The Mental Health and Mental Retardation Authority of Harris County

By now, most everyone associated with the MHMRA system of services and supports is aware of the extensive reengineering process that has been initiated within many of the infrastructure components of the Agency. Recognizing the continuing changes in expectations and performance requirements within the public healthcare environment, along with the increasing pressures on the limited financial resources available to address consumer service and support needs (pressures which have intensified since last summer due to the impact of Tropical Storm Allison), MHMRA made the decision within FY2001 to undertake a substantive self-examination process which incorporated the review and subsequent recommendations from a number of knowledgeable, specialized consultants. The Agency has set in motion significant plans along with the necessary changes required to adequately and appropriately address the identified “opportunities for improvement.”

Nice, huh? But, what does this mean? It means that we, as an organization, were operating in several of the critical areas which underlie and support the consumer service functions of our Agency (our reason for existing) with procedures, practices, tools, and technology that were antiquated, slow, and limited in their responsiveness, at best, and, at worst, created barriers to the full realization of our mission — providing or ensuring the provision of those services and supports for persons with mental disabilities within Harris County who meet the criteria of priority population such that they may become as fully participating, contributing members of our community as possible, within the constraints imposed by the available resources of a given fiscal year.

Built upon the ways of the past, cobbled together with “spit and bailing wire,” the infrastructure tried to keep a level of accountability by looking backward — retrospectively — at a time when we, as a organization, need to be able to look prospectively forward — to identify trends, make adjustments and mid-course corrections, and ensure maximum “bang” for the dollars available. Increasingly, we like most public healthcare organizations have been required (required is the operative word here) to earn up major portions of our operating budget to maintain the financial viability of the organization, address inflationary and market forces, and respond as best as possible to the seemingly unending needs of those significantly impaired persons who turn to us for assistance as a major component of the public “safety net” of services and supports. A model T engine, in a Ferrari body, with different sized tires on each wheel will not work — and, certainly, will not permit the Agency to fulfill the expectations and requirements on public healthcare for the future: accountability for resources, flexibility and adaptability to market changes and opportunities, timeliness and accuracy of documentation, quality and effectiveness of services/supports, and, last but by no means least, satisfaction by the consumer public.

Going forward means being willing to look honestly at the weaknesses that exist — maybe not even fully understanding how we got there — or why — and developing state-of-the-art practices, procedures, and technology along with the knowledgeable, trained staff to implement those to enable MHMRA to more fully and completely function as the Local Authority for TDMHMR. The expectations and requirements are intensifying. Doing things the “way things have been done in the past” will, simply put, not cut it in the future.

So, where are we in this process? First, and most importantly, this is a work in progress. Significant steps have been taken but much, much more remains to be done. This process will take months — months — with continuing adjustments as we implement and then, fine tune, the policies, procedures, practices — as we acquire and refine the necessary technology and software essential to perform these functions and demonstrate the level of accountability expected by our Board of Trustees and the various funders of service. In fact, the reengineering process is being defined clearly to address the changes needed now, but, the expectation of MHMRA administration is that the support functions, like our clinical services, of the Agency will continuously evolve based on feedback from the policy makers/funders as well as the providers in the network to ensure the continuing responsivity and financial viability of the organization.

Here’s where we are at this point in time:

Finance and Accounting: Our new CFO (Mr. David Witt) has been hired and will assume the position toward the end of February. One of the early tasks on his plate will be to review the consultant recommendations for a reorganization of this department. The reorganization, definition of job duties and functions within this department has already taken the initial steps. Others await his coming on board. Once finalized, positions will be carefully defined and several key positions in the department currently vacant and newly created will be posted and filled. The ROSS software accounting system will be thoroughly evaluated to determine its level of adequacy in providing the responsivity and timeliness of its report functions across the organization. Having timely, accurate data as to where we are in terms of both expenses made/obligated and revenues generated/collected as well as the ability to project trends and identify changes mid-course in the year is essential and fundamental to this reengineering process. We have already taken major steps under the temporary leadership in place to be able to reflect this information each month and throughout the fiscal year and now post these reports on the shared folder, available to the component managers. Through revisions already implemented the Agency expects to save literally hundreds of thousands of dollars in previous expenses and will be able to redeploy these dollars within the system. Ensuring a cost efficient monitoring process for reoccurring expenses is high on our list such that the funds will be available to enable us to address identified areas needing financial attention, i.e., employee mileage reimbursement. A number of other accounting practice changes have already been implemented. We now have tighter control over our expenses and collections and brought our budget into much better alignment. Our budget for the first four months this fiscal year reflects that revenues exceeded expenses — a much more positive position than experienced for the past several years.

