Cartesian Solutions Inc. Case Study

Across the country, a steady increase has been noted in the number of patients presenting to emergency departments for psychiatric complaints (Zun, 2014). Patients also attempt to use their primary care doctors to treat their mental illnesses. The mental health care options for these patients are extremely limited, especially for minority populations such as African Americans and Hispanics. One out of four adults in America suffers from some form of mental illness, yet only one out of three of those affected receives treatment (Safran, 2009). Furthermore, patients are routinely misdiagnosed, receive poor quality of care, receive care from providers who have no understanding of their cultures and values, or are not even able to receive care in the first place (Sanchez, 2012).

The Institute for Healthcare Improvement is partnering with approximately 30 organizations throughout the U.S. Together, they are integrating behavioral health services into primary care. Some states have already adopted this model of patient care.

Certain screening tools are highly underutilized by providers everywhere. “Despite the high prevalence of mental health and substance use problems, too many Americans go without treatment – in part because their disorders go undiagnosed” (SAMHSA-HRSA, n.d.). Perhaps part of the problems is that providers may not have enough time with the patient to discuss current medical problems as well as screen appropriately for an underlying mental illness. “Diagnosis and treatment of alcohol-related problems are time-intensive procedures that often are difficult to implement in busy clinical settings” (SAMHSA-HRSA, n.d., para. 13). This time constraint may make providers more apt to shy away from figuring out a patient’s underlying mental illness. Currently,

In Ohio, rising health care costs are driving initiatives to shift towards payment for value rather than volume. Ohio has initiated comprehensive reforms to expand access to behavioral health services to individuals including: (1) behavioral health redesign, (2) Medicaid managed care value based payment, and (3) State sponsored value based payment. The reforms modernize how services are administered and expand some services to fill gaps, both of which is necessary to further integrate physical and behavioral health care.

Long-term drug treatment center is becoming popular because of the lack of accountability for those services that are being provided. Many drug treatment centers like Concerted Care Group (CCG) and Baltimore Behavioral Health (BBH) use a method called, “the trust method,” which is saying they are going to put the trust in their clients to do be able to monitor their own medication that is supposed to be maintenance by a drug treatment center. With this “trust method,” clients can take home methadone, weeks at a time and only needs to return the bottles that the methadone came in (Ericson, 2015). Terry Brown, vice president of BBH, explained in 2008, BBH revenue was $20.4 million and was able to expand their services by adding more physicians and staffs (Ericson, 2015). In the 2000’s BBH was able to bill medical assistances for co-diagnosis in which they were billing for mental and substance abuse services. “Brown estimates that 525 of BBH’s 600 patients are co-diagnosed with mental illness” (Ericson, 2015). Baltimore Behavior Health was audit do to BBH being inefficient with services that they were providing. Baltimore Behavior Health was not using Baltimore Substance Abuse Systems (bSAS), which helps provides create efficient services to inpatient and outpatient facilities. Baltimore Behavior Health (BBH) were billing through the managed-care organizations (MCOs) to have the ability to maximized

Behavioral healthcare has morphed its face over the last century from one that was focused on inpatient psychiatric hospitals to community-based behavioral health centers. From the beginning, “notions that people with mental illness are sometimes unpredictable and perhaps dangerous to know”, has caused a large stigma associated with behavioral health (Lawrie, 2015). With these changing facets also come challenges. There are challenges of consumer expectations and the treatment of behavioral health disorders from primary care providers. Insurance access also raises another challenge, that has slowly changed, as well as the retention of staffing. The financial stability of a facility is also an important factor for healthcare and for the behavioral healthcare system.

In June of the current year Dr. Thomas Russell, Executive Director, and Susan Smyth, Accountant, at the Bridgestone Behavioral Health Center were discussing the necessity of gaining a better understanding of how to monitor the Center’s operating and financial performance. Located in Cleveland, Ohio, Bridgestone provides prevention, intervention, and treatment services for individuals with substance abuse problems. Bridgestone’s management is concerned about its financial performance after realizing a loss in the prior year although a small profit was projected. Despite management’s concern and attention of Bridgestone’s profitability troubles, the

