Individual communities will need to determine their priorities and unique needs. Some mobile crisis solutions work better in some environments than others. For example, a rural environment that also has inconsistent broadband, workforce challenges and limited funding may benefit most from an MCT that provides in-person response at a lower cost and lower workforce need. In this case, leveraging a co-responder model that builds upon the existing public safety services who currently respond in person may be the best fit.
In a more urban setting, the focus may be on supporting diverse populations with tailored responses, such as those for youth, LGBTQ+ and communities of color, while also leveraging better access to technology. These communities may benefit more from the traditional SAMHSA best practice of clinician-led, in-person response teams, including those that support youth with stabilization services.
The ability Optum has to log and validate all current mobile crisis providers shows national trends. For example, rural and frontier areas tend to have fewer resources. They are also more likely to have restrictions, such as hours of operation and populations served. At times, they may lack the ability to provide in-home response services, opting instead to meet residents at the hospital.
When building or adding an MCT, there are elements to keep at the forefront to ensure a successful community program. These elements include collaboration, a data-driven approach, transparency and sustainability. The first element of collaboration is vital to developing a program. MCTs need to complement any existing crisis services in the community.11
Collaboration
Crisis providers must work together to support a continuum of services to meet the needs of all individuals. This requires inclusion of key partners such as first responders, outpatient mental health providers, individuals with lived experiences, underrepresented groups and ER staff. By involving these stakeholders from the beginning and shaping the services that the community desires, MCTs are more likely to be well-utilized.
Data-driven approach
Leveraging existing data on current community needs is critical to understanding who and where the service should be focused. One method of doing this is to engage the local Public Safety Answering Point (PSAP) call center, heavily utilized ERs and managed care organizations to understand where the individuals are located who are using emergency care.
Heat mapping is an effective way of doing this to better illustrate the geographic areas of need and project future utilization numbers. As the MCTs are developed and begin providing service, data must be collected on individuals served including demographics, clinical reasons for the service, and resolution. Tracking this data at the outset will be helpful when analyzing trends or future areas of needs.
Transparency and shareability
Data transparency and easy shareability is key to engaging the community and garnering ongoing support. The state of Connecticut, among other crisis systems, regularly does this by publishing their monthly crisis system data on youth.19 This approach encourages the analysis of the data collected and an opportunity to engage in continuous improvement and reevaluation.
Disparities in populations served may be better identified, a necessary first step in addressing these disparities in resources and care. Optum believes in partnering with crisis providers to receive timely crisis data. These partnerships are present in several markets that improve understanding of crisis utilization and needs.
Optum also supports transparency in crisis service and posts all validated mobile crisis providers nationally to its public website, Optum Wellbeing. To support seamless connections, the Optum San Diego Access and Crisis Line transfers calls in real-time to the member’s MCO as appropriate for resolution and resource support. This enables other MCOs to support members with in-the-moment crisis support and determine any ongoing needs including care management.
Sustainability of funding streams
The final element that must be included in developing MCTs is a focus on the sustainability of funding streams. The most common method of funding crisis services is a braiding of state general funds, federal mental health block grant dollars, and reimbursement from Medicaid.2 In particular, state general fund dollars are heavily utilized for startup needs including infrastructure and training.31 Currently, there is an opportunity for CCBHCs to receive an 85% federal medical assistance percentage (FMAP) for mobile crisis in certain scenarios for up to 3 years.32,33 However, the availability of this funding and other mobile crisis planning grants offered by SAMHSA are currently set to conclude by 2027.
This time frame allows for a community to benefit from the unprecedented grant funding currently available to support startup costs but will require MCTs to transition to their own more sustainable funding methods in a few short years. Optum supports rewarding providers for achieving quality outcomes. Leveraging value-based care and alternative payment arrangements can be creative ways to support more sustainable financial success of crisis providers.
For those models that rely more heavily on law enforcement staff, funding often comes directly from a city or county budget. Grants may also be available through the Department of Justice, Community Oriented Policing Services (COPS), and the Justice Assistance Grant (JAG) Program.34
Regardless of the funding sources, MCTs must make provisions to support ongoing operational and staffing costs including a significant amount of downtime, transportation time and services to uninsured individuals, all of which are not reimbursable by Medicaid but are required as part of the MCT approach to crisis care.24 For this reason, the firehouse model of funding through local government budgets is often utilized. This supports the idea that funding needs to be available consistently if services are on-demand to support the surges and downtimes that are part of the crisis cycle.14
Optum also works with local partners to ensure that support is available to individuals after a crisis episode ends. The role of the health plan is to reengage the member in care and support their ongoing recovery. Optum has partnered with several organizations to support this post-crisis period and intends to expand further into this arena.