Managed Care: Recognizing the importance of tracking each and all billable services, that the service as authorized was delivered by a qualified provider in the network to a consumer meeting criteria for coverage under their “plan,” these functions were transferred to the Managed Care department under the direction of Ms. Gee Carey, with the revisions in both staff and procedures well down the road. Assuring that we have appropriately credentialed and trained providers in our network is an active part of this process. Addressing the authorization for and documentation of services such that the Agency collects each appropriate dollar of reimbursement has begun to reflect substantial progress. Addressing the “lag” between delivery of service and entry into the data system, billing for the service, monitoring payment, and challenging “denials,” as appropriate, still has a ways to go.

Contracts and Purchasing: A much more appropriate process to first establish, implement, and monitor the contracts of the Agency are in progress. Under the leadership of the new Director, Mr. Michael Kushner, we now have a revised process to recreate contracts with legal and funder safeguards in place, identify the method of financing and obtaining Board approval for fiscal year Budget inclusion, and monitor obligations, expenditures, performance, and documentation. Payments under the new contracts are tied to demonstrated compliance with contract requirements. While this too is in progress, and much remains to be done to “debug” delays due to system handling, the level of monitoring, oversight, and accountability has improved. On the purchasing side, evaluation is underway of existing procedures and processes, paper versus electronic requisitions and, potentially, direct ordering under certain areas of Agency acquisitions (i.e., supplies). Speeding up the necessary acquisition and delivery of needed, approved operational materials, goods, services, equipment, etc., is one of the key agenda items of this department.

Organizational Development / Human Resources: Dr. Cherry Salinas has been selected as the department head with Mr. Mike Roberson assuming leadership under her direction of the HR component. A reconfiguration of and reduction in time required for the new orientation process has occurred. The new related generalist HR staff positions have been filled. Recruitment activities and job “postings” have been shifted in an effort to improve timeliness in filling vacant positions with competent, credentialed personnel. The electronic support needs of the department are being evaluated with outside consultative assistance. A small organization/training staff has been added and plans are underway to address critical Agency staff needs. The final positions will be posted and filled during the summer months. By year end, between the reductions in positions and realignment of functions and roles within that department, OD/HR will move from the 26 FTEs and 5 relief staff at the start of the fiscal year to a total departmental staff of 20 FTEs as we enter FY2003. Overall, the departmental salary funds will be redeployed to cover the costs associated with enhanced professional credentials, experience, and expectations for the OD/HR staff.

Information Technology / Practice Management: Under the leadership of newly appointed Director, Mr. Bobby Brownstein, the reconfigured IT Department has been working diligently to overcome the devastation of Tropical Storm Allison, accommodating the extensive technology equipment needs of the staff relocations from the storm as well as transferring the telephone and data primary Agency-wide systems from Fonteno to 7011 Southwest Freeway. The Anasazi Project Manager under IT, Ms. Patti Tremble, has been working with the software contractor to ensure delivery of Agency acquired components, system “fixes” for software problems, and enhancements to increase end-user functioning and satisfaction. An employee training component within IT has been established and implemented with a “superusers” group established to provide on-site component expertise to assist in rapidly addressing many system “glitches.”

Pharmacy Services: Following an extensive consultative review with subsequent recommendations by HealthLink, Inc., MHMRA is poised to implement a major reengineering of one of the vital components of our Mental Health system — our internal Pharmacy Services Department. A revised staffing plan for pharmacists and pharmacy technicians addressing workload and performance expectations as well as incorporating market place salary adjustments will be implemented in the next several months. A workgroup has been formed in conjunction with Contracts and Purchasing to define the specifications for bid to obtain a new software system to address serious current pharmacy tracking and medical staff practice management needs. Over the next months, a plan will be developed for pharmacy facility modifications to, once undertaken, create more state-of-the-art pharmacy environments for the delivery of Agency consumer services. And, finally, the external pharmacy contract services will continue to be evaluated for consumer benefit, responsivity, and cost to ascertain whether the best value is being provided for the Agency and its consumers, or whether adjustments need to be undertaken.

This is, truly, a work in progress. Practices and procedures are being closely evaluated and reworked with the intent that, ultimately, we will ensure both a heightened level of accountability in the Agency’s deployment of its limited financial resources to support the consumer functions and mission of MHMRA. Staff changes have and will occur but should be stabilizing. We have been rapidly improving budgetary balance (earned revenues and expenses) and electronic oversight of these resources. We are, in a word, in a stronger financial position today than at virtually any point over the past several years. And, through several already identified efficiencies, we are poised to realign dollars within the fiscal year budget to better address market place and inflationary needs. It is clearly, at times, a slow and painful process but will reap immeasurable benefits throughout our organization, which, ultimately, will benefit our consumers and their families. Thanks to each of our staff and contractors for your patience and understanding as we work through this process.