County approves Third Avenue mental health hub agreement, but Scripps bows out – The San Diego Union-Tribune

Though one of their two partners refused to sign at the last minute, county supervisors unanimously moved forward Tuesday with plans to spend more than $100 million on a mental health hub at Third Avenue in Hillcrest.

Initially, the idea was for the county to make a formal agreement with UC San Diego Health and Scripps Health, with each operating their own mental health units attached to hospitals that are within walking distance of the property.

But county officials announced Tuesday morning that Scripps did not sign off on the memorandum of understanding that the three parties have been pulling together since representatives from all three organizations gathered at the site to make a joint statement of unity in late October.

Unfazed, supervisors approved a memorandum of understanding with UC San Diego that will serve as a rough framework for building a new building with space for a range of mental health services and including 60 inpatient beds, on the Third Avenue property. Supervisors made it clear that their vote, and their investment, was about more than a building that will take five years to construct and open.

In the end, its not just the facility, but whats going to be going on in there thats really important, said supervisor Dianne Jacob.

Jacob commended her colleague, Supervisor Nathan Fletcher, for pushing to have the Third Avenue property used for mental health rather than residential redevelopment and for sinking a large amount of political capital into pushing for changes that go deeper than merely building a few additional buildings with enough beds to replace those that will be lost in coming years.

Fletcher, who said UC San Diego Health Chief Executive Officer Patty Maysent was instrumental in making the agreement happen, said the real secret sauce will be a new legal entity, a joint venture, capable of directing the efforts of care coordinators and others whose jobs will be to make sure that patients are not lost in the shuffle when they move between the wide range of programs that each serve a different piece of the mental health care pie.

We are creating a joint venture, an entity that can move now on care coordination, an entity that can move now on data sharing and an entity that can move now on better outcomes and value-based health care, Fletcher said.

The phrase care coordination has long been a buzzword of growing currency in the health care world as providers and policy wonks try to find ways to prevent health care problems while theyre still small, rather than following the traditional model, which has traditionally been less proactive than reactive.

Dr. Nick Yphantides, the countys chief medical officer, said Tuesdays action represents the countys investment in taking care coordination beyond the buzzword stage. The idea, he said, will be to hire additional people trained to stick with clients, whether theyre in a hospital or back in the community, and make sure theyre doing the things, from taking medications to making follow-up appointsments, that are most likely to keep them from ending up back in a hospital bed or a jail cell.

What we are looking to do is build a model where there is a single person, who you trust, who does not let go of your hand throughout the journey, Yphantides said. They stay with you, versus what is currently happening where you go from one person to another to another.

Such close one-on-one relationships, pursued countywide, would require hiring thousands of new care coordinators. At first, said Dr. Luke Bergmann, director of behavioral health services for the county, UCSD and the county plan to focus on those at greatest risk of hospitalization, either at the countys psychiatric hospital on Rosecrans Street or in the behavioral health unit of UC San Diego Medical Center in Hillcrest.

A multi-tiered staffing approach, Bergmann said, would rely on training those with lived experience to serve as front-line coordinators who would in turn be supervised by those with higher-level psychiatric expertise. While it might seem like an expensive proposition, Bergmann said that the cost of hospitalization is so enormous that employing care coordinators is expected to be cheap.

We can pay for a day of care coordination vastly more cheaply than we can pay for a day of hospitalization, Bergmann said.

He credited Fletcher for making the plan, which many have been discussing for a long time, arrive at the point where real results are not on the horizon. The first batch of care coordinators, he said, should be trained and on the job by the end of the year.

Supervisor Fletchers embrace of this issue, his championing of it, has been critical to our efforts to stand this up, Bergmann said.

Chris Van Gorder, Scripps chief executive officer, said in emails Tuesday that the plan between the university and the county, which had been in development for more than a year before Scripps got involved, looked pretty traditional with the county building the facility and then leasing it to the university.

So in the end, the goal of developing more behavioral beds for patients has been met, and we are pleased with the results, Van Gorder said."Id like to think we played a small part in getting this important project to what is really the beginning.

Van Gorder, who said Scripps does plan to participate in the new care coordination system that UCSD and the county are building, added that his organization intends to stick with plans to build a 120-bed stand-alone mental health hospital on land in Chula Vista in partnership with for-profit operator Acadia Healthcare Company Inc.

Scripps has faced significant criticism from many in the area who have noted that Acadia has faced a wide range of operational problems and fines in recent years, and an online petition, now signed by 4,552 people, calls for the facility to be relocated.

Van Gorder said he had heard both support and opposition for the Chula Vista site.

I think almost everyone understands the community need but hope the need will be met in someone elses neighborhood, Van Gorder said. Its the same thing we face when wanting to build or replace an acute care hospital, but these facilities need to be somewhere in our community.

UCSDs Maysent, who said she is happy to work with Scripps on care coordination, added after Tuesdays meeting that UCSD will change its redevelopment plans for its Hillcrest medical campus, using the beds at the Third Avenue hub to replace its medical centers existing behavioral health unit rather than building a new unit on the site.

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County approves Third Avenue mental health hub agreement, but Scripps bows out - The San Diego Union-Tribune