NH Community Behavioral Health Association Workforce Challenges and Opportunities January 10, 2018 Prepared by Patrick Miller, Founder and Principal Pero Consulting Group, LLC 1
Topics of Discussion 1. NHCBHA Overview 2. Community Mental Health Center Workforce Trends 3. Impacts and Proposed Solutions 2
1. NHCBHA Overview 3
The Association Ten Community Mental Health Centers o Center for Life Management o Community Partners o Genesis Behavioral Health o Greater Nashua Mental Health Center at Community Council o Monadnock Family Services o Northern Human Services o Riverbend Mental Health Center o Seacoast Mental Health Center o The Mental Health Center of Greater Manchester o West Central Behavioral Health Mission o CBHA advocates for the priorities of our members which includes the sustainability of a high quality and effective system of behavioral health care in each of our NH communities. Annually serves nearly 50,000 adults and children Primarily those with severe and persistent illness o Majority are NH Medicaid eligible 4
2. Community Mental Health Center Workforce Trends 5
Data Collection Summary Nine of the ten CMHCs participate in a monthly data collection process (MFS does not) Monthly reports are generated for use by CMHCs and partners Began in Dec 2015 as a way to learn more about Assertive Community Treatment (ACT) and Supported Employment (SE) postings under the Community Mental Health Agreement (CMHA) Expanded to all postings in January 20, and data set elements have continued to evolve 6
Total Budgeted Head Count and Total Budgeted FTEs Both are trending upward 2,300 Total Budgeted Head Count Compared with Total Budgeted FTEs January CY20 - December CY20 2,200 2,100 2,000 1,900 1,800 1,700 Total Budgeted Head Count Total Budgeted FTE Count Linear (Total Budgeted Head Count) Linear (Total Budgeted FTE Count) 7
Total Vacant Postings by Month Both are trending upward 215 vacancies represent ~$8M in wages not entering the economy 220 210 200 Total Vacancies and Total Clinical Vacancies for All Centers January CY20 - December CY20 100% 90% 80% # Vacancies 190 180 0 0 70% 60% 50% 40% 30% % Clinical Vacancies 150 20% 140 10% 130 May May Jan- Feb- Mar- Apr- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- Jun- Jul- Aug- Sep- Oct- Nov- Dec- 0% - - Total Vacancies 148 155 5 157 153 145 151 3 189 186 2 5 181 186 4 5 2 4 184 194 209 206 215 215 Clinical Vacancies 144 148 154 149 147 140 144 0 2 9 155 155 6 3 159 151 147 154 0 8 5 3 187 193 % Clinical Vacancies 97% 95% 93% 95% 96% 97% 95% 98% 91% 91% 90% 89% 92% 93% 91% 92% 91% 89% 87% 87% 84% 84% 87% 90% 8
Vacancy Rate Variation Vacancy rate for all Centers has an upward trend Large variation amongst individual Centers 25% Vacancy Rates of Open and New Postings to Budgeted Head Count for All Centers February CY20 - December CY20 20% 15% Ratio 10% 5% 0% Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Monthly Vacancy Rate 8.01% 7.61% 7.41% 7.04% 7.24% 8.34% 9.00% 8.66% 8.01% 8.% 8.43% 8.66% 8.10% 7.73% 7.52% 8.08% 8.59% 9.08% 9.81% 9.43% 9.84% 9.86% Monthly High 13% 14% 15% 14% 12% 12% 12% 22% 12% 11% 14% % % 15% 15% 14% 13% 13% 13% 14% 15% 19% Monthly Low 5% 3% 3% 3% 5% 4% 4% 4% 4% 5% 4% 5% 4% 4% 3% 2% 5% 3% 3% 2% 3% 2% 9
