We are growing for our community

100,000 sq. ft. hospital expansion coming soon

Ozarks Medical Center Behavioral Healthcare

2019 Strategic Plan

The strategic plan for Ozarks Medical Center (OMC) Behavioral Healthcare (BHC) has been developed by BHC management and employees to provide a disciplined approach to management of the organization over the coming years. OMC BHC has developed a consumer advisory board to provide structured consumer input.

Background Statement/History

OMC BHC was formed in 1997 when it was awarded the contract as administrative agent for the Missouri Department of Mental Health (DMH) for mental health services in the seven county region that includes Howell, Oregon, Shannon, Texas, Wright, Douglas, and Ozark Counties.

OMC BHC provides psychiatry, psychotherapy, case management, health home, crisis services, and psychosocial day treatment programs. Case management currently serves an average of 600 clients with a diagnosis of mental illness. The Health Home program serves approximately 380 people.

OMC BHC added a Family Support Provider and a Peer Support Specialist in 2018. Both of these providers have lived experience with mental health and use their story to help families and individuals with access to services and supports. The Peer Support Specialist left the organization in 2019 and we are currently seeking a replacement.

Demographics

  • Three counties in our catchment area are among the lowest ten in the state in terms of persons below the poverty level:
    1. Oregon: 27.7%

    2. Wright: 27.5%

    3. Shannon: 25.2%

      Source: U.S. Census Bureau, American Community Survey, http://factfinder2.census.gov

  • We have a larger-than-average (both Missouri and the United States) population of individuals over 65 years old

    Source: Ozarks Medical Center Community Health Needs Assessment, 2016

  • Our community is overwhelmingly white

    Source: Ozarks Medical Center Community Health Needs Assessment, 2016

  • 70% or more of our population are considered rural

    Source: Ozarks Medical Center Community Health Needs Assessment, 2016

Management and Staff

OMC BHC is a department of Ozarks Medical Center. The primary responsibility for assuring that OMC achieves its mission rests with the OMC Board of Directors. It is a 15-member, volunteer board made up of physicians and dedicated community members. OMC policies and procedures are used as operational guidelines for OMC BHC.

The Director of OMC BHC reports to the Vice President of OMC Clinical Services. The BHC management team is:

Clinic Director: Richard McGee, MBA

Clinical Manager (CPRC): Curtis Cook, LPC

Clinical Manager (Therapy): Myriah Wallace, LPC

Medical Services Manager: Joy Anderson, LPN

Integrated Services Manager: Kristy Potts, MA, QMHP

Support Systems Manager: Jennifer Wheeler

Medical Director: Jesse Rhoads, DO

Community Advisory Board

The Community Advisory Board (CAB) began meeting in January of 2018. The first meeting included clients and staff, and it has since expanded to include representatives from collaborative agencies. General topics of discussion have included access to care, de-stigmatization of mental health in the community, and improving clients’ experience once they are here. Specific topics have included better hand off when switching providers, child-friendly waiting room, expansion of PSR activities, involvement in more rural community events, options for transportation, and adding or expanding groups. Improvements that have resulted from CAB suggestions include reduction in the length of time it takes to begin weekly sessions with a CSS due to the removal of the psychiatric evaluation requirement for CPRC services, optional hospital tours for BHC staff so we are better able to assist our BHC clients in finding other services in the hospital, and an updated Request For Service process increasing ease of scheduling & accessing services. Projects the Community Advisory Board are currently working on include expanding membership, adding support groups, developing a plain-language flyer, and engaging the community in mental health awareness activities.

Organizational Tenets

Our Mission: To provide exceptional, compassionate care to all we serve.

Our Vision: We will change lives by nurturing hope, improving health and encouraging wellness – every person, every time.

Our Values:

  • Superior Service

  • Teamwork

  • Integrity

  • Compassion

  • Enthusiasm

  • Accountability

  • Respect

Finance

Financial statements are prepared monthly and reviewed by OMC Senior Leadership. Income statement, cash flow statement, and balance sheet are reviewed monthly with the OMC Board of Directors. Financial goals are compared to plan. An annual audit of financial reports is performed by BKD LLC, a firm that is independent of OMC.

