Youth Health Enters Age of Managed Care: Brightside of Managed Care

Heather Szerlag
November 1, 1995

We asked ourselves: how were we going to still be useful? We took the perspective of defining how managed care happens before it defines us.

-Cynthia Smith, Executive Director Brightside for Families and Children

Brightside for Families and Children has come a long way since its founding as a home for orphans by the Sisters of Providence In 1873. Executive Director Cynthia Smith believes the agency's switch to managed care probably has been its greatest challenge — and perhaps its greatest accomplishment.

Today, the multi-service family oriented agency is part of Massachusetts's MHMA, the HMO providing all the mental health care services to the state’s Medicaid population. Brightside entered the managed care field six years ago under the leadership of Gerard Malouin, now director of Florida's Hillsborough County Children's Board.

In that brief period, Brightside has moved light years ahead of most other nonprofit providers seeking to enter the highly competitive managed care arena, and has become a how-to Mecca for others wishing to follow in its footsteps. Brightside also has been involved in the Child Welfare League of America's managed care regional conference circuit and assisted the League with its soon-to-be-released managed care guidelines.

Perhaps one of the most difficult hurdles of the transition, says Smith, was changing the culture around the client-therapist relationship. "In the old way of doing things, therapists would sit around and say, til take this patient, I've never had a father who molested his daughter.' Now we operate more like a M.A.S.H unit."

She said the agency has moved to a triage system where the level of care needed by the patient is assessed early and often throughout treatment.

Brightside has developed a full array of services, creating its own behavioral health network. It includes a staff of 360; 24-hour, on-call, social workers; round-the-clock phone lines with live operators; an acute-case, residential treatment program: a school for at-risk youth: as well as family reunification and preservation programs. Brightside also runs family stabilization teams that go into the home and tailor assistance to family needs.

Services focus on prevention to avoid unnecessary and expensive hospital stays and lower the recidivism rate among patients.

Beyond that, Brightside has installed a new computer system that tracks all its patients' vital statistics and produces bills — a must in dealing with the blizzard of paperwork required by most managed care firms. One of the keys to its success, however, has been the transformation into a marketing machine. "Frankly, we've made ourselves marketable, you name the expertise and we've got it," Smith tells HMOs. Brightside puts out snappy brochures and has, a 20-minute video presentation trumpeting its range of services to potential clients and contractors. Many non-profits are uncomfortable with the concept of aggressive self-promotion, but in the managed care system, it's best to think like Coca-Cola.

For all its successes, Brightside is still grappling with one of managed care's more intractable problems — outcome measurements. "Especially in the behavioral health field, it's hard to define the terms, like what safety is, what stability is," Smith said. For now, Brightside continues to use a sliding scale system (1-100). Rating patients on a range of issues from ability to sleep to potential for violence. Anything under 50 is considered unsafe. The elusive quest for a different, more precise outcome measurement system continues.

"It's been hard, hard tedious work changing our culture," says Smith. "But it's worth it if we want to have a say in the future."

Szerlag, Heather. "Youth Health Enters Age of Managed Care: Brightside of Managed Care." Youth Today, November/December 1995, p. 33.

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