Fourfront Contributor is a coalition featuring four of the largest behavioral health providers in Washington. Members collaborate to develop innovative approaches to improving access to behavioral healthcare and advocate for policies and initiatives to improve healthcare outcomes. They are also advocating for a statewide certified community behavioral health clinic (CCBHC) model to provide stability for the state’s mental health system.
State of Reform discussed Fourfront Contributor’s goals with three of its members—Jodi Daly (CEO of Comprehensive Healthcare), Katrina Egner (CEO of Sound), and Tom Sebastian (CEO of Compass Health) in this Q&A.
State of Reform: What are Fourfront Contributor’s advocacy priorities for the 2024 legislative session?
Tom Sebastian: “Since our inception, Fourfront Contributor has taken a two-pronged approach to advocacy—encouraging annual investments in community behavioral health to deliver immediate relief to providers facing unprecedented demand for services, while generating momentum toward a long-term solution that will establish the modern and sustainable community behavioral health system our communities need and deserve.
For the last few years, annual investments such as Medicaid and non-Medicaid rate increases have been crucial in addressing the challenges that we, as providers, are facing. Service requests are up 30 to 40 percent, our industry is still facing a workforce shortage, and on top of all that, we’re contending with inflationary pressures that are driving up our operational costs. Suffice to say, we need any support that state leaders are willing to lend, so this legislative session, we’re asking for a 5 percent increase in Medicaid and non-Medicaid rates to alleviate some of the pressure.
However, to provide the relief that our community behavioral health system truly needs, we’re urging state leaders to continue progress toward the long-term solution we’ve long supported—statewide adoption of the CCBHC model.”
State of Reform: Can you tell our readers more about the CCHBC model?
Katrina Egner: “The CCBHC model is a nationally proven, evidence-based approach that will modernize funding and the delivery of behavioral health services in Washington.
We know this because we see it happening in the 12 states that have adopted the model statewide. On average, these states are serving 25 percent more clients, they’re eliminating waitlists and expanding programs and services, and they’re hiring and retaining the staff needed to provide care.
Across early-adopter states, CCBHCs are driving value for not only providers and clients, but also for emergency services partners, including law enforcement and hospitals. For example, in Missouri, by connecting individuals to the appropriate services for behavioral health conditions and keeping them engaged in care, the state saw a 20 percent decrease in hospitalizations and a 36 percent drop in emergency department visits within three years of adopting the CCBHC model statewide.
All this—and more—is possible for Washington through CCBHCs.”
State of Reform: How would the CCBHC model transform behavioral healthcare in Washington?
Jodi Daly: “Our state’s current community behavioral health [system] maximizes every resource we have, but we’re limited by an outdated and unsustainable funding system.
Annual investments and rate increases, no matter how large, can’t solve the problems that Washington’s community behavioral health system is facing. They’re helpful in the immediate, no doubt, but they merely cover up holes in a compromised foundation.
What makes CCBHCs so successful is the financial foundation they provide. CCBHCs operate using a distinctive funding model that allows for forecasting community needs, so that providers can secure adequate funding to deliver preventive, comprehensive, system-wide care.
Take Central Washington for example, where Comprehensive Healthcare received three CCBHC planning, demonstration, and implementation (PDI) grants. Through a CCBHC pilot in Yakima, we launched same-day access to care, reducing wait times for a client’s first appointment from up to 60 days to just one day. We’ve also seen our no-show rates for those initial appointments go from 53 percent to nearly zero, and our service engagement rates have increased by 88 percent, meaning that by having the programs and staff in place to meet clients’ immediate needs, we’re also making more efficient use of our providers’ schedules.
Through CCBHC grant funding, we’ve also been able to create staff positions that are simply not feasible through our current system, because there’s no billing code for their services. This includes hiring care coordinators who help clients when they’re transitioning from crisis or inpatient care to outpatient or other ongoing services. Research shows that poor transitions during this time increase the risk for death by suicide by 200 times in the first month after discharge, and 300 times in the first week. Our CCBHC-funded care coordinators are doing critical work to ensure clients remain connected to care and continue on their journey to recovery.
While this is all very exciting, the reality is that these outcomes are time-limited as each PDI grant lasts only two to four years. To fully realize the potential CCBHCs hold, for all our communities and residents, we need to implement the model statewide.”
State of Reform: Where is Washington at in the process of CCBHC model adoption? And what’s next?
Tom Sebastian: “Fortunately for Washington, 2024 marks a pivotal moment in our state’s journey to CCBHC model adoption. That’s because, in 2025, our state will have the opportunity to apply for a CCBHC (Substance Abuse and Mental Health Services Administration) planning grant, and preparation for that grant must start this year.
Securing a CCBHC planning grant is the first step toward unlocking federal funding that will allow us to certify clinics as CCBHCs and establish the state funding system under which CCBHCs operate, putting us one step closer to becoming a demonstration site for the CCBHC model. Fourfront Contributor is ready to lend its collective expertise and experience to help ensure our state’s application is successful. We’re on the front lines, delivering the behavioral healthcare our communities need. And at the forefront of CCBHCs in Washington, we know what the solution looks like, and we can help develop the plan to achieve it.”