Brajer: Reforming Medicaid and mental health care is complex task

Published 12:00 am Saturday, January 9, 2016

Department of Health and Human Services Secretary Rick Brajer says he “smiles while being in the role.” Governor Pat McCrory appointed Brajer as DHHS secretary last August.

Brajer has been on the job for five months, and says he’s making the rounds around the state. Friday, he stopped by Salisbury while sorting out some timeliness issues in Greensboro. The department, he says, is “tangled.”

“Clearly, the department’s had some challenges over the past few years,” he said.

His predecessor, Alonda Wos, served a tenure that drew harsh criticism before she abruptly resigned.

Before joining the state agency, Brajer worked with healthcare in the private sector for 25 years, most recently serving as the CEO of Pro-Nerve. He had no previous public service experience before his appointment, but the leadership role feels natural, he said.

“I love complexity and I really respect the opportunity for impact here,” he said.

His first five months have been spent focusing on Medicaid reform, mental health and substance abuse and food and nutrition services, among other issues.

State legislators voted in September to privatize Medicaid as a way to solve unpredictable spending. Brajer said that for several years the Medicaid budget was plagued by overspending, but it has finished the past two years with cash on hand.

The privatized system means the state would have contracts with insurers and with provider-led entities. In what Brajer calls “crowd sourcing,” DHHS is engaging stakeholders that include advocacy organizations, hospitals, doctor’s offices and medical associations to send to Centers for Medicare and Medicaid Services.

“So it’s been a slice across the system,” he said.

Roughly one in five, or 1.9 million, N.C. residents currently rely on Medicaid.

“We’re beginning the process now of designing what the system will look like.”

DHHS will take its plans before the legislature in March and then to an open public comment period later that month.

The system would also involve integrating physical and mental health, with a focus on early intervention and reducing stigma.

“People don’t know how to access the system — there are resources, it’s not as if there isn’t spending — but no one knows how to enter the system,” Brajer said.

Patients would receive holistic care from physicians — who in a proposed system may work collaboratively with case managers and mental health professionals to provide behavioral health care.

Part of Brajer’s initiative on mental health involves training personnel, parole and probation officers, DHHS employees and college faculty and staff in mental health first aid — a program that trains people to be aware and attentive to mental health issues.

The new model would also feature more support services for those who have serious and persistent mental illnesses including supportive housing and employment. To date, Brajer says, the State has supplied 636 individuals with supportive housing and 1,496 with supported employment.

While it received criticism in 2014, NC FAST, a relatively new public benefits software, has brought the department a long way, Brajer said. Before NC FAST, there was no way to properly measure DHHS’s performance with processing food stamp claims. Several areas have fallen behind on timeliness, but that’s something that’s steadily improving, Brajer says.

“It was very rough, but we’ve made incredible progress,” he said.

When he was appointed in August, DHHS was averaging 78 percent timeliness; in December they were at 89 percent, and Brajer says DHHS hopes to reach 95 percent timeliness by June. The standard for timeliness is to have an EBT food stamp card in the client’s hand within one week for expedited cases, and 30 days for others

DHHS is also working on initiatives and programs to reduce infant mortality rates. North Carolina ranks 42nd in the nation for infant mortality with a 2015 rate of 7.1 per 1,000 births. Top state causes for infant mortality include obesity, diabetes, smoking, short spacing between pregnancies and stress.

Brajer says he’s working on statewide initiatives and programs that will provide optional supports for women who desire to become pregnant, and optional long-term, reversible contraceptive options for those who don’t.

There are things to celebrate, Brajer said. Last year N.C. improved its national health ranking as measured by the United Health Foundation, moving from 37th to 31st. The same report listed N.C.’s childhood immunization rate, 81 percent, as the second highest in the nation, and its HPV immunization rate of girls aged 13 to 17 at 54 percent.

“We’re the most improved state according to the United Health Foundation,” Brajer said.