Editor’s Note: This area is reserved for your thoughts and insights about your day-to-day work. We all experience “aha!” moments that emerge from our work – many of these are hard won but too seldom shared. This story from Mitch Bruski, the CEO of the Kenneth Young Center, a comprehensive provider of mental health and senior citizens’ support services in suburban Chicago, is a great example of what we hope to get from you . . . informal and without a lot of puff, it is straight from the heart and exemplary of the kind of creativity and innovation that occurs all over the sector on a daily basis.
This column is a subjective report from a community-based mental health and senior service nonprofit in suburban Chicago regarding current events and attempts to be creative in hard times. It is a story about heartbreak with a side of opportunity.
People who go into the social work field generally and genuinely want to connect with and provide direct help to those in need. The current state of the economy is increasing demand from those in need. Ironically, entitlement and safety net funding appears to be targeted for cuts despite the fact that those of us in the nonprofit sector actually save the state money by providing community based services that prevent more costly and extensive institutional services.
As states look to cuts to balance budgets, nonprofits have had to improvise. This is the story of innovation by way of improvisation.
One way states spend less on services for needy people, and market it politically as “well thought out,” is to manage the care. More often than not, this looks more like denying and complicating access to care than the true goal of managed care, which is to offer the “right service, at the right time, in the right amount.”
The result of the more primitive implementation of “managed care” is that many of the professionals who wanted to provide service to those with serious problems are being asked to do things for which they have no training and little aptitude. They must concentrate on increasing their productivity, not the quality of their intervention. They must spend valuable time getting authorizations for service, which actually takes away time providing direct service. (That loss of billable time is shifted to the provider.) And they must be the direct bearer of bad news to clients explaining what service they can’t have rather than use their skills to provide it.
Another method of limiting care is to make organizations financially and legally responsible for new rules that are so (unnecessarily) complex that expensive software is necessary to survive. This becomes an additional system. Complexity increases the likeliness of mistakes, which results in payment rejections. These also become the problem of the provider, not the funder.
The combination of these things contributes to an underlying depression in organizations that are trying to combat illness. It’s a little like taking bullets away from soldiers. Though there are many clouds on the horizon there is a forced ray of sun. Our organization didn’t want to spend a great deal for a commercial system that had to be modified (additional cost) to track state specific needs. I was lucky enough to recruit a gifted information systems programmer who was also very familiar with the field.
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An ethical aside is that he worked for a county mental health center and once I found him, though I wanted to steal him immediately, I said I wouldn’t do it without the blessing of my colleague (bad times do not mean we should invade our neighbors for what they have). When I discussed the issue with him, the fellow director realized that the employees’ capacities were stifled in a governmental setting and gave his support.
Another interesting aside, this time relating to workplace/personal balance, is that good programmers need to be obsessive and I had to tell him in the interview he could not bring a cot into his office. Though he loves his work, I said that there had to be limits to the work/life demarcation. He did later move his family six minutes from work so that if he dreams of an idea (which he does) he can come in at 2 a.m. and work on it.
Over the last 10 years, we have developed a record/billing system that is far better than commercial for-profit systems. Many nonprofits have asked to buy in to our product. They are able to use this at far less cost than a commercial system, it is tuned to exactly the work we do so needs little modification and it has become one of our agency’s largest programs. We now provide community mental health software for over half of all providers of this type that use software in our state.
The good news is that this is new income for an organization deeply impacted by public budget cuts. It also provides a now necessary component at a low cost to other nonprofits. We saved many agencies from extinction because of inability to bill. Some of these were small rural agencies which provide access in communities where otherwise a client would have to travel an hour or more to get treatment.
There is a David and Goliath backstory to this: The biggest of all providers (with a $16 M international software system) came to us because their megasystem was not able to bill the mental health component. We were able to solve their problem for less than 1/100th the cost. Both the developer’s and my wife say we charged too little. Financially, that is true, but there is more to life than charging what the market will bear. Good will has a benefit that cannot be bought. Anyway, it’s part of our mission “to help people feel good, do better and find solutions.”
The sad news is that this innovation comes in response to conscious political efforts to reduce service for those in our community that need it most.
Mitch Bruski is the CEO of the Kenneth Young Center, a comprehensive provider of mental health and senior citizens’ support services in suburban Chicago. Its mission is to help people “feel good, do better and find solutions.”