The Effects of Behavioral Health Reform on Safety-Net Institutions: A Mixed-Method Assessment in a Rural State

Abstract

In July 2005, New Mexico initiated a major reform of publicly-funded behavioral healthcare to reduce cost and bureaucracy. We used a mixed-method approach to examine how this reform impacted the workplaces and employees of service agencies that care for low-income adults in rural and urban areas. Information technology problems and cumbersome processes to enroll patients, procure authorizations, and submit claims led to payment delays that affected the financial status of the agencies, their ability to deliver care, and employee morale. Rural employees experienced lower levels of job satisfaction and organizational commitment and higher levels of turnover intentions under the reform when compared to their urban counterparts.

The Transformation of Behavioral Healthcare in New Mexico

“…Key findings from this work (Table 1) replicate those reported in our earlier analyses of reform (Semansky et al 2012; Waitzkin et al 2002; Watson et al, 2011; Willging et al 2013). Collectively, our studies illustrate that top-down planning shaped by outer context considerations, insufficient concern for ensuring innovation fit, minimal preparation at the system and organizational levels, and inadequate delineation of key expectations and implementation processes, create challenges for service agencies and providers.…”

“…However, there was little in the way of data collection to formally evaluate and then improve upon implementation processes related to CCSS, CHs, and CHs. Importantly, this pattern has dominated system change efforts within NM since 1997 (Waitzkin et al 2002; Willging et al 2013). Other states, however, have successfully engaged in purposeful, data-driven planning related to systems change.…”

“…Strategies to ameliorate the inherent disadvantages faced by providers in rural states include technical assistance tailored to agency characteristics and organizational readiness, training through webinars, and infrastructure grants for improved IT systems to facilitate information exchange about clients (Alakeson & Frank 2010; Merrell & Berenson 2010). Ongoing assessment is essential to identify strengths and weaknesses of this transition process, develop context-relevant strategies to bolster organizational climate and culture, facilitate change, and determine required support and incentives (Arrons et al 2011; Willging et al 2013). …”

“…The agencies were located in three rural counties and three counties having metropolitan statistical areas that contained a central city or core of at least 50,000 residents. As we have described (Willging et al 2013), each agency cared for low-income adults with serious mental illness and received most of their funding from public sources. Interviews with 177 rural personnel and 148 urban personnel occurred at each agency 9 months (Time 1 or T1) after initial implementation of the reform, and 18 (Time 2 or T2) and 36 months (Time 3 or T3) later, enabling us to follow the roll-out of key initiatives.…”

Buffering the Uneven Impact of the Affordable Care Act: Immigrant‐serving Safety‐net Providers in New Mexico

“…Willging and her colleagues chronicled a series of four overhauls of the publicly funded behavioral health care system in New Mexico since the late 1990s (Willging and Semansky ; Willging et al. ). They found that the largest of these reforms (in 2005) impinged on the work environments of providers and staff by introducing new time constraints, paperwork burdens, provider shortages, and demanding patients with complex needs (Willging et al.…”