Expert opinions on health care

Ted Dallas gave new meaning to the phrase “Hit the ground running” when he became secretary of the Department of Human Services in January 2015. In addition to the host of responsibilities attendant to running the largest state agency in Pennsylvania – DHS provides services to 3.1 million residents, thanks to a $36.7 billion annual budget and some 17,000 employees – Dallas made it a priority to expand Medicaid on an unprecedented scale, which has resulted in more than 670,000 Pennsylvanians moving from the ranks of the uninsured.

C&S: What is the DHS elevator pitch?

TD: We cover everything from Medicaid program to children, youth and families, to mental health, substance abuse – a range of just about every social service you can think of.

C&S: The DHS website has a prominently featured list of five priorities, including ones that seem more suited for a private company than a state agency. How did you develop this list?

TD: I was No. 2 in the department in the Rendell administration, so that gave me a head start for ideas. What underlies everything is that we want folks to be treated just how we would want our own family members to be treated. We want access to services that are high-quality and good enough for our own family members.

C&S: Could you explain your focus on keeping people who need care in the community instead of in facilities?

TD: Every human services agency looks at something called program integrity. You look at Pennsylvania right now, there are 50,000 folks in nursing homes, state mental hospitals, homes for mental disabilities – it’s a number roughly equal to the population of Harrisburg. Whether it’s a nursing home we contribute money for or a facility we run, the research is clear: If it’s a choice between a nursing home and being in the community longer, not only is it common sense to keep people in the community, but research shows it keeps people healthier.

Folks are in places they don’t want to be, and it costs a lot more: 95 percent of people in the state want to age in place. Right now, we only serve 51 percent in the community. There is a big gap between where people want to be n where we serve them And it costs more money: $62,000 a year to keep someone in a nursing home, versus $31,000 to keep them in
the community.

C&S: What are some of the lesser-known benefits of helping so many people get health insurance?

TD: Of those 670,000 people, in the first year, about 62-63,000 of them accessed drug and alcohol services. A big part of that is the opioid crisis, something that affects people from all walks of life. Before that, people were dealing with substance abuse disorder without any access to health care.

C&S: How would you allocate a funding windfall?

TD: By providing services we don’t cover in Medicaid yet, like dental care, expanding early intervention in child services – they have an impact and benefit for kids not only as they grow up but into adulthood – and for folks with intellectual disabilities and autism. There is a growing need out there that we cannot always meet. ■

Arthur C. Evans Jr., Commissioner, Philadelphia’s Department of Behavioral Health and Intellectual disAbility Service

Arthur C. Evans Jr. heads up an agency with an unwieldy name – he is the commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Service (DBHIDS) – and an impressively increasing range of impact on the citizens of Philadelphia and beyond. Evans, who also holds faculty appointments at the University of Pennsylvania School Of Medicine and the Philadelphia College of Osteopathic Medicine, is responsible for integrating the city’s behavioral health care and intellectual disability services into one comprehensive system by, according to the agency’s website, “providing services through a network of agencies while collaborating with the Philadelphia School District, child welfare and judicial systems and other stakeholders.” Evans is also innovating mental health applications that can be used nationwide.

C&S: What is your DBHIDS elevator pitch?

AE: We are a city agency responsible for mental health, substance use and intellectual disability needs – we are the safety net for the city of 1.5 million people.

C&S: What are behavioral health issues that citizens should be paying more attention to?

AE: Opioid addiction is a big issue we are dealing with right now, of course. We are also trying to improve the mental health literacy of the population.  After Sandy Hook, there was a big push to train people in mental health first aid. The idea is that you want people in the community to recognize when people have mental health challenges and what to do about it

Many people know CPR for basic physical health challenges; they are not familiar with what to do with mental health challenges – most people don’t know the difference between depression and schizophrenia. We have been training people to have a basic understanding of and what to do when friends, family and coworkers have challenges. So far, we have reached 20,000 people – we have a broad-based strategy, and are a national leader on it.

C&S: If you had a wish list for funding initiatives, what would be on it?

AE: Absolutely, to have more flexible funding for public health strategies. To put it in perspective, our annual budget is $1.2 billion; almost all of it goes to treating people who have a diagnosis and are ill – very little of it goes to prevention and intervention. As a result, health care systems are very inefficient. We have partnered with other agencies to work further upstream and not wait for crises. When we have community health fairs, people screen for heart disease, diabetes – we are taking that strategy and employing it in mental health. One of the things we have to do is identify issues much earlier.

For example, we are the first major city in the country to have hospital-based interventions to provide psychological interventions in addition to traditional ones.

We are screening children in pediatric settings for trauma. We are working with the city’s Mural Arts Program to reduce the stigma and make it more likely people will reach out for help.

C&S: How much interaction and partner opportunities do you have with other agencies in the city and
the state?

AE: We have trained more than 2,400 police officers in crisis intervention training so they can recognize when people are having mental health challenges and know how to de-escalate a situation. We put headphones on them to give them the experience of hearing voices giving them commands – they see what it is like for someone who has a mental illness and is trying to listen to a police officer give them commands.

We also have mental health professionals embedded in the courts and the child welfare system, and in the school district – part of our strategy is to help build capacity of other agencies to deal with mental health.

One of the things we have tried to do is be very efficient – part of our responsibility is to oversee the managed health care contract that the city has with the state. So far, we have saved $226 million over 10 years that we have been able to reinvest in services. When there are agencies that are doing this work in an effective way, saving taxpayer dollars, those kinds of efforts get recognized by the public. ■