NorthSTAR Director’s Report

DANSA Board Meeting

10056 Marsh Lane

Dallas, Texas

1/14/04

John Theiss, Ph.D.

Four Observations and a Conclusion

• all-but-eliminated support services provided to consumers with major depression in the community,

• reduced community-support services to consumers with schizophrenia and bipolar disorder through aggressive restrictions on approval, including service denials (so far, from our data) to 4% of ACT consumers;

• eliminated access to new generation medications except through a state hospital admission; and

• significantly over-utilized state hospital bed-days in the same time period.

So, clinically, a critic would see a program whose response to a crisis in financing has been to drift toward a crisis model of care

Support Services to Persons with Major Depression

-

5

10

15

20

25

30

35

Q100

Q200

Q300

Q400

Q101

Q201

Q301

Q401

Q102

Q202

Q302

Q402

Q103

Q203

Q303

Q403

Units/person

Enc/Person

Rehab to Persons with Schizophrenia and/or Bi-Polar Disorder

-

2

4

6

8

10

12

14

16

18

20

Q100

Q200

Q300

Q400

Q101

Q201

Q301

Q401

Q102

Q202

Q302

Q402

Q103

Q203

Q303

Q403

CSS units /Person

Units /person

NorthSTAR Persons Received ACT

ACT Customers

-

100

200

300

400

500

600

700

Sep-99

Nov-99

Jan-00

Mar-00

May-00

Jul-00

Sep-00

Nov-00

Jan-01

Mar-01

May-01

Jul-01

Sep-01

Nov-01

Jan-02

Mar-02

May-02

Jul-02

Sep-02

Nov-02

Jan-03

Mar-03

May-03

Jul-03

Sep-03

NorthSTAR Provides More ACT

Served Q1 2004 Population

ACT per person

ACT per 100,000 Persons

NS ACT Mo 652 3,290,277 0.000198 19.82 Non NS ACT Mo 1,950 18,867,849 0.000103 10.34

SFY 2003 Q1 04 ChangeNS ACT Mo 610 652 7%Non NS ACT Mo 2,371 1,950 -18%

New Gen Med Use Increases

0

2000

4000

6000

8000

10000

12000

14000

16000

Q1-2000 Q2 2000 Q3 2000 Q4 2000 Q1-2001 Q2 2001 Q3 2001 Q4 2001 Q1-2002 Q2 2002 Q3 2002 Q4 2002 Q1-2003 Q2 2003 Q3 2003 Q4 2003

Atypical Anti-psychotic

Selective Seratonin Reuptake

New Gen Medications (unduplicated)

NorthSTAR State-funded Atypical Meds Penetration Similar to Non-NorthSTAR

2003 IndigentFund Source 6

Only

MonthlyServed

Population State funded AtypicalAnti-Psychotic /

100,000 Population

NS Atypicals 2,138 3,290,277 64.98

Non NS Atypicals 11,310 18,867,849 59.94

CARE Shows NorthSTAR SH Overuse

VO and DANSA ended SFY 2003 with substantial apparent overuse of the State Hospital. A review of the CARE data used to generate the Trust Fund utilization information indicates that there are problems with the accuracy and adequacy of the information underlying the data. The state is working with DANSA and VO to identify these problems and determine the extent of any over use.

SH Trust Fund Utilization

$1,500,000

$1,750,000

$2,000,000

$2,250,000

$2,500,000

Nov

-01

Dec

-01

Jan-

02

Feb-

02

Mar

-02

Apr

-02

May

-02

Jun-

02

Jul-

02

Aug

-02

Sep-

02

Oct

-02

Nov

-02

Dec

-02

Jan-

03

Feb-

03

Mar

-03

Apr

-03

May

-03

Jun-

03

Jul-

03

Aug

-03

Sep-

03

Oct

-03

Nov

-03

Trust Fund

Expenditures

High Return on Investment

COMMUNITY Per Capita Served per Per Capita/MHAs Funding MHAs 1000 Pop MHAs Penetration=

Lakes Regional 30.00$ Anderson/Cherokee 16.34 NorthSTAR 1.30 West Texas Center 29.72$ Lakes Regional 16.04 Bluebonnet Trails 1.36 Central Texas 22.29$ Spindletop 12.14 Austin-Travis 1.59 Border Region 21.04$ Bluebonnet Trails 11.39 Heart of Texas 1.62 Permian Basin 19.97$ NorthSTAR 10.13 Lubbock 1.71 Concho Valley 19.25$ Nueces County 10.04 Pecan Valley 1.78 Spindletop Services 18.46$ Permian Basin 8.96 Statewide 1.87 Pecan Valley 15.75$ Austin-Travis 8.20 Center for HCS 2.02 Bluebonnet Trails 15.45$ Hill Country 7.57 Sabine Valley 2.11 Brazos Valley 14.66$ Concho Valley 7.12 Texoma 2.18 Tropical Texas 14.49$ Northeast Texas 6.73 Brazos Valley 2.19 NorthSTAR 13.16$ Texoma 6.12 Andrews Center 2.42 Austin-Travis 13.02$ Gulf Coast 6.03 Border Region 2.45 Harris County 11.12$ Tropical Texas 5.43 Tropical Texas 2.67

MH Provider Payments Increase

$-

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

SFY 2000 SFY 2001 SFY 2002 SFY 2003

MH communityIndigent Pharmacy ServicesState HospitalCD Community Services

Increases # Served Each Year

30000

32000

34000

36000

38000

40000

42000

44000

SFY 2000 SFY 2001 SFY 2002 SFY 2003

NorthSTAR Serves a Higher Population Proportion

Q1 SFY 2004 Served per 100,000Adults (18+ yrs)

NorthSTARDifference

Adults Q12004

2004Population

NorthSTAR 638.99 4% 15,170 2,374,061Non-NorthSTAR 612.26 83,862 13,697,092

Q1 SFY 2004 Served per 100,000Children (<18 yrs)

NorthSTARDifference

Children Q12004

2004Population

NorthSTAR 393.14 36% 3,602 916,216Non-NorthSTAR 288.04 14,894 5,170,757

VO Consistently Exceeds DSCT

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

SFY 2000 SFY 2001 SFY 2002 SFY 2003 SFY 2004-05 est

PaymentsDirect Service ExpendituresRequired Service Expenditures

Increase # Served Each Quarter

10000

12000

14000

16000

18000

20000

22000

24000

26000

28000

Four Observations and a Conclusion

• all-but-eliminated support services provided to consumers with major depression in the community,

• reduced community-support services to consumers with schizophrenia and bipolar disorder through aggressive restrictions on approval, including service denials (so far, from our data) to 4% of ACT consumers;

• eliminated access to new generation medications except through a state hospital admission; and

• significantly over-utilized state hospital bed-days in the same time period.

So, clinically, a critic would see a program whose response to a crisis in financing has been to drift toward a crisis model of care

Improved Distribution by Adult Pri Pop

0%5%

10%15%20%25%30%35%40%

Schi

zoph

reni

a+R

elat

ed

Bip

olar

Dis

orde

r

Maj

orD

epre

ssio

n

Oth

er

SFY 1998 NS Counties

SFY 2000 NorthSTAR

SFY 2002 NorthSTAR

SFY 2004 NorthSTAR

Adult Pri Pop Looks More Like Texas

0%

5%

10%

15%

20%

25%

30%

35%

40%

SFY 1998 NSCounties

SFY 1998Non NS

SFY 2004NorthSTAR

SFY 2004Non NS

Schizophrenia +RelatedBipolar DisorderMajor DepressionOther