LME consolidation getting ‘a hard look’

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By Jason King
Assistant Communications Director

The Department of Health and Human Services will be “proactively moving” toward consolidation of Local Management Entities’ business services, such as administrative and information technology functions, in an effort to make the provision of mental health services more stable and sustainable for the state, according to the department’s new secretary.

Dempsey Benton, the new director of the Department of Health and Human Services, is a veteran city government manager, having served in the cities of Raleigh, Elizabeth City and Rocky Mount. (Photo by Jason King)

Dempsey Benton, who was appointed DHHS secretary by Gov. Mike Easley in September, and Rep. Verla Insko addressed the delivery of mental health services during a Nov. 9 meeting of the NCACC Human Services Steering Committee.

“It may be in conflict but the key point is we’ve got to get the system stable and we’ve got to make it sustainable in terms of the resources that are available to provide those very important services for that fragile population,” Benton said.

LMEs in Guilford, Mecklenburg and the 12-county Smokey Mountain service area have already entered into a joint venture to look at consolidating administrative functions, accounting and IT services, Benton said. He said several LMEs operate with a single administrative service organization.

Insko, co-chair of the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services and a former Orange County commissioner, said that approach is one the oversight committee could support.

Insko said the Governor’s Office is pushing for a further reduction in the number of LMEs, but she believes the state cannot manage a huge healthcare system and hopes that any consolidation that occurs will be at the administrative level – not at the full LME level. The original goal of the mental health reform plan called for 20 LMEs; there are currently 25.

“It has to be a system where you have your feet on the ground, where you can see the providers,” she said. “We already have lost the public face of mental health in a lot of our communities.”

Benton would not rule out further consolidation of full LMEs and said DHHS is working with a national consultant – The Mercer Group – to look at potential consolidations and improvements in management structure.

“We’re going to look at whether that’s the most efficient way to manage just a few mental health systems, or whether we can further streamline that and look at having fewer of those Local Management Entities,” he said. “I know when I say that people are a little nervous about that … but we are going to take a hard look at that over the next six months.

“The state is spending a lot of money supporting these 25 entities. Every dollar we spend on administrative services that isn’t needed is a dollar that doesn’t go to direct service delivery.”

Benton did promise not to leave LMEs in the dark about which way the department is leaning. In his first month, the former City of Raleigh manager hit the road to visit each of the 25 LMEs across the state.

“They are at the table now every time we make a decision,” he said. “I think we are now working off the same page.”

Both Benton and Insko agreed that the state must do a better job of making sure corporate providers are qualified to treat the mentally ill, and that LMEs must raise their own standards and improve consistency in their business with providers.

Committee members expressed concern that new efforts to raise the bar for private providers will leave hard-to-serve clients without services because providers are likely to “cherry pick” the areas they service.

“In some areas of the state, providers that meet the current standards are impossible to get,” said Duplin County Commissioner L.S. Guy.

The Joint Legislative Oversight Committee is working on the problem, Insko said, and is in search of a model for rural service delivery.

Benton said DHHS has suspended enrolling any new providers until July 2008 in order to address service adequacy and client progress. There are currently more than 700 providers operating in North Carolina.

“Some are doing a great job. A few are not doing a good job, and we need to raise their quality-of-service standard,” he said.

Another focus of the Joint Legislative Oversight Committee, Insko said, is expanding substance abuse services beyond the targeted population. Benton agreed that there is a need for improvement and that too many citizens with substance abuse issues are ending up in hospital emergency rooms and county jails.

According to Benton, the General Assembly has identified more than $20 million to develop consistency among crisis service centers across the state.

“You have got to have that kind of presence that is clearly identifiable so when people are in a personal crisis we’ve got a way to say, ‘here’s where you go,’” he said. “That’s one of those areas where you’ve got to deal with the balance between state standardization and local flexibility.”

In addition, Benton outlined his initiatives for other departmental services, namely full funding of children’s healthcare for families at 200 percent of the federal poverty level, with a companion program for families that are up to 300 percent of the poverty level via insurance premiums.

The committee also outlined several areas of future interest, including health and wellness initiatives; health insurance coverage, programs and facilities for the aging population; and adult guardianship.

Prior to the meeting, Bryan named commissioners Lewis Hoggard III (Bertie County) and Sue Weimar (Perquimans) as committee co-vice chairs. The committee will meet again Jan. 24 in Raleigh.

Intergovernmental Relations Director Rebecca Troutman, staff liaison to the committee, contributed to this article.