Milwaukee County Continues Transition toward a Robust Community-Based Model of Mental Health Care

MILWAUKEE, WI – The Milwaukee County Behavioral Health Division (BHD) has released a Request for Proposal (RFP) for the next significant phase of mental health redesign in Milwaukee County. The County is seeking a provider to provide inpatient, observation and emergency services. This will allow BHD to hone its focus on what it does best – assure access to high-quality services for those who need it. As a part of the system change, the County will close the outmoded and financially unsustainable hospital building on Watertown Plank Road and continue Milwaukee County’s transition to a more effective community-based model of delivering mental health services in line with the latest research and data.

“This is a major system change that continues our redesign to a community based system of care that is less reliant on psychiatric inpatient admissions and emergency room visits,” County Executive Chris Abele said. “We are transitioning to an evidence-based and community-based model of providing services in Milwaukee County. This reform will bring the quality of mental health services in Milwaukee County to the high level that our community deserves.”The RFP is seeking a provider to enter into a 20 year contract with BHD to deliver services to adults and children that include acute inpatient behavioral health services, a 24-hour psychiatric emergency department, and observation services. Proposals will be judged by a distinguished and diverse panel of both professionals and community representatives. Proposers will need to demonstrate strong experience with a culturally diverse patient mix and a successful track record of behavioral health operations and management. Proposals will be based on the providers’ ability to adopt evidence-based best practices and provide high quality services. BHD will continue to pay for clients who have no other payer source. Savings from this transition are anticipated to be reinvested in enhancing community-based services.

“This RFP process will allow us to use a diverse group of experts to arrive at a solution that best meets the needs of Milwaukee County,” Health & Human Services Director Héctor Colón said. “We are determined to select a vendor that provides an exceptional level of service in Milwaukee County, and this process will help us get there.”

The provider is expected to embrace BHD’s person-centered, recovery-oriented, trauma-informed, and culturally intelligent focused philosophy of care that is available to all clients, including high acuity and involuntarily detained clients. To ensure accountability, the provider will be held to a high standard through the use of performance measures and will have reimbursment deducted if those measures are not met.

“We are setting ambitious goals for quality of service and will coordinate closely with our provider to ensure accountability,” Behavioral Health Division Administrator Patricia Schroeder said. “The RFP was designed to create high expectations for the provider while offering enough flexibility to use their expertise to determine how to meet those expectations.”

The RFP is unique in its emphasis on data-driven, disciplined decision-making and continuous improvement. The provider is offered financial incentives and disincentives tied to nationally recognized measures of service quality, the compassionate treatment of patients, continuity of care, and patient satisfaction measures. In their proposal, providers will have to outline a process for providing a facility to house its various services that meets both industry standards and community needs in size, location, number of beds, layout, and accessibility. This will provide a substantial improvement over the current Watertown Plank Road facility.

“The state legislature passed historic mental health legislation by a 122 to 1 vote in order to fundamentally change Milwaukee County’s mental health system for the better,” Abele said. “We have already come a long way since then and this RFP is another crucial step towards fulfilling that promise.”

Since 2010, BHD experienced a 20% reduction in the utilization of the psychiatric emergency department, a 30% reduction in emergency detentions, and a 48% decrease in admissions to adult inpatient units. In 2014, BHD closed one of its nursing home units and is expected to close the second and last one this year. These reductions and changes were achieved under the premise that emergency, inpatient, and long-term care services should be used as a last resort. If there is a robust system of community-based interventions, including crisis services, the need for emergency and inpatient services should decline. The goal is to make sure clients remain stabilized through wraparound services and have access to crisis services in the community when needed. This strategy reflects the national trend in strengthening community services, and supports the rights of individuals with mental disabilities to live in the community in the least restrictive setting.

It is anticipated that a Notice of Intent Award will be sent out in early 2016. In its application, the provider must commit to having an acute facility available for use and occupancy by the first quarter of 2018 at the latest. For more information, visit the Department of Health & Human Services Information Page at http://county.milwaukee.gov/DHHS_bids.

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