The Board of Supervisors extended the review period for several mental healthcare contracts for another two months before beginning the process of transitioning from its current administrative service model.
Earlier this month, during a discussion about $22 million in contracts for mental health services, the Board decided that the county should take over the financial oversight of specialty mental healthcare. Previously, Redwood Quality Management Company, or RQMC, had that responsibility, as County Counsel Christian Curtis described on July 11.
“Under the proposal in the contracts you have in front of you, the ones as initially submitted would have had you paying RQMC to oversee RQMC in the services it was providing. The department chose to go ahead and prepare a modified contract that would essentially take the oversight function for that particular vendor in house. I think the question I’m hearing from Supervisor Williams has to do with whether the same decision should be made with regard to RCS?”
Supervisor Ted Williams had questioned the wisdom of having RQMC or Anchor Health Management, which is the county’s mental health Administrative Service Organization, audit itself or Redwood Community Services, given that Camille Schrader, of Anchor Health, is the mother of Victoria Kelly, who runs RCS. He did not cite evidence of wrongdoing, but questioned the quality of outcome data the company provides.
At the same meeting, Dr. Jenine Miller, who heads up the county’s Behavioral Health department, sketched out the main changes in the contracts. “This year, we’re holding the contracts with the provider directly,” she told the Board. “We’ve also moved to make sure there isn’t a conflict of interest. We’ve also moved to remove Redwood Quality Management from any conversations regarding finances related to the contractors with the subcontractors.”
On July 25, Sarah Walsh, with Anchor Health Management, asserted that Anchor Health receives high marks from state agencies and blasted the Board for either “having an agenda” or being ignorant of the county’s mental healthcare system. She contended that there should have been a transition period before changing the contract with RCS, saying during public comment that, “Anchor Health has gone out of its way to provide the information to the Board. We've participated in an ad hoc committee to provide client outcomes and taken individual requests from Board members. Furthermore, we’ve listened to feedback from the community and incorporated that input into our reports. We submit the reports to the county annually, quarterly, and monthly at bare minimum. Board members espouse transparency as justification to disbelieve what is presented. It is disingenuous not only to the hard-working staff but to the constituents you serve.”
Also on July 25, Supervisor Ted Williams asked why the payment amount to RQMC had not changed, if oversight duties have been removed. He raised the specter of previous mental healthcare debacles when he asked for more time to review the contracts.
“I read the Ortner contracts,” he said. “Much more thorough in protecting patients and protecting public money. The contracts that are before us, there are a lot of holes. Electronic health records. We’re not keeping those records. It may create a situation like what we have with OMG (Ortner Management Group) today. So my recommendation, rather than go line by line in those contracts with what I’ve circled is, give it to staff. Let them come back. Once they’ve had time to more thoroughly review, it may be that we have to perform an exercise similar to what we had to go through with Naphcare to put the county in a much stronger long-term position.”
Ortner Management Group was delivering specialty adult mental healthcare until 2016, when RQMC and the county’s Health and Human Services Agency took over. Naphcare is the healthcare provider for inmates at the county jail.
Miller said she had no objection to extending the time to review the contracts, as long as service is not interrupted during the Board’s August recess. She said Anchor will still upload financial information, but that oversight will be transferred over to the county. She is hoping for a year-long transition period, unlike the chaotic three-month transfer from Ortner.
“The new contract that went through takes out any financial oversight of any of the contractors,” she emphasized. “So the ASO (Administrative Service Organization, which is Anchor Health Management) does not have financial oversight of any of the providers any longer. The contract amounts, contract rates, billing and everything is overseen directly by the county. They do have a part of their contract. Because they host electronic health records, the billing does go through. They upload the billing to the county system. So there is a pass-through of billing. But the oversight is really at the county level now. The direct oversight of RCS, Redwood Community Services, has been removed from that contract and is now directly with the county. They are still doing some care coordination with the other providers. There is still some care coordination with RCS in the sense that the clients are referred through a system, and we can’t break the whole system while we look to do a transition…We will be working with the ASO to transition services that they’ve currently been doing back to the county Behavioral Health Department. That is spread across a year so that we don’t miss anything. We have all documentations. We don’t want to end up in a similar situation that we experienced with Ortner. That was a three months’ transition and as we know not all documentation and everything we needed across the system were provided. So this allows us a year to get client records completely transitioned over appropriately and all historical data.”
Victoria Kelly, the Executive Director of Redwood Community Services, felt cut out of the decision-making process. “The decisions you are making impact real people’s lives,” she said. “The lives of our staff and the people we serve. The Board has not engaged us as a provider network in discussing regarding what is working and what is important to the system management and how to appropriately transition from the ASO to county management without detrimental impact to the financial and service delivery system.”
The 90-day period to review the contracts began on July first.
