At Tuesday night’s Rockland County Legislative meeting, a letter emailed to Chairwoman Harriet Cornell and Legislator Ilan Schoenberger was read aloud. The letter was from an employee of the county’s mental health department—who later in the evening came forward as Mary Rodriguez—and she spoke of her concerns with lack of information about the new state-mandated Health Homes initiative, possible layoffs and a request for more staff involvement or communication.
The New York State Department of Health’s new initiative, Health Homes, hopes to help patients with specific medical care and save on health costs. This came out of Governor Andrew Cuomo’s Medicaid Redesign team and focuses on coordinated care for complex patients.
After the letter was read, Mary Ann Walsh-Tozer, commissioner of the Rockland County mental health department, reflected on the letter. Then two employees came forward to speak, one of whom was Rodriguez.
Here are excerpts from the letter:
I feel that it’s absolutely necessary to address a new service that’s being immediately implemented in our county by the state office of mental health and department of health. The target dates to begin implementing these services are April 1, 2012.
With respect to our current county positions … we would like to point out our specific services in the case management unit will be a vital part of the future of mental health treatment. The crux of this new wave of services equals quality, experience and knowledgeable care managers. Ironically, it is the same service that we already have been providing for years.
It could only benefit the county and the clients we serve to keep our unit intact. It makes sense to keep current care managers that are already in place as employees.
We will continue to bring in revenue to the county. We already know and service the clients who transferred into this kind of care … it seems that the re is no need to contract out for these services.
We hope that you will investigate these … important changes coming down on us.
Walsh-Tozer said she did not know of these staff concerns.
“I had spoken to the supervisors and they were not aware that there were concerns from the staff,” she said, adding that she encourages staff to approach her and the administration with all their concerns.
“Health Homes … is a care management service model.
She explained that the Health Home Initiative is from the Affordable Care Act of 2010.
“The initiative is coming out of the state. They are transitioning and phasing in what they’re calling ‘care management,” she said. “The intention of this is to ensure that an individual’s care is completely coordinated, their health care, behavioral health care, social services need … there is someone, not only coordinating that care, but focusing strongly on ensuring that everyone that is part of each consumer health care team … are all talking to each other.”
Schoenberger was one of the legislators to receive Rodriguez’s email among others.
“I apologize if it put (Rodriguez) in an uncomfortable position,” he said, adding that he has written, in the past, a law called the Rockland County Whistleblower Protection Act. “Any county employee that comes forward and tells us of things in the county government that could be done better or done more, has immunity protection from any discipline or any kind of action. I appreciate the email, (the employees) coming here and the commissioner’s comments.”
Coordinated care can lengthen the lives of individuals with complex care needs.
“The care coordinator in a health care home is the center of the wheel,” said Walsh-Tozer. “I happen to think that there is a great deal of value in this initiative.”
“The services that Commissioner Walsh-Tozer described for care coordinators is exactly what we have been doing for 20 years now with the Department of Mental Health,” said Rodriguez. “We are the key point care coordinators for, not only the mental health piece of our clients’ lives, but also the health related, housing related, you name it, the gamut of what they need. We are the only advocates that they have. We do pull together all the services that they need.”
Rodriguez added that the current employees have established long-standing relationships with community services as well.
Informing the Staff
“It’s important (for the staff) to know that the state is doing webinars on this issue of health homes and part of that has to do with case management, which this letter is referring to. The staff has been invited to attend these webinars,” said Walsh-Tozer.
She added that she had involved case managers and supervisors in the discussions.
“It is my hope that the staff will not only be part of the training but also be interested in moving over and becoming care coordinators,” she said. “They’re very talented and very able to do this job.”
Legislator Philip Soskin suggested that Walsh-Tozer have a meeting with her staff and keep them informed for them to make plans for the future.
“This is very important both to the county and to those individuals who are concerned,” he said.
“We have done that and will continue to (inform staff). We have included staff to the best of our knowledge of what is happening,” she said.
On the other hand, Rodriguez claims were different.
“We did go to our supervisors and asked about what is coming down to the pipe with respect to our services and the heath home services … he is in the dark, from what he tells us,” she said, adding that she and others had to sign up for emails with the NYS DOH for notifications such as the webinars.
“The atmosphere in our department is very tense, chaotic, confusing. The clients have questions. We’re not going to be able to answer those questions because we don’t know what our role is,” said Rodriguez.
Walsh-Tozer said that the department is not certain of how long the transition will take.
“It could be a year or it two years, … in the short term, foreseeable future, (we’re) utilizing the case managers who are … very well trained and perform in their jobs very well and they will be transitioned into being—and will remain on county rolls as county employees for a period of time—in their current jobs as care coordinators,” she said.
However, she added that the state is going to “eliminate these positions down the road and create care management positions … to better integrate behavioral health and physical health needs of clients and ultimately, eliminate … undermanaged care.”
Walsh-Tozer added that they just went through two serious layoffs in the department of mental health.
“None of it is done easily.”
At the podium, Rodriguez offered a possible solution to layoffs.
“Monetarily, I don’t know what the reimbursement rates are … with a care coordinator title. I know it’s less (than current salaries), but I know we’re able to carry larger caseloads. So conceivably I would think, we would be able to cover our whole salaries at no cost to the county if our caseloads were increased, which they would be,” said Rodriguez. “There is a whole host of dynamics that I feel that are not being discussed, certainly not within our department.
Another employee, Debra Villar came forward to add that they have done a tremendous amount of research online.
“Their idea of health homes, we’re not against it. It actually sounds like a very viable move,” said Villar. “We’re just very adamant that we would be a huge contribution to that as well and we should be involved.”
“Yes I’m fighting for my job … but by the same token, the division that OMH wants, what the future of the services of mental health is, is what we do now,” said Rodriguez. “I’m a little confused about why we’re being told how to do this. It minimizes the value of what we’ve been doing for 20-30 years.”
Rodriguez’s letter also spoke of the need for an upgraded billing system:
It seems feasible that the use of computers for billing could be easily be facilitated down in the department of social services building, which is walking distance from our offices.
This may enable us to directly build on the e-net system, another requirement of the DOH program
This would certainly rectify most of the current billing problems. Access to the system … we would be able to find out our clients’ … information vital to our clients
“It’s not something we’re aware that is an issue,” said Walsh-Tozer. “I can tell you that not having computers and electronic medical records is extraordinarily debilitating
Soskin added that although the legislature could not do much on the issue, but they could help facilitate a meeting between administration and employees. He also requested representation at the future meeting from the department of social services and someone from MIS who is knowledgeable about software to upgrade billing technology.
Correction 4/11—all references of 'union' have been changed to 'unit' in the letter excerpts