At Houston-based Harris Center for Mental Health and IDD, leaders are combining multiple public and partner funding streams to build a continuum of care for high-need populations while managing operational, compliance and sustainability challenges.
For decades, behavioral healthcare has faced inadequate funding and reimbursement rates, especially for safety-net providers. To expand comprehensive care, these organizations are increasingly seeking creative funding strategies.
“It is a lot of trying to achieve a vision of significant care interventions in a way that is affordable and sustainable,” Wayne Young, CEO of the center, told Becker’s. “For us, braided funding is what that is often looked like.”
One campus is designed to serve individuals at the intersection of homelessness, criminal justice involvement and serious mental illness. To purchase the building, the center relied on funding from the city and county, each contributing about $5 million, Mr. Young said.
Another $5 million funding stream supports staffing for a jail diversion program. The center layered hospital homes services into that program, funded by a pool of legislatively directed funds aimed at supporting individuals experiencing homelessness, mental illness and substance use disorder.
The campus also offers 20 jail reentry beds, funded by county and law enforcement sources. These beds are designed for individuals leaving the local jail who are unhoused, allowing the center to transport individuals to the campus.
A state hospital partners with the center to fund stepdown care for individuals who have been hospitalized for more than six years on average, helping them transition back into the community.
Braided funding programs are integrated into the facility to offset costs and expanded staffing. For example, the campus previously had a part-time psychiatrist but added a full-time psychiatrist shared across programs, Mr. Young said.
“They’re now beginning to offset [costs] and because of the economy of scale, we don’t always need to add more. We can just expand what’s there or share the cost components,” he said.
Challenges arise because different funding sources carry varying expectations around billing, outcomes and reporting timelines. Nearly all funding is expense-based reimbursement, Mr. Young said.
“We’ve got to be able to float that money up front. Then we’ve got to customize the billing interaction and the timelines based on what that payer’s intentions and expectations are,” he said. “They each have their own payment timeline. They often each have their own invoicing kind of framework and model and the documentation required to prove up those expenses.”
The organization manages about 70 grants or contracts. To streamline operations, the center created a revenue cycle team dedicated to grant and contract billing. A separate data team and data collection system track outcomes.
“We do a lot of tracking and managing to make sure that we stay on the right side of the ethics and the compliance requirements associated with the different funding sources, and that we keep all of that above board,” Mr. Young said.
A site leader oversees the campus, supported by program leaders for each initiative. The organization also uses a dyad relationship model, pairing an on-site operational leader with the site leader.
“You’ve got to be comfortable with wading through the ambiguity of that, because inevitably, it doesn’t all come together exactly at the same time and exactly at one place at one point,” Mr. Young said. “What I described about the campus evolving was probably a three-, three-and-a-half-year process.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
