An elephant in the room
The regional behavioral health authority (RBHA) in southern Arizona is Cenpatico Integrated Care, since October 1, 2015. This is going to become Arizona Complete Health as of October 1, 2018. (RBHA is pronounced like "ree-bah".)
The situation with the current RBHA can be tricky to discuss, and sometimes is discussed in terms of euphemisms such as "instability in the behavioral health field" or something else. It makes honest discussion difficult within the system, or by system providers. There is also a fear of retaliation if anything critical of the RBHA is discussed, at least if it could get back to the current RBHA. It's like there's an elephant in the room that people are not supposed to talk about, unless the RBHA is not present and will not hear about it.
At this time, the RBHA gives money to agencies and treatment providers, for giving services. For example, an agency with a contract with the RBHA may get paid for a psychiatrist appointment, or an appointment with a case manager, or some other service. Or a treatment provider may get paid for having someone get services in a group home (now called a behavioral health residential facility or BHRF). A hospital gets paid for how many days a person stayed there, a pharmacy gets paid for medications given, a therapist gets paid for a session.
This has been how things have worked for years.
When Cenpatico won the contract with the state of Arizona to be the RBHA, there was some talk of their "open network" system. Basically, you would be free to see any treatment provider in their network, without having to change agencies. So, if you had services at Agency X and wanted to go to a group at Agency Y, you could do that without having to do a whole new intake at Agency Y.
This was different from the previous RBHA. Under the old system, if you were at Agency X, and wanted to go to a group at Agency Y, you were often made to completely change your services to Agency Y. That is, you had to go through a whole new intake at Agency Y, and disenroll from Agency X. This was a huge pain in the butt, because it meant you had to have a whole new intake, a whole new psychiatric evaluation (if you needed medications) and could risk a lapse in services. A change was really needed in this system.
Also, there was talk of caseloads going down, so that case managers could provide better service. Also, there was talk that staff should be paid more, which was encouraging. At least one agency felt it was okay to have caseloads of over 400 people per case manager, which was difficult or impossible to make work.
There was some hope that these changes would be helpful. The caseloads did go down, and staff pay did increase a bit. There was also a lot of anxiety because of other changes that were going to happen, for example with how agencies were paid, and how agencies could lose money. Under the new system with the new RBHA, it could be too easy to get fined or otherwise have your money taken back. This was shown early on. Shortly after the change to the new RBHA, one agency was fined around $2 million for not billing enough units, and there was a rumor that it would have to shut down operations (the agency did not shut down and continues to be a major presence in southern Arizona).
Money has always been a major factor in the system here. Under the new system, it has become more of a problem. Agencies seem to have a harder time getting it, as time goes on, in the new system. This has led to more problems for agencies. At the same time, there are more and more expectations that the agencies have to meet. It has simply become harder to provide services and make ends meet. The talk generally is that the RBHA is a for-profit insurance company and works to find any number of ways to keep more money for itself. (The previous RBHA was non-profit.) You can have money taken back for a range of reasons. Now, money problems are not a new thing. Around 2009, for example, there were huge budget cuts by the state of Arizona that caused huge problems, and things did not really start to get better until some money was restored around 2012.
Layoffs seem to be a problem at some of the agencies, recently. Due to money problems, they sometimes simply can't afford some staff, or at least people in charge think they can't afford some staff. The whole "lower caseloads" thing also seems to have gone out the window. One site director at an agency threatened case management staff that it would be okay if there were only a very few of them, each carrying caseloads of 400+ people (the implication being that the rest would be fired or laid off).
There is a tendency to blame Cenpatico at the agencies, not to the Cenpatico's face of course. A lot of agency staff members have been told by their supervisors or site directors that the problems are because of Cenpatico. I don't know if it's different in other parts of the state that don't fall under Cenpatico. For example, Maricopa County (Phoenix, the surrounding cities, and the county they're in) is under a non-profit RBHA, Mercy Maricopa Integrated Care, but I don't know if things are working better there. Basically, "we had to lay off a bunch of people because Cenpatico." "Things are more stressful because Cenpatico." Cenpatico serves as a lightning rod to draw the dislike of staff members. It is convenient to blame the RBHA, and the RBHA has not helped with some of its behaviors (funding cuts and fines and other things). It also doesn't always work, as staff members also feel dislike for their agencies, or at least their executive leadership. Staff members may remember that their management seems to come up with new ways or new procedures that make their lives more stressful, and may not be sure that this is necessarily because Cenpatico. A quick look at employee ratings of their agencies given on indeed.com or glassdoor.com shows reviews that have the same types of complaints against several of the agencies.
