Centerpoint Health, a comprehensive behavioral healthcare agency in Cincinnati, Ohio, was incorporated in January after months of preparation. The agency was formed through the consolidation of three Greater Cincinnati mental health agencies: Center for Children and Families (CCF), Core Behavioral Health Centers, and NORCEN Behavioral Health Systems.

Each agency had been a specialty service organization: Core provided adult case management and adult outpatient services; CCF focused on child outpatient care with limited child case management services; and NORCEN provided adult outpatient programming. This model had been forcing consumers and families, who often had limited resources, to navigate systemic barriers while still not receiving integrated treatment planning. The merger was an opportunity to improve consumer access, integrate care, and reduce administrative costs. Centerpoint Health marks a return to comprehensive, neighborhood-based centers serving clients where they live and work.

Early Affiliation

The founding agencies were formed in the 1970s as part of the federal community mental health center initiative. In the early 1990s, Hamilton County's mental health system was reorganized to have specialized service providers, which moved service delivery away from the comprehensive model.

The road to consolidation truly began in the late 1990s, when CCF, Core, and NORCEN started to combine backroom operations through affiliation agreements with Talbert House, a community-wide nonprofit social services network in Greater Cincinnati. Talbert House, opened in 1965 as a halfway house, provides programs in community corrections, mental health, substance abuse, and welfare-to-work. Under the “affiliation model” each agency had a separate 501(c)3 status, budget, and board of trustees.

This model created a network of services for the region and reduced administrative costs, with Talbert House offering finance, human resources, information technology, and development services to the three agencies. Merging the backroom operations increased economies of scale for all four agencies. For example, the group purchased a computerized clinical records system with integrated billing services that none of the organizations would have been able to afford independently.

Merger Support

According to the Scripps Howard Center for Civic Engagement and Nonprofit Development at Northern Kentucky University, Greater Cincinnati nonprofits have been growing rapidly, with one in five being established since 2000. As a result, The United Way of Greater Cincinnati and Hamilton County Board of Commissioners encouraged nonprofits to merge to maximize dwindling community resources. The Hamilton County Mental Health and Recovery Services Board, the agencies' main funding source, also had a financial incentive to encourage mergers, as consolidation would provide significant indirect savings by eliminating multiple contracting and oversight costs.

Each agency's board debated the pros and cons of consolidation, focusing on issues such as better access to funding, loss of community identity, and corporate structure. To facilitate a decision, the agencies created an ad hoc committee comprised of three board members from each agency. After careful review, the committee recommended consolidation of the affiliate agencies. The three agency boards independently debated the merits of consolidation and voted separately in September 2007 to approve the merger, effective January 1, 2008. The Talbert House board then ratified the decision, strengthening the affiliation structure with this new consolidated agency while allowing for future partnerships.

To oversee the restructuring and to identify ways to improve productivity, a consultant specializing in work-flow management was hired in June 2007. Also, an internal redesign team comprised of staff from various job classifications was established, and several suggestions from the team were implemented, including establishing a lead financial support position, refining documentation practices at each office, and creating a central intake department to assign and schedule all new referrals into the organization.

It became clear that five of Talbert House's mental health programs would be better aligned with Centerpoint, since the new agency would be specializing in integrated mental health programs. The programs merged into Centerpoint included a 24-hour crisis hotline, prevention services, substance abuse/mental illness case management, victims' services, and early childhood intervention.

Centerpoint Health founding agencies*

Challenges

Major challenges for the consolidation included filling supervisory positions, managing staff's anxiety, establishing a new company culture, communicating to clients and stakeholders, and merging the separate boards.

Filling key roles and managing staff anxiety. I was appointed executive director two weeks before the official consolidation, and management staff selection was completed in early January. This quick action reduced anxiety and provided stability for the staff. Although the staff was assured from the start that no layoffs would occur, the five-month planning process created anxiety at all levels, especially among management and support staff. A weekly e-mail newsletter sent to staff effectively addressed rumors and anxiety. All-staff meetings and a “meet and greet” reception also worked well as avenues to provide information, respond to questions, and network with new team members.

Changing culture. Culture change will be the most important long-term challenge, and it will demand the most energy. By design, many directors were reassigned to new offices and service lines to embed change. Weekly team meetings have focused on team building, problem solving, and culture change. Directors and managers who have not completed the affiliation's leadership training programs will be enrolled over the next year. While consolidation has taken significant staff and financial resources, staff members are embracing the model as they begin to see the positive impact on care and the better opportunity for professional development. Teamwork is developing and the clinical staff is brainstorming ways to further improve access to care and quality of services.

Reaching out to the community. Communicating with clients and external stakeholders was identified as critical to the referral and contracting process. Written announcements to providers, contractors, community leaders, and governmental departments were sent as soon as the consolidation was official. Management staff continues to attend meetings at other organizations to clarify the merger and explain Centerpoint's vision. Centerpoint notified all active clients of the merger by letter, assuring them that providers, services, and locations would remain unchanged. Providers also explained the changes to clients during their first post-merger contact.

Selecting newboard members. The Centerpoint Board includes board members selected from the founding agencies as well as four members from the community. This change allowed Centerpoint to begin a cultural shift at the policy level and created a diverse board while maintaining continuity and institutional knowledge.

Planning for Growth

Centerpoint provides better opportunities for both clients and staff. Growing consumer services is possible as the agency looks to expand its integrated care model to primary care and substance abuse treatment. We predict this will be the delivery model of the future because it improves service quality, reduces barriers to access, and aligns services in an anticipated move toward a Medicaid managed care model. The consolidation also should increase Centerpoint's ability to recruit qualified professionals, as savings in administrative costs are shifted to support raises for professional staff.

Centerpoint anticipates serving 15,000 registered clients this year with a $14 million budget and 220 staff members. During the next year, Centerpoint will work toward the vision of creating a “no wrong door” care model by integrating primary healthcare, substance abuse treatment, and behavioral healthcare services, thus creating a truly holistic approach.

Alan Mabry, PhD, is Executive Director of Centerpoint Health in Cincinnati, Ohio. He is the former executive director of Core Behavioral Health Centers and former interim executive director of the Center for Children and Families.

To contact Dr. Mabry, call (513) 221-4673 or e-mail alan.mabry@centerpointhealth.org.

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