When the Behavioral Health Task Force established by Governor Polis recommended the creation of the Behavioral Health Administration, the original concept suggested that all programs and funding related to behavioral health in the Executive Branch would move under this new entity. It would ensure that our system was more efficient and effective. Or, that was the intent.
At the time, we engaged Health Management Associates (HMA) – a national consulting firm – to help us do the research to determine the right model for the BHA. They were responsible for a number of different components of research:
- Identify all of the programs and funding that “touch” behavioral health across all state agencies and branches
- Learn from other States about what has worked and not worked in undertaking a similar endeavor to establish a new centralized entity
- Determine what legislative changes would have to be made once the new entity was created
- Explore untapped funding opportunities
When HMA completed the first step in its research, there were two big surprises: (1) they found over 120 programs across 13 State agencies (including the Executive and Judicial branches) that “touch” behavioral health; and (2) almost none of the programs were duplicative. Many of the behavioral health programs were smaller in size, and created to address a distinct need and/or population.
HMA, which completed the research but did not make the decisions, talked to other states that had established entities similar to what we were considering for our Behavioral Health Administration. One of the biggest takeaways was that it took much longer and way more energy than anticipated to consolidate programs under the new entity. In states where it had been expected to take 3 years, it took 7-8 years. And all of the energy spent on establishing the new agency diverted attention from helping people access quality care. And in the end, the consolidation did not result in a more effective and efficient system.
Thus, with this data, the concept for the Behavioral Health Administration in Colorado evolved. Rather than consolidate all programs and funding, we – the Executive Committee – decided to create an entity that would serve as the “hub.” While programs and funding would not be consolidated under the BHA, the BHA would still track programs and funding. It would also be the “go to” entity for behavioral health legislative and funding ideas. In other words, any state agency that was considering legislation related to behavioral health would discuss it with the BHA to ensure it was in alignment with the State’s vision. This was also true for budgets: the BHA would not control the dollars in other state agencies, but it would track them and provide input. We wanted to answer the age-old question, “What money is being invested in communities across the State, where was it coming from, and what were the results?”
The revised concept of the BHA is codified in statute. The BHA, as outlined in House Bill 22-1278 (HB22-1278), is charged with “creating a coordinated, cohesive, and effective behavioral health system in Colorado. Any state agency that administers a behavioral health program shall collaborate with the BHA to achieve the goals and objectives established by the BHA. In order to ensure regular engagement with other state agencies and to maintain alignment in state programs, resource allocation, priorities, and strategic planning, the commissioner shall chair a regular meeting of the executive directors of state agencies.”
Realistically, this puts the BHA in a delicate position: it is accountable for the behavioral health system with little ability to directly influence it. It must hold other agencies to task while also collaborating and coordinating with them. And yet – it is possible. And it must happen.