I will probably have more to say about the elephant in the room as time goes on.
The situation with the current RBHA can be tricky to discuss, and sometimes is discussed in terms of euphemisms such as "instability in the behavioral health field" or something else. It makes honest discussion difficult within the system, or by system providers. There is also a fear of retaliation if anything critical of the RBHA is discussed, at least if it could get back to the current RBHA. It's like there's an elephant in the room that people are not supposed to talk about, unless the RBHA is not present and will not hear about it.
At this time, the RBHA gives money to agencies and treatment providers, for giving services. For example, an agency with a contract with the RBHA may get paid for a psychiatrist appointment, or an appointment with a case manager, or some other service. Or a treatment provider may get paid for having someone get services in a group home (now called a behavioral health residential facility or BHRF). A hospital gets paid for how many days a person stayed there, a pharmacy gets paid for medications given, a therapist gets paid for a session.
This has been how things have worked for years.
When Cenpatico won the contract with the state of Arizona to be the RBHA, there was some talk of their "open network" system. Basically, you would be free to see any treatment provider in their network, without having to change agencies. So, if you had services at Agency X and wanted to go to a group at Agency Y, you could do that without having to do a whole new intake at Agency Y.
This was different from the previous RBHA. Under the old system, if you were at Agency X, and wanted to go to a group at Agency Y, you were often made to completely change your services to Agency Y. That is, you had to go through a whole new intake at Agency Y, and disenroll from Agency X. This was a huge pain in the butt, because it meant you had to have a whole new intake, a whole new psychiatric evaluation (if you needed medications) and could risk a lapse in services. A change was really needed in this system.
Also, there was talk of caseloads going down, so that case managers could provide better service. Also, there was talk that staff should be paid more, which was encouraging. At least one agency felt it was okay to have caseloads of over 400 people per case manager, which was difficult or impossible to make work.
There was some hope that these changes would be helpful. The caseloads did go down, and staff pay did increase a bit. There was also a lot of anxiety because of other changes that were going to happen, for example with how agencies were paid, and how agencies could lose money. Under the new system with the new RBHA, it could be too easy to get fined or otherwise have your money taken back. This was shown early on. Shortly after the change to the new RBHA, one agency was fined around $2 million for not billing enough units, and there was a rumor that it would have to shut down operations (the agency did not shut down and continues to be a major presence in southern Arizona).
Money has always been a major factor in the system here. Under the new system, it has become more of a problem. Agencies seem to have a harder time getting it, as time goes on, in the new system. This has led to more problems for agencies. At the same time, there are more and more expectations that the agencies have to meet. It has simply become harder to provide services and make ends meet. The talk generally is that the RBHA is a for-profit insurance company and works to find any number of ways to keep more money for itself. (The previous RBHA was non-profit.) You can have money taken back for a range of reasons. Now, money problems are not a new thing. Around 2009, for example, there were huge budget cuts by the state of Arizona that caused huge problems, and things did not really start to get better until some money was restored around 2012.
Layoffs seem to be a problem at some of the agencies, recently. Due to money problems, they sometimes simply can't afford some staff, or at least people in charge think they can't afford some staff. The whole "lower caseloads" thing also seems to have gone out the window. One site director at an agency threatened case management staff that it would be okay if there were only a very few of them, each carrying caseloads of 400+ people (the implication being that the rest would be fired or laid off).
There is a tendency to blame Cenpatico at the agencies, not to the Cenpatico's face of course. A lot of agency staff members have been told by their supervisors or site directors that the problems are because of Cenpatico. I don't know if it's different in other parts of the state that don't fall under Cenpatico. For example, Maricopa County (Phoenix, the surrounding cities, and the county they're in) is under a non-profit RBHA, Mercy Maricopa Integrated Care, but I don't know if things are working better there. Basically, "we had to lay off a bunch of people because Cenpatico." "Things are more stressful because Cenpatico." Cenpatico serves as a lightning rod to draw the dislike of staff members. It is convenient to blame the RBHA, and the RBHA has not helped with some of its behaviors (funding cuts and fines and other things). It also doesn't always work, as staff members also feel dislike for their agencies, or at least their executive leadership. Staff members may remember that their management seems to come up with new ways or new procedures that make their lives more stressful, and may not be sure that this is necessarily because Cenpatico. A quick look at employee ratings of their agencies given on indeed.com or glassdoor.com shows reviews that have the same types of complaints against several of the agencies.
I will probably have more to say about the elephant in the room as time goes on.
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