The OMC BHC income statement is reviewed each month by the Director, Financial Analyst, and the BHC Management Team.

SWOT Analysis

SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis is a way of appraising the status quo as a predicate to determining planning goals and setting development priorities.

Strengths:

  • The state of Missouri provides significant funding for mental health services for residents who do not have insurance.

  • BHC Healthcare Home has been recognized by the American Psychiatric Association for improving the health of patients with a mental health diagnosis and a chronic medical diagnosis.

  • OMC and OMC BHC are accredited by the Joint Commission and CARF.

  • Family Support Provider Services: OMC administration approved the addition of a Family Support Provider in August 2017.This position assists youth CPRC teams integrate families into services.The Family Support Provider is a requirement for CCBHC status.This position was filled in January 2018.

Weaknesses:

  • The lack of a fully functional behavioral health EMR causes inefficiencies

    • Manual filing system must be maintained: requires physical space

      • All CPRC records are paper

      • Treatment plans are paper

    • Inability to obtain electronic signature of clients in the field

    • Inability to manage client case load

    • Inability to maintain an integrated treatment plan

    • Inability to report outcome measures

    • Inability to perform population management diagnostic evaluations

  • Lack of professionals in rural Missouri impedes the ability of the organization to acquire additional psychiatrists, psychologists, Licensed Professional Counselors (LPCs), Licensed Clinical Social Workers (LCSWs), and Qualified Mental Health Professionals (QMHPs).

  • Substance abuse programming: OMC BHC is exploring the development of a Dual Diagnosis program, known as ITCD in the state of Missouri, Integrated Treatment of Co-Occurring Disorders.

  • Human Resources: hiring and recruiting processes have been slow and 2019 turnover is higher than in previous years

Opportunities:

  • Excellence in Mental Health Act should provide additional funding opportunities: On March 31, 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. Once again, behavioral health clinics will have a federal definition with defined quality standards and reimbursement that reflects the actual cost of care. The legislation:

    • Creates criteria for “Certified Community Behavioral Health Clinics” (CCBHCs) as entities designed to serve individuals with serious mental illnesses and substance use disorders that provide intensive, person-centered, multidisciplinary, evidence-based screening, assessment, diagnostics, treatment, prevention, and wellness services. The Secretary of the Department of Health and Human Services is directed to establish a process for selecting eight states to participate in a 2-year pilot program.

Requires participating states to develop a Prospective Payment System (PPS) for reimbursing Certified Behavioral Health Clinics for required services provided by these entities. Participating states will receive an enhanced Medicaid match rate for all of the required

  • services provided by the Certified Community Behavioral Health Clinics.

  • OMC was deemed ineligible to participate in the 2-year pilot program because the primary clinic is an outpatient department of the hospital.Only those agencies that were a CMHC or FQHC were allowed to participate.We have asked the Department of Mental Health to outline a path forward for those agencies that are set up as outpatient departments.They have informed us that they intend to give us the ability to become CCBHC as an outpatient department, but the details have yet to be worked out.It is unknown at this time when OMC BHC may become CCBHC.

  • Housing: Several community mental health centers in Missouri provide housing services.The types of services vary from diversion to independent supported living to supervised living facilities.Missouri has identified a shortage of sufficient housing options for the behavioral health population.OMC would need to acquire expertise in order to pursue housing as a service line option.

  • ECT: Electro-Convulsive Therapy is not currently available in our area.We have made a proposal for ECT services to OMC administration.

  • TMS: Transcranial Magnetic Stimulation is an evidence-based practice for the treatment-resistant depression.We have included capital funds for this in our 2020 budget.We will need to source another on-site psychiatrist.

  • Substance Use Treatment: We could develop an ITCD program and/or obtain the Alcohol and Drug Abuse (ADA) contract for Service Area 18.

