UnityPoint — Berryhill presentation to the Webster County Board of Supervisors on Nov. 20, 2018

There are a number of ways to get paid for providing mental health services aside from county funding — such as Medicaid dollars. What Aaron McHone, executive director of UnityPoint Health — Berryhill Center, would like to see is a focus on funding infrastructure.

“My view is, it is more helpful for a region to focus on infrastructure as opposed to direct fee for service payments. Most people who qualify for county funds are eligible for Medicaid,” McHone told the Webster County Board of Supervisors Tuesday. “I would rather encourage this body to move toward things that aren’t funded by Medicaid, specifically infrastructure to start up new services.”

McHone spoke one week after a number of mental health care providers addressed the board, and after the board had considered switching from County Social Services to a new mental health treatment region.

The region discussion does not impact the Berryhill Center as much as other agencies, McHone said, because only about 1.3 percent of its total budget comes from mental health regions.

“What I want to hear you say is thank you,” McHone said. “The region has 1.3 percent of our budget. I don’t want that to be interpreted as ‘just’ 1.3 percent. The margins are slim in this business. We appreciate all the support we get.”

McHone told the supervisors about what the Berryhill center does, who it serves, and where it gets funding.

About 44 percent of the patients who come in have their own insurance, McHone said. Thirty-eight percent are funded by Medicaid and 17 percent by Medicare, for a total of 55 percent Medicaid/Medicare.

However, of the center’s total fees for services, 61 percent of payments come from Medicaid and 19 percent come from Medicare.

“Even though we have fewer patients on Medicaid, those Medicaid recipients tend to utilize more services,” McHone said.

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The center serves all levels of complexity when it comes to mental health.

“So we have some patients who are struggling with mild anxiety and need to see someone, but it’s not a chronic long-term issue. And then we have some other patients who have chronic schizophrenia,” he said. “We treat that whole range of symptoms.”

The reason CSS is only about 1 percent of the budget is because of the Medicaid expansion in January 2014 due to the Affordable Care Act, McHone said.

With that expansion, Medicaid will pay for people who make 138 percent of the federal poverty rate.

CSS and other regions are mandated by law to pay for people who make up to 150 percent of the poverty rate. Regions were created in 2012 to take on duties that had been done by counties individually before.

“The window of patients that fall between 139 percent and 150 percent of the federal poverty line is relatively small,” McHone said.

One important role CSS and other regions play is giving rural outreach payments, McHone said. This helps provide services in small, rural communities that couldn’t financially support their own clinic alone.

“The truth is, there is the volume in Webster County to support the overhead costs,” he said. “But when I go up to our Pocahontas office, when we have eight patients seen there, and we’re paying for the provider to get there, we’re paying for the office to be manned, we’re paying for rent and such, it just doesn’t make itself work in rural areas.

“Now regions are responsible to assure there is care in rural areas, and one of the ways they do that is with rural outreach payments.”

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Berryhill also receives performance indicator payments from Medicaid’s Managed Care Organizations, McHone said. These payments come when, through being proactive with treatment, the Berryhill Center is able to treat someone once and not have them need to come back within a 30-day period.

Berryhill’s budget is about 85 percent fees for service, he said, and 15 percent from other revenue, including grants, performance indicator payments, and rural outreach payments.

McHone also said that since he started as director, the Berryhill Center has decreased wait times by recruiting more doctors and providers, and that it’s expanded to treating children as well as adults. The center also reaches out into schools and to the community, not only treating the patients who walk through the door.