Jefferson Healthcare is backing off its proposal to acquire Discovery Behavioral Health – formerly called Jefferson Mental Health Services – but is continuing to talk about how to affiliate itself with the private, nonprofit mental health care provider.

Jefferson Healthcare CEO Mike Glenn told hospital commissioners Aug. 16 that after months of conversations between both organizations, a consensus on a framework of an agreement has been reached.

And it doesn’t include an outright purchase of the nonprofit.

“We believe we have identified and reached consensus on what we are calling a framework of an agreement,” said Glenn, adding that agreement would include continuing to “expand and improve the quality, scope and scale of behavioral health services in the community.”

Glenn then went on to acknowledge that moving mental health care under the umbrella of a physical health care system was hard.

“When it comes to rural hospital and behavioral health affiliation, we’re creating the model,” he said. “If this feels like we are making this up as we go along, it’s because we’re making this up as we go along.”

BARRIERS OUTLINED

Glenn outlined barriers to full acquisition, which included a lack of a working example anywhere in the state of Washington of a small hospital like Jefferson Healthcare acquiring a nonprofit mental health clinic; uncertainty over financial reimbursements for providing services as a critical access hospital (a designation applied to Jefferson Healthcare that relates to how it is paid for providing services); and problems with electronic medical records systems that don’t work well together.

While health officials know that the “head is attached to the body,” Glenn said that trying to achieve full integration between mental health services and physical health services is problematic.

During conversations with consultants and with officials of the two agencies – health care and mental health – there have been “wait, wait” moments in the past few months, he said.

“This is complex stuff and ‘Let’s talk about this more’” was said by all involved, Glenn said.

“In February, we came to the board and said we want to move with an affiliation process that could lead all the way up to acquisition, and the board said proceed,” Glenn said. Now, he said, “This is moving more to a tight affiliation than a full-out acquisition.”

Glenn said he expects to present something more concrete to the hospital board in September. An agreement also would be presented to the Discovery Behavioral Health board at the same time.

NO EXAMPLES

Glenn told commissioners that there is no working example of mental health and physical health provider systems in Washington actually working together.

Glenn said he and others are starting to speak out about the issue in the state and at national conferences.

What they are finding is that the two kinds of services have not been “engineered” to integrate. That includes not only mental health services, but chemical dependency services as well.

Uncertainty over financial reimbursements also has a role in Glenn and others wanting to “wait, wait.”

“Do we have an Affordable Care Act or do we not have an Affordable Care Act?” he asked. “If the answer is we do not have an Affordable Care Act, that would have dire consequences to Jefferson County and particularly to behavioral health patients,” he said of the resulting lack of funding hampering access to care.

And if that happens, Glenn said, legislators in Olympia would have to figure out “how to backfill $36 billion over the next five or six years” and it’s unclear how they would do that.

He also expressed concerned that two top state officials who had worked on Medicaid expansion and were most knowledgeable about the subject have recently left the state.

“It’s clear to me that the best way to provide access to behavioral health services in rural communities, where there are many service deserts in our state, is to allow the health care organizations in those rural communities to provide behavioral health services underneath the critical access hospital model,” Glenn said.

“Things are changing so fast. I think it pays now to study the landscape and watch for what seems to be permanent, and then be able to adapt your community resources to that,” he advised.