  • EAP programs: OMC BHC currently has an EAP arrangement with Burton Creek Rural Clinic.This could be expanded to other employers in the area.

Threats:

  • A substantial reduction of state tax revenue could threaten DMH funding

  • Loss of contribution funds to fund BHC growth due to competing OMC priorities

  • Loss of federal DSH payments to OMC undermines financial performance

  • Lack of Medicaid expansion in Missouri exacerbates the loss of DSH payments because it has not reduced the amount of self-pay consumers to the OMC system

  • Missouri Ozarks FQHC has been aggressive in our western counties and established a clinic in Mountain Grove in August 2015.They are providing mental health counseling services.

  • An inability to recruit and retain qualified providers could increase the delay in individuals’ accessing services in a timely manner.

Major Objectives:

The following objectives were identified by BHC management. The objectives were ranked in order of importance by BHC employees on October 19, 2018. These objectives were also discussed with the Community Advisory Board at their meeting on March 4, 2019. Community and client members agreed that walk-in primary care services is a priority for them. They also perceived that BHC offering support groups is a priority.

Description

Ranking

ERE: Emergency Room Enhancement program is focused on the high-utilizer population to reduce emergency room and inpatient admissions through case management, communication, and resource assistance.

3

ECT (Electro-Convulsive Treatment) or TMS (Transcranial Magnetic Stimulation) therapies: many of our patients are candidates for these treatments and must drive to Springfield.

5

Provide walk-in primary care services in Parkway, primarily for the mental health population.

2

Expand EAP services to area employers

6

Electronic Health Record: Implement an EMR that is functional with all BHC services. The current EMR is not capable of integrated treatment plans.

1

ITCD: Integrated Treatment of Co-occurring Disorders: co-occurring individual counseling, group counseling & education

4

Patient Flow: Re-arrange Parkway patient flow to reduce congestion in hallways

7

Plan

Electronic Health Record: Implementation of an EMR that is fully functional with all BHC services has been ranked as the number one objective by employees for many years. Case management and Healthcare Home files are predominately paper and must be manually maintained. OMC has decided to roll out a new EMR to the organization on January 1, 2020. That project has consumed a vast amount of resources in the organization, and will do so into the first part of 2020. The goal in updating the EMR is to provide better continuity of care across services and improve ease of documentation for providers.

Primary Care Walk-In Services: Although our stakeholders acknowledge having walk-in primary care services on site with Behavioral Healthcare would increase ease of access for our clients, the organization encourages referrals to our Primary Care and Pediatric Clinic instead.

Emergency Room Enhancement (ERE): We have requested funding for Emergency Room Enhancement from the state of Missouri and have not been successful in obtaining funding. We are currently working on a new proposal. This program works with high-utilizers of the emergency room whom have a mental health diagnosis.

Integrated Treatment of Co-Occurring Disorders (ITCD): We began development of an ITCD program but placed the project on hold due to competing demands. We currently have Dual-Diagnosis group therapy.

Electro-Convulsive Treatment (ECT) or Transcranial Magnetic Stimulation (TMS): TMS is an evidence-based practice for treatment-resistant depression. Providing ECT and/or TMS would prevent those who would benefit from this treatment from having to travel to Springfield to receive it. We have made a proposal for ECT services to OMC administration. We have included capital funds for TMS in our 2020 budget. We will need to source another on-site psychiatrist.

Expand Employee Assistance Program (EAP): We entered an agreement with Missouri State University - West Plains to offer a Student Assistance Program, which was utilized as soon as it was established.

Patient Flow/Privacy: Press-Ganey survey results and comments indicated our clients would prefer greater privacy than our triage space currently allows. BHC submitted a capital request to redesign the space, which was approved. Remodel of the triage area is scheduled to occur in the fourth quarter of 2019.

Support Groups: Support groups were not identified as a major objective by Behavioral healthcare staff, but they were identified as a priority by community and client stakeholders. Establishing support groups remains an active initiative on the Community Advisory Board agenda.