Recently I purchased a plain wooden microwave cart for the lake cabin from IKEA. The item came in a box with several descriptive charts, lots of little pieces and a baffling array of hardware. I waded into the task trusting the directions and the accuracy of the assembler’s count of screws and bolts. I can say the project was a success and I am reminded how unlike an IKEA package, other things are in life! The directions for implementing the structure that supports participation in the Affordable Care Act have not always been very clear. In Beltrami County, providers have had a slow start. While other parts of the state have large behavioral and health care organizations that have successfully applied for grants and help, we were largely unaware of the scope of the change. It became obvious to the 11 agency members that we needed to collaborate in order to share the financial benefits associated with the new payment models for Medicare and Medicaid.
The ACA goals also known as the ‘Triple Aims’ of increased health, reduced cost and happier patients are not new ideas any longer, but seemed like lofty goals without a list of tools to be used to attain them. For Beltrami County, our challenges were even greater as our school district is roughly the size of Rhode Island. We also have an isolated, poor population, without central transportation, poor access to services, low wages, high rates of incarceration and crime and suicide as well as high rates of drug and alcohol abuse. In addition, Red Lake Nation, Leech Lake and White Earth Reservations are effected by historical and complex trauma, racism and social exclusion, poverty and high unemployment. In short, the demand for services remains unrelenting and routinely overwhelms the agencies in the area. While mental health providers have had a history of competition and little integration, there has long been the belief that we would likely be better off if agencies collaborated in order to meet the overwhelming needs. The area agencies are often underfunded, with huge demand for services. Perhaps because we are not in competition for business, it made collaboration, despite our history of niche market providers, highly desirable.