When the Washtenaw Community Health Organization (WCHO) in Ypsilanti, Mich., appointed Patrick Barrie as its new executive director in November of last year, they gained a leader with more than 30 years of experience and the financial know-how that can help see them through the economic turmoil in the Wolverine State.
The WCHO was created in 2000 by the Washtenaw County Board of Commissioners and the Regents of the University of Michigan to provide integrated care to Medicaid and indigent consumers with mental illness, developmental disabilities, and substance abuse problems.
Barrie, who has a master's in psychology from Duquesne University, as well as a master's in history from Michigan State University, began his career in Pittsburgh, but returned to his home state of Michigan to work for a series of community mental health centers (in both clinical and clinical-supervisory capacities) before going to work for the state in 1995. He served for six years as the director of the mental health and substance abuse services administration with the Michigan Department of Community Health, acting simultaneously as the state Medicaid director and mental health/substance abuse director, before he went to work with the WCHO in 2008 as a deputy administrator.
“When I came to the WCHO, I was first focused on trying to develop some state interest in funding disease management for consumers with serious mental illness who either had significant medical co-morbidities or precursor conditions,” Barrie says.
He has served as interim executive director since February 2009, replacing retiring director Kathleen Reynolds, who had led the organization since its inception.
Establishing medical homes
The WCHO's top priority is developing an integrated healthcare infrastructure for its consumer community. It's well known that patients with mental health and substance abuse issues face much higher risks from otherwise preventable or treatable diseases. The WCHO hopes to improve outcomes by partnering with primary care providers and non-profit community clinics, and creating “medical homes” where these patients can receive primary and behavioral healthcare services at one site.
“We've started to get more focused on doing a better job of identifying people with multiple morbidities and looking at their pattern of healthcare use, as well as our own tracking of their healthcare status and needs,” Barrie says.
WCHO initiated a pilot study that provided a broad set of data from state Medicaid recipients that has allowed the organization to do some predictive modeling, and to stratify groups of consumers based on their risk profiles to improve interventions. “We've linked up with some high-volume community clinics, and we hope to move into paying for some demonstration medical homes for consumers who use those clinics, but don't have a regular connection with a physician,” Barrie says. “The data has been quite sobering just in terms of showing us the degree of need that's out there.”
Trying economic times
In addition to his experience as a clinician, Barrie is considered a national expert on Medicaid financing for behavioral healthcare and served as a member of the joint national task force on Medicaid and Mental Health.
In 2002, he wrote a monograph arguing in favor of sole-source contracting arrangements with community mental health service providers (as opposed to competitive bidding) that was submitted to the Health Care Financing Administration (HCFA) as part of the Department of Community Health's 1915(b) waiver renewal, which the HCFA ultimately accepted. “At that time, we were building on some of the failures of the competitive models, and we successfully argued to continue sole-source contracting with public entities,” Barrie says.
He also secured approximately $60 million in additional federal funds over two years for community mental health services programs in the state by redirecting local resources to match the increased federal funds.
That background will serve him well at the WCHO, where Barrie says his biggest challenge will be Michigan's dire economic situation. The state is facing an estimated $1.6 billion budget shortfall for its next fiscal year, a situation that has been compounded by high unemployment, swelling welfare rolls, and larger Medicaid caseloads.
“Stimulus funding has been a significant help to the state in maintaining essential services, particularly the increase in Medicaid matching rates,” Barrie says. “Once those funds run out, the state's projections are not very reassuring. Our biggest concern is how we survive under these very difficult circumstances.”
Behavioral Healthcare 2010 February;30(2):40