On Monday, Valley Mental Health will send letters to 400 mentally ill clients in Salt Lake County, informing them that they will need to seek treatment elsewhere.
Valley anticipates sending letters to an additional 1,700 clients within several months, as part of a plan to cease treatment of clients with the least "severe" mental-health conditions-"those with the least-severe conditions; those who have not been hospitalized in the last six months; and those who do not present a suicide risk," according to a letter sent to Valley staff (scroll down to read the letter).
The letter sent to patients will include an 1-800 number that clients can call to talk to someone about going to another provider of mental-health services. OptumHealth, which manages Valley's mental-health contract, has given assurances to Valley and Salt Lake County that clients will be immediately placed with one of a large number of alternative mental-health-care providers in the valley.
Salt Lake County's mental-health director, Tim Whalen, said Valley is taking each case on an individual basis, and that there is some flexibility in Valley's plan if clients did not want to leave or demonstrated fragility.
The move appears to be part of a dramatic restructuring of Valley's business, and follows Salt Lake County sending out a letter to its network of behavioral-health-services providers June 11, 2013, informing them of cuts. In Valley's case, its spending cap for the fiscal year June 2014 would be cut by $1.2 million. Valley says the cut is actually $2 million because it includes $750,000 the county agreed to in additional expenses for 2013.
The total Medicaid and non-Medicaid funding for Valley for 2014 amounts to $22 million, down from $24.4 million the previous year.
Word reached Valley staff of the plan to reduce client numbers June 27, when Valley Mental Health CEO Gary Larcenaire sent a letter to employees, warning that Utah's largest mental-health provider was considering releasing 2,200 clients because of the cuts.
Salt Lake County brought in OptumHealth two years ago to manage its mental-health budget after longtime-sole-provider Valley's relationship with the county hit problems several years ago. Since then, Valley has become one of numerous providers of mental-health services in the Salt Lake County.
In the letter, Larcenaire blamed Salt Lake County and Optum officials for the decision it now faces. "While Optum and Salt Lake County tout the success of their partnership, they are neglecting to acknowledge that services are being cut and clients with mental illness are not being appropriately served."
The tone of the letter came as a surprise to the county's mental-health chief, Whalen. In a phone conversation Whalen had with Larcenaire on June 28, Larcenaire "was messaging very different from the letter that went out to staff," Whalen says.
Six or seven months ago, Whalen says, Valley approached both the county and Medicaid with the idea of moving less-challenging clients to other providers and focusing on clients with complex needs, notably those who are Severe & Persistently Mentally Ill [SPMI]. "We said, 'That's great, that's what you're best at,'" Whalen recalled.
Larcenaire said there had been discussions over the past 11 to 14 months about Valley focusing on the most complex clients. After a meeting Friday morning with Optum, Larcenaire said the plan was to reduce the adult mental-health-outpatient-client base by between 1,600 and 2,100 by Sept. 1, 2013. The patients who would be leaving were those who, after a mental-illness had proved able to manage their illness, had not been hospitalized in a while and were typically "people coming in to see a doctor to get a [prescription] renewed."
Larcenaire said no layoffs were envisioned with regard to the reduction in both spending cap and client base, "but as people quit, that is allowing our clinical-oversight team to reconfigure our needs with more complex cases." Valley is developing small teams to deal immediately with patients in mental-health crisis, for example, those just released from the state mental hospital in Provo.
"What we're doing is really getting ready for Medicaid expansion that we are going to be experiencing in January," Larcenaire added. Valley will be partnering with a variety of payers, he says. In terms of Salt Lake County, Valley is simply "trying to help" a struggling payer.