the 1981 verdict in Arnold v. Sarn, an Arizona Supreme Court case that granted Maricopa County residents a legal right to mental health care.

The effectiveness of the program was called into question after a series of audits revealed serious flaws with the county’s mental health system administered by Magellan Health Services, a private company hired in by the county in 2008.

No official announcement has been made by Brewer, and the Governor’s Office was unavailable for comment. But Rep. Nancy Barto, a Republican from Phoenix, said she has “every reason to believe” Brewer plans to take the helm of reform efforts.

Barto and Sen. Carolyn Allen, a Republican from Scottsdale, have met with Brewer several times during the past few weeks to identify steps the Legislature should take to remedy problems with Magellan.

“We should be hearing more specifics in the next few weeks on the timeline and some of the plans,” Barto said. “I am just really thrilled because this issue encompasses so many different elements and it really belongs on the Ninth Floor. I just think this is a perfect development.”

Barto, the chairman of the House Health and Human Services Committee, has responded to Brewer’s decision by removing H2205 from the committee’s hearing schedule. The bill, sponsored by Barto, aimed to create a legislative task force to examine the treatment models and the financial efficiencies of Magellan. Members of the task force would have included lawmakers, agency heads and representatives from the courts.

As for the role legislators will play in reforming mental health care services, Barto said the best decision would be to postpone action until receiving direction from the Governor’s Office.
“There are a lot of ideas and opinions,” Barto said. “Frankly, we have to ask a lot of questions before we can move in any direction. Legislation at this point, I think, would be very premature.”

MAGELLAN HEALTH SERVICES CEO RESPONDS TO SCATHING AUDIT

In advance of next month’s scheduled hearing on the court monitor’s extremely critical audit of Magellan Health Services, company CEO Richard Clarke recently sat down for an interview with KPNX Channel 12’s Joe Dana.

While Clarke claimed the media incorrectly reported the audit’s findings and then tried to paint a rosy picture of Magellan’s efforts, he never addressed issues that resulted in the beating deaths of two children just before Christmas or two other murders in Maricopa County that have taken place since Magellan became the Regional Behavioral Health Authority here.

Below is the story that appeared on the 12 News website. You can follow this link to the story and see video of Richard Clarke and the station’s interview:

http://tinyurl.com/dfresx

MAGELLAN CEO RESPONDS TO SCATHING AUDIT

Depending on whom you ask, Arizona’s mental health care system is either an ongoing failure or an encouraging work in progress.

In January, The Maricopa County Superior Court Office of the Monitor released a report concluding Maricopa County’s mental health system, which serves more than 19,000 people with serious mental illness, is regressing and deficient in basic services.But the man leading the overhaul of the system says the changes to mental health care envisioned by state legislators are “happening and moving forward.”

“I think we have to look at the court monitor’s report with a careful eye,” said Richard Clarke, CEO of Magellan Health Services, during an interview with 12 News. The company is in the middle of a three year, 1.5 billion dollar contract with the state.

“We have to say the report reflects part of the system, it tells part of a story. Some of it’s true, some of it does not reflect the wide scale change that’s going on in the system right now,” Clark said.

According to the report, 83 percent of “priority” clients are not having their behavioral health needs met according to their treatment plans. Priority clients are those who have been at one time a resident of the state hospital or an inmate in jail. It’s a statistic that court monitor Nancy Diggs called “disgraceful.”
While Clarke acknowledges there are many areas in which the health system needs to improve, he questions the validity of that finding.

“Frankly I think it’s a generalization that is not completely accurate,” Clarke said. He believes the court monitor’s audit only shows “a slice of the full story.” For example, Clarke said a separate survey conducted by the state in January actually reflects dramatic improvements in patient care.
“The state surveyed for us satisfaction scores for clients about their feelings of whether or not they’re being treated with dignity and respect in our system. The performance on that is 84%. And that’s over 6,900 individuals that were surveyed versus 200 in t he court monitor report,” Clarke said. “You can’t have scores like that… if you’re not doing something right.”

In contrast, the court monitor’s report concludes three in five patients do not have an adequate clinical team. Four in five patients do not have a complete assessment of their mental-health needs.

There are other benchmarks of progress that are not reflected in the survey, Clarke said. Since August, Magellan transferred 11 clinics into community ownership. The move is the result of a mandate by the state legislature to give local providers control on how services are delivered.

Magellan also dramatically improved its community-based treatment program, said Clarke. The community-based philosophy focuses on surrounding a client with a team of professionals, including a life skills developer and employment coach.

According to Clarke, the satisfaction level among clients of community-based treatment has gone from 36% in 2006 to 74% this year.

“That is big change for a very significant number of people who are getting very good care,” Clarke said.
Magellan also capped administrative fees and increased peer-delivered services, Clarke said.

“Those are concepts helping people become self-determiners in life, helping them engage with voice and choice and participation,” Clarke said.

Both Clarke and the court monitor are in agreement about Magellan’s failure to respond to a client’s changing needs. According to the court monitor’s report, only 40% of priority patients agreed that during a change in their lives, a case manager/clinical team responded in a timely manner.

“There are some areas of our system that are not very responsive to meeting people’s needs. So when they call they don’t get phone calls back. It takes them a while to get into the system. I think it’s a very serious issue,” Clarke said.

Still, Diggs says that any improvements made by Magellan are not significant enough, according to court’s expectations.

“This is a company that came in and promised they would improve things in a very short time and that has not happened,” Diggs said.

A court hearing is scheduled in May where a judge is expected to review the results of the audit.