APRN and MD Vacancies Both are trending upward 12 # and % of MD and APRN Vacancies by Month All Centers February CY20 - December CY20 APRN Mean = 6.8 MD Mean = 5.2 11 10 10 10 10 10 9 8 8 8 8 8 Posting Count 6 6 5 5 7 6 7 6 6 7 7 7 7 7 6 7 5 4 4 4 3 3 3 3 4 4 4 4 4 4 2 1 0 Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- APRN Count 6 5 4 4 1 5 7 8 8 9 6 7 6 6 8 7 8 10 10 10 10 11 MD Count 6 5 3 3 3 3 4 4 4 4 4 4 6 6 7 7 7 7 7 6 7 5 10
Bachelors, Masters and Other Vacancies by Month Majority of all Center postings are Bachelors and Masters-level postings 105 # and % of Vacant Bachelors, Masters, and Other Postings All Centers February CY20 - December CY20 Bachelors Mean= 64 Masters Mean = 76 Other Mean = 38 95 85 84 84 92 90 88 86 84 82 83 81 82 79 75 74 74 73 73 73 72 72 69 69 70 70 70 69 67 65 66 65 66 64 62 62 63 63 60 61 60 59 60 58 59 55 55 55 56 57 55 52 52 53 47 47 48 45 42 43 39 40 40 38 36 36 37 35 34 32 29 30 25 26 26 24 19 15 Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Bachelors Count 60 62 62 64 55 63 73 63 73 70 67 61 60 55 59 52 55 56 60 66 69 79 83 Masters Count 66 73 69 65 58 69 74 84 74 59 70 84 90 82 72 70 72 81 82 86 84 88 92 Other 29 30 26 24 32 19 26 42 39 43 38 36 36 37 34 40 47 47 52 57 53 48 40 11
YTD Turnover Rate Variation 12-Month Rolling Turnover Rate January CY20 - December CY20 35% 32.74% 32.31% 32.54% 30% 25% 23.28% 22.60% 22.96% 20% 15%.33%.10% 13.91% 14.79% 10% 5% 0% 01 Northern 02 West Central 03 Genesis 04 Riverbend 06 Nashua 07 Manchester 08 Seacoast 09 Community Partners 10 CLM Center Mean 12
TrendedTurnover Rate Variation 12-Month Rolling Turnover Rates by Center and Center Average December CY20 to December CY20 60% 50% 40% 40% 2% 30% 20% 5% 10% 12% % 3% 72% 1% 13% 10% 0% 01 Northern 02 West Central 03 Genesis 04 Riverbend 06 Nashua 07 Manchester 08 Seacoast 09 Community Partners 10 CLM Center Mean Dec 20.54% 21.06% 36.70% 19.86% 31.64% 14.36% 25.37% 45.57% 22.41% 25.95% Jan 20 15.14% 22.15% 36.38% 19.42% 33.70% 14.80% 22.90% 47.87% 23.92% 26.25% Feb 20.54% 22.61% 34.79% 19.25% 32.24% 13.88% 21.55% 48.02% 25.35% 26.03% Mar 20 15.13% 23.13% 33.52% 19.44% 29.27% 12.65% 21.43% 45.78% 25.39% 25.08% Apr 20 15.13% 22.33% 30.66% 19.99% 29.34% 12.82% 20.77% 44.92% 24.33% 24.48% May 20.53% 21.54% 31.22% 19.33% 28.95% 12.97% 19.50% 43.13% 25.35% 24.28% Jun 20.10% 21.35% 29.42% 19.84% 28.55% 12.20% 18.81% 42.67% 25.06% 23.78% Jul 20.63% 19.48% 27.52% 19.48% 25.66% 11.50%.56% 37.77% 25.12% 22.30% Aug 20 15.30% 19.21% 27.45% 19.71% 26.92% 13.69%.49% 40.80% 23.46% 22.67% Sep 20.21% 19.77% 27.61% 19.08% 28.71% 13.27%.85% 35.63% 21.56% 22.19% Oct 20.38% 20.93% 27.46% 18.67% 34.49% 13.95% 14.45% 37.83% 22.33% 22.94% Nov 20.39% 20.89% 30.39%.87% 33.75% 13.92% 14.77% 37.86% 21.80% 22.96% Dec 20.33% 23.28% 32.74%.10% 32.31% 13.91% 14.79% 32.54% 22.60% 22.96% 13
Ratio Filled-to-New Vacancies While fluctuating month-to-month, the overall filled vacancy trend is increasing which means more postings are being filled than newly created across the 22-month period. 3.00 Filled and New Vacancies and Ratio of Both by Month for All Centers February CY20 - December CY20 90 2.50 80 70 Ratio FIlled:New Vacancies 2.00 1.50 1.00 60 50 40 30 # Vacancies 0.50 Filled Vacancies Rolling Mean = 50.1 New Vacancies Rolling Mean = 49.2 Ratio Filled:New Rolling Mean = 1.10 20 10 0.00 Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Ratio Filled:New Vacancies 2.85 0.88 1.14 1.02 1.18 0.89 0.60 0.93 1.15 1.47 0.95 0.97 0.83 1.02 1.21 1.12 0.92 0.98 0.88 0.93 1.25 0.89 1.15 Filled Vacancies 37 35 49 44 45 51 35 55 54 50 38 56 43 53 46 56 45 64 52 77 64 48 55 New Vacancies 13 40 43 43 38 57 58 59 47 34 40 58 52 52 38 50 49 65 59 83 51 54 48 0 14
