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The behavioral health system in Colorado is complex. We thought we’d take a moment to clarify a few of the most common misconceptions and provide an insider’s look into how WellPower (WellPower) serves our communities.
Myth #1: WellPower looks for reasons to refuse treatment for people who need it.
Fact: WellPower exists to serve people from a variety of backgrounds, including those who experience complex and layered mental health needs. We do everything we can to help each person access the support they need for their recovery and well-being based on clinical best practice.
There are a few situations in which we might not be able to serve someone:
- When a person refuses treatment, we need to respect their decision. Treatment refusal happens for a variety of reasons including a condition known as “anosognosia,” or a clinical inability to recognize one’s own mental illness. We will do everything we can to try to engage that person into treatment, such as helping them find employment, housing and other resources to support their recovery. If, however, they refuse treatment, we must accept their refusal because people have a legal right to decline treatment in the U.S. Learn more on anosognosia.
- When someone’s insurance doesn’t include us in their network, it limits our ability to provide the full range of care that might be needed. In this case, we refer them to providers that do take their insurance so they can access care.
- When the person needs a higher level of care than what we offer, such as hospitalization or inpatient care, we connect them to other providers through mobile crisis assessments, mental health holds and other pathways. Our sole focus is on what each person needs, which sometimes involves connections to hospitals, inpatient settings and other providers.
Myth #2: WellPower provides the same services as private practitioners, but at a higher cost.
Fact: It’s true that our “unit cost,” or what it costs us to provide an average “unit” of service, is higher than many private practice clinicians; however, this reflects a significant difference in the types of services we offer compared to private practitioners.
Individual providers often limit services to individual, group, or family therapy, and other services that are reimbursed at higher levels. Because of our role as a community mental health center, WellPower offers a more comprehensive array of services based on what is needed by the people we serve, who often have complex, layered needs. Our population may also face barriers to treatment that would not be true for those served in a private practice model, including lack of access to technology (computer or smart phone), email, housing and transportation.
Some of the services we provide to address complex needs and barriers – such as our intensive case management, psychiatric rehabilitation, residential and pharmacy programs – are reimbursed either at low levels or not at all. With our approach to case management, for example, we support people in ways private practitioners could not, such as driving people to appointments, going with them to the grocery store and seeking them out in the community if they miss an appointment, which can take hours and is not covered by Medicaid. This higher level of care is important and costs more to provide, which increases our overall “unit cost.”
We also have several programs like our walk-in crisis center that are open and staffed 24/7/365 (our walk-in center has never closed since it first opened in 2014), regardless of how many people access services at any given time – an approach that is often known as the “firehouse model.” A private practice cannot have a program fully staffed that does not provide enough services to support the cost. This is another aspect of how we serve the community that increases our average cost per unit of service.
Myth #3: WellPower underpays staff while overpaying executives.
Fact: To attract and retain the best talent, WellPower offers competitive wages that are above the industry average, as well as an excellent benefit package at all levels. In December 2021, we implemented a minimum salary of $50,000 per year, or $24.04 per hour, and made immediate adjustments to bring the average pay for each job to the 60th percentile of market rate – not just among other community mental health centers but across all of healthcare.
In alignment with industry standards and best practices, our board of directors consults with an independent consultant to complete executive salary analyses on a regular basis. The compensation of executives, including our CEO, is determined each year by the board with guidance from this consultant, and has consistently been found to be fair, reasonable and comparable to similar-size and scope healthcare providers across the country.
Myth #4: WellPower is sitting on a multi-million-dollar rainy day fund.
Fact: WellPower has an operating reserve that allows us to meet our balance of payments and continue providing services to the community in times of unexpected financial hardship. All organizations establish a desired level of reserves to have on hand in case of sudden increases in costs or decreases in revenues. Our mandate is to have at least 90 days and ideally 120 days of cash on hand (many other organizations have 200-300 days’ worth of reserves).
At WellPower, much of our funding is based on reimbursement that comes in several months after we use whatever resources are available at the time to provide services when they’re needed. In this case, we cover all costs up front and hope to be reimbursed in full afterwards, which does not always happen. The cost of these services combined with staff salaries, building costs and much more, adds up to around $9 million in monthly expenses that all need to be paid on time.
During the early days of the COVID-19 pandemic, when the organization experienced sudden funding losses and significant technology costs to ensure people could still access services remotely, we were able to use our reserve to:
- Continue providing a high level of care for the people we serve,
- Keep all staff employed,
- Avoid furlough days,
- Pay staff at their normal rate even when they couldn’t work their full schedules due to COVID-19 issues, such as school or facility closures.
Myth #5: WellPower has a preferential deal with the state for exorbitant funding.
Fact: We receive state general funds each year, mostly to provide services for people experiencing homelessness who are not covered by Medicaid or other insurance; however, those funds tend to last only through the first six months of each year due to shortages in state funding and the expense of serving this important and complex population. This means we have to find other ways to cover the cost of these services the rest of the year, which is a factor in our unit cost (see “Myth #2” above).
Myth #6: Only community mental health centers can receive Medicaid funding.
Fact: In Denver, private practitioners provide most of the behavioral health services that are covered by Medicaid: private clinicians receive reimbursement for 55% of services covered by Medicaid, while WellPower provides the remaining 45%. The difference is that private practitioners mostly serve people with more straightforward conditions, while we focus on people with complex cases such as those with layered diagnoses, a need for stable housing and other challenges for which services are not covered by Medicaid.
Myth #7: WellPower double-bills Medicaid and the state for the same services.
Fact: Sometimes people who are uninsured and experiencing homelessness initially have their care covered by the state Office of Behavioral Health (OBH), and then become enrolled in Medicaid. The myth here is that we would bill both OBH and Medicaid for the same services, which is a misread of how this very technical system works.
In short, people served by WellPower don’t have both Medicaid and OBH coverage at the same time. People who are experiencing homelessness and are not enrolled in Medicaid or any other insurance qualify for behavioral health coverage under OBH. As part of their services with WellPower, many people are assisted in gaining coverage under Medicaid, which then makes them ineligible for OBH funding. When this happens, Medicaid-eligible services that were already billed to OBH are automatically reversed – or “voided” – by our computer billing system to ensure that only one source is billed for each service.
To get a little more technical, we report both Medicaid and “indigent” claims to OBH using a computer system that does not allow double billing. When backdated Medicaid eligibility for any individual occurs, claims to OBH for those services are voided and reprocessed, which results in three billing lines for each service: first an OBH claim, then a Medicaid claim and finally an OBH void, which reverses the first OBH claim and leaves only the Medicaid claim active. When looking at billing and accounting systems, it’s important to find not only the first two billing lines, but the void line as well – otherwise, it might look like double-billing, which is not possible in our computer system.
And finally, in addition to our computer system and our own diligence, there are two other ways we make sure that billing is done correctly: 1) all claims are first sent through an external clearinghouse to ensure there is not accidental duplication, and 2) the whole system is reviewed annually by external auditors as part of our commitment to efficiency and responsible financial stewardship.