2. Influences on behavioral health service delivery come from the combination of social, political, and economic forces. These three forces are intertwined and affect each other. For an example, legislation must be passed so that healthcare is accessible for everyone. One of the main factors preventing a person from seeking mental health is the cost.The ACA provided an opportunity to transform a fragmented and inadequate healthcare delivery system, especially when it comes to providing mental health and substance abuse services. It expanded eligibility of Medicaid, reduced the rate of Medicare rates, restricted annual limits for those with pre-existing conditions, increased accountability, encouraged an integrated continuum of care,

Behavioral Health System Baltimore (BHSB) is the area’s leading expert and resources in advancing behavioral health and wellness. They assist in guiding innovative approaches to prevention, initial intervention, treatment, and reclaim for people who are comprised in mental health and substance use disorders to assist build healthier individuals, stronger families, and safer communities. This paper is deeming with the purpose of explaining the mission statement, and the responsibilities of the Behavioral Health System Baltimore (BHSB).

The PCMH model is relatively new and is part of the efforts to reform healthcare. The efforts to integrate primary care with behavioral health using the primary care model continues to evolve and requires continued research and evaluation on its effectiveness, both the quality of care and the value provided to its community. National core measures for the PCMH, monitor only depression statistics. With nearly 50% of patient with chronic health conditions having one or more mental health conditions (Katon, W.J. & Unutzer, 2013; Manderscheid & Kathol, 2014) this evaluation hopes to demonstration, a) an insight into common mental health issues seen in the PCMH model, b) the potential prevalence of common mental health diagnosis in the patient

In June of the current year Dr. Thomas Russell, Executive Director, and Susan Smyth, Accountant, at the Bridgestone Behavioral Health Center were discussing the necessity of gaining a better understanding of how to monitor the Center’s operating and financial performance. Located in Cleveland, Ohio, Bridgestone provides prevention, intervention, and treatment services for individuals with substance abuse problems. Bridgestone’s management is concerned about its financial performance after realizing a loss in the prior year although a small profit was projected. Despite management’s concern and attention of Bridgestone’s profitability troubles, the

Sovereign Health is a residential rehabilitation, for-profit company for substance abuse, mental health disorder, and dual diagnosis. The agency has a total of nine locations in Arizona, California, Florida, Texas and Utah. The Los Angeles location will be assessed in this paper. Sovereign Health’s mission is, “to help people gain control over their health and various illness that may threaten it” (Sovereign Health, n.d.).

There wasn’t a federal database monitoring prescriptions for controlled medications and duplicate refills. The lack of follow through by physicians and the failure to recognize the addiction or underlying mental health condition prevented patients from obtaining the necessary care in treatment programs they needed. The difficulties with access to programs, as well as poor continuity of care providers and treatment planning, created cracks in which a significant percentage of dually diagnosed patients were lost to follow-up or deteriorated to the point inpatient admission was necessary (Lambert, M. T. 2012).

The debate to whether the Mental Health Parity is being enforced, accessed, and is equal relies on the representatives, consumers and advocates. One of the claims from the consumers is that plans are using more indirect ways to make mental health and substance use treatment less available than treatment for other conditions and reports that timeliness to network providers raises a concern. Survey reveals that “patients were twice as likely to be denied mental health care (29 percent) based on "medical necessity" than other medical care (14 percent) (Goodell, 2015). On the other hand, stakeholders have partnered with the Institute of Medicine (IOM) to develop a framework for establishing evidence-based standards for mental health and substance use treatments (Goodell, 2015). In hopes that the studies shall give sufficient data on how to better enforce these laws and regulations with insurance providers and

Mezoweb Solutions Inc. is a small company which specializes in website development. Founded by Zac Harris and Hector Giraldo, this company does projects for small to big budget clients. Zac, the main programmer at Mezoweb, developed the Mez OS, which is a content management system; CMS. This simple system allows the client edit the content of the website without having to contact the programmer which time a change is needed to be done. The Mez OS allows the client to not only edit the content, but also add more pages or remove pages as needed. The client is able to change the content of the website as well as move the content freely and without much difficulty. Also, the Mez OS is very responsive, which makes it very mobile friendly. The whole system is written in PHP and it is composed of two parts: a core and a client folder. The core contains the main components and features of the system while the client folder will contain the website design and specifics. The core is the same one for all the websites, so if changes are done, all websites on the server are affected. In the client folder, there is one page that is the template for all pages; index.php. This template is used by the system for all the pages of the website; which means there is only one page design. Each website is design personally for the client. Mezoweb Solutions has a designer, but if the client as a concept or an idea, he can work with the designer and make their own design. All websites have the basic