Wage Gap CMHC wage posting amounts lag behind State wage means: APRNs & MDs $230,000 $210,000 $190,000 $0,000 APRN and MD Mean Wages* 20 YTD CMHC Low & High Posted Ranges Compared with State Mean** $199,364 $2,921 NH Mean Wage Gap $207,500 $150,000 $130,000 $110,000 $90,000 $97,627 $108,0 $102,571 $6K (5%) $8K (4%) $35K (20%) $70,000 $50,000 $11K (11%) APRNs MDs CMHC Low Posted Range CMHC High Range State Mean * Postings opened or filled in CY 20. ** State mean from US Bureau of Labor Statistics: http://www.bls.gov/oes/current/oes_nh.htm, May 20 15
Wage Gap CMHC wage posting amounts lag behind State wage means: Therapists $65,000 $60,000 Masters Licensed or Licensable Therapist Mean Wages* 20 YTD CMHC Low & High Posted Ranges Compared with State Mean** $60,225 NH Mean Wage Gap $55,000 $50,000 $45,000 $46,299 $40,000 $35,000 $30,000 $25,000 $40,904 $19K (47%) Therapists $14K (30%) CMHC Low Posted Range CMHC High Range State Mean * Postings opened or filled in CY 20. ** State mean from US Bureau of Labor Statistics: http://www.bls.gov/oes/current/oes_nh.htm, May 20
3. Impacts and Proposed Solutions
Patient and Center Impacts Patients Less Individualized care Risk of decreasing timely access due to staff vacancies Increased wait list for particular services Reduced continuity of care and EBPs due to turnover Risk to patient quality of care due to turnover Jeopardizes ability to meet CMHA requirements Centers Lower staff morale Increased turnover Increased locums and overtime Increased overall cost of recruitment activities Increased training costs Decreased Center reputation Decreased FFS revenues Risk of losing capitation due to not meeting Maintenance of Effort Jeopardizes ability to meet CMHA requirements 18
Proposed Solutions Financial policies State policies Federal policies Shared CMHC practices Increase Medicaid rates beyond 2006 levels Expansion of student loan forgiveness programs Provide incentives for graduate education Provide funding for Fair Labor Standards Act (FLSA) regulation Remove impediments to licensing of out-ofstate providers such as allowing reciprocity Reduce administrative burden (e.g., mandated Center paperwork vs. private practice) for patient intake and other reporting functions Eliminate silos within NH DHHS (e.g., SUD clinician paperwork) Ask Centers for Medicare and Medicaid Services (CMS) to allow licensed professionals to sign treatment plans for services within credential scope; State would then update its rules Modify telehealth payment rules to reflect physician shortages in all geographies, not just rural Eliminate incident to" Medicare billing requirements for onsite physician Assertive Community Treatment (ACT) and Supported Employment (SE) learning collaboratives Online training programming Work with the State to develop a plan for ensuring state competiveness Ongoing data collection and benchmarking 19
Thank you! Questions? Contact Information: Patrick Miller, Founder and Principal, Pero Consulting Group, LLC 603-536-4265, patrick@perogroup.com Roland Lamy, Executive Director, NH Community Behavioral 603-225-6633, rlamy@helmsco.org Suellen Griffin, Chief Executive Officer, West Central Behavioral Health 603-448-0126, sgriffin@wcbh.org 20