Developing the Infrastructure to Transition to an SUD Managed Care System
Elizabeth Stanley-Salazar, MPH
With the support of the Blue Shield of California Foundation, the CIBHS DMC-ODS WAIVER FORUM creates a collaborative think tank to support county behavioral health and substance use disorder leaders in the planning and implementation of the Drug Medi-Cal Organized Delivery System. Working with the CBHDA SAPT Committee, the first FORUM was held in September 2016 and focused on the transition from the current county alcohol and drug services administration to a specialty managed care organization.
Ron Kercheval of Advocates for Human Potential (AHP), Inc kicked off the Forum with an overview of the elements of an effective Managed Care Organization. He outlined the functional administration and the operating environment for a public agency as a manager of benefits, payment, and quality control.
Rama Kahlsa, Ph.D. of Behavioral Health Concepts, Inc. (the Department of Health Care Services’ EQRO subcontractor for the DMC-ODS Waiver) presented an overview of the administrative components of quality improvement and the role of the local administrator in improvement vs. compliance management.
The Forum participants broke into two small groups facilitated by county leaders who have been successful in the submission and negotiation of their county implementation plans. The counties identified strengths that exist in the current opt-in counties to one degree or another. Those counties that have opted into the Waiver have built the ODS Implementation Plan using these strengths. The summary of the county discussions that follows sheds light onto the challenges, barriers and the possible enhancements needed for success.