The Office of the Medical Director is responsible for a variety of functions, all of which relate to its primary role of assuring that the provision of psychiatric medical care by BHCS psychiatrists and nurses is of high quality. Providing this level of care within the managed care environment and budget limitations also includes the need to control health care costs, particularly the very high cost of psychotropic medications. Our Office, therefore, addresses both of these areas in a number of different ways:
- Monitors quality of medical care at service sites through a variety of methods, including chart reviews of physician practice using established clinical guidelines
- Chairs BHCS Psychiatric Practices Committee composed of representative psychiatrists from both CBO and county-operated outpatient programs
- Manages a comprehensive pharmacy system, including containment of costs
- Provides CMA accredited Continuing Medical Education program
- Provides psychopharmacological consultation/evaluation
- Delivers client, family and community organization education/presentations
- Coordinates centralized psychiatrist recruitment for BHCS programs
- Participates on State-wide Medical Directors Medical Services Committee
Alameda County BHCS strongly supports open access to all of the atypical antipsychotic medications, primarily due to advancements over older agents. These improvements include greater efficacy with negative symptoms and cognition, less EPS, lower risk of TD, and overall side effects. BHCS prescribing of these agents has steadily increased over the past 6 years, and it is currently estimated that 70% of all antipsychotic prescriptions are for these newer agents. In addition, our Outcome Studies have shown both symptom efficacy and overall costs savings to the system even though the medication prescription costs are higher for these newer agents. This is due to both a clinical and cost shift away from costly inpatient services, and towards outpatient support and re-integration.
As medication costs have risen, more patients cannot afford their prescribed treatments. In regards to mental health, medications are necessary for both recovery and reintegration. The Alameda County Behavioral Health Care Services (BHCS) Medically Indigent Adult (MIA) Medication Program works with the various drug manufacturers’ patient assistance programs (PAPs), to overcome cost barriers for patients without third-part coverage. These PAPs can provide brand-name medication to patients with limited financial resources. Although this unique program took over 3 years to fully implement, it has provided more than $1.9 million worth of medications to patients without third party coverage. Within 12 months, ~65% of the patients enrolled in the MIA Program will be MediCal eligible, and no longer eligible for this program.