Mental Health Center of Denver is a non-profit, 501(c)(3), community mental health organization providing comprehensive outpatient mental health and substance abuse treatment. It is a primary treatment center in Denver and surrounding areas, providing primary health care along with mental health services since its founding in 1989. The Center employs over 500 professional staff, treats more than 15,000 individuals at 35 sites working with over 100 community partners.
The initial motivation to become a part of the RAISE study was the recognition of the need for clinical capacity building to treat individuals with first-episode psychosis. The site was also in the forefront of many major national studies and developed value-building networks through such studies. The study recruitment includes referrals through Denver Health (primary safety net hospital), and other acute care treatment sites (Porter, Highland Behavioral, and West Pines, Mental Health Access Team), local providers, local newsletters and other advertisements. There were also attempts to partner with local college and educational institutions for referrals.
The biggest reported challenge in NAVIGATE service delivery was meeting the unexpected level of need for case management services. The Center was prepared to provide all of the specialized services essential to the NAVIGATE program, but they did not realize the high level of case management that would be needed for the participants. Such case management included accompanying clients to appointments, assisting them with acquiring benefits, locating housing arrangements, helping clients to negotiate family issues, and providing general emotional support. This proved to be a major drain on available resources.
Financing of Services
The Center has a capitated reimbursement arrangement with Medicaid. This arrangement has been in place since the 1990's, when Colorado obtained a waiver to use a capitation model to finance its behavioral health services. To some extent, salaries of some project staff (e.g., 12 hours of project director time, five hours per week for supported employment specialist) are also covered by the RAISE contract. However, overall the study team acknowledges that the RAISE ETP services are underfunded. Some needed services, such as job development, job coaching, planning and coordination, and supported education are rarely reimbursable by traditional government or private insurance sources (Table 3.1).
There were 14 individuals enrolled in the study with two of them having only private insurance, four on Medicaid, and the rest receiving services through state General Fund. For those on Medicaid, the Mental Health Center of Denver has a capitated arrangement to pay for all behavioral health services, which the site uses to pay for the full range of RAISE NAVIGATE services and treatments. While staff members agree that dependence on public benefits such as Medicaid cannot be the ultimate goal, they see Medicaid as an important source of financing, mainly due to high cost of medications and the flexibility of the benefits under the capitation arrangement. For some privately insured patients, the Center is able to arrange special extra-contractual benefits and a case rate. Also, there is a big focus on supported employment with this study, and they were able to get some funding from the Department of Vocational Rehabilitation for supported employment services. (The Medicaid capitation could not be used to pay for supported employment.)
The Center engages with many partners in blending and braiding of resources to provide mental health services. (Blending and braiding is a metaphor for combining resources in a way that each component of the pooled resources is recognizable, that is the resources are not fungible but can be used in concert.) These partners include the Council on Substance Abuse and Mental Health, Colorado Behavioral Health Care Council, local National Alliance on Mental Illness chapter, Mental Health America of Colorado, and Colorado Coalition for the Homeless. In addition, they also work closely with Colorado Access (Medicaid), Denver Health, and Denver Public Schools. The state General Fund provides almost one-quarter of the Center revenues.
|TABLE 3.1. Mental Health Center of Denver, Denver, CO: RAISE NAVIGATE Early Treatment Components and Funding Sources|
(e.g., VA, Tricare)
|Outreach and engagement||X|
|Alcohol and substance use treatment|
|Other outpatient visits|
|Inpatient care as needed||X||X||X||X||X|
|Planning (e.g., treatment and/or recovery plans)|
|Job coaching and other vocational supports||X|
|Individual resilience training||X||X|
|Benefits counseling (e.g., WIPA)|
|Treatment and primary care coordination|
|Other (e.g., occupational or psychosocial therapy, groups, etc.)|
|NOTE: In-house or Other means services provided by staff directly and not billed to any payer. Out-of-pocket means services were paid for either entirely out-of-pocket or some cost-sharing was required.|