Colonial Behavioral Health: David A. Coe, Executive Director

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Located in Williamsburg, Va., Colonial Behavioral Health is a community-based public provider of services for those dealing with mental-health issues, intellectual and developmental disabilities, and substance-abuse disorders.

Colonial is one of 40 independently operated Community Services Boards across the state of Virginia. Considered to be a part of the public system, each center operates together in several ways, but each is independently governed by a locally appointed board of directors. Each center also has a designated service area.

Colonial serves the upper peninsula of Virginia, including the city of Poquoson, as well as America’s Historic Triangle of Jamestown, Williamsburg, and Yorktown.

An aggressive community force

Founded in 1971, Colonial is entering its 40th year of operations. It has 203 employees and a budget of $13.3 million. Colonial services four localities with an approximate population of 150,000 and saw 4,530 individuals during its last fiscal year of July 2010 through June 2011.

Colonial offers services for the entire life span, from children’s services to senior services, including  crisis services (with a crisis counselor being available 24/7/365); day programs for adults with mental-health disorders and intellectual disabilities; residential programs for individuals facing intellectual disabilities; a  full range of outpatient individual, group, and family services for children, adults, and seniors in each diagnostic category; two intensive outpatient programs for adults with substance-abuse disorders; and enclave employment work for individuals with intellectual or developmental disabilities.

More than a year ago, Colonial opened the Greater Williamsburg Childhood Assessment Center (GWCAC) as an expansion of its children’s services. This center will act as a centralized child-assessment service for the community, parents, and providers who are looking to get assessment referral and a one hand-off to providers. As part of its services, the center offers an electronic web-based database of information designed to help parents and guardians locate over 400 services in the area.

‘With this electronic backbone, folks can get a picture of what’s going on,” David A. Coe, executive director, said. “They can get an idea of who provides what service, transportation options, what insurances are available, and so on.”

Colonial is actively working with local and primary-care clinics, community health centers, and free clinics in the area on integrating behavioral healthcare with primary healthcare. These efforts include providing training and telepsychiatry consults. Colonial has also embedded psychiatrists and licensed clinical social workers inside those clinics.

“We have a lot of positive things in the community that helps pull them together rather than split them apart, and we’re proud to be a part of that,” Coe said.

Reaching out to the working poor

With its primary source of revenue being Medicaid, the continual cuts to this program have challenged Colonial in multiple ways.

“We’ve had the challenge of Medicaid all along,” Coe said. “In the community in which we live, there is a lot of tourist activity, not a lot of large industry, so we have a disproportionate number of individuals in our community who are working multiple part-time jobs in tourist industries or hospitality industries.”

Unfortunately, most of these individuals make too much money to qualify for Medicaid, but the nature of their work doesn’t bring them health insurance. As Coe noted, 60 percent of the population in Colonial’s service area is comprised of the working poor. While some of the clinics in Virginia have 75-80 percent of their budgets provided by Medicaid, Colonial only has 30 percent of its budget funded by Medicaid. With state budgets being cut, this conundrum becomes more tangled and problematic.

“In recent years, we’ve taken much more in the way of cuts than we have in ways of growth, so one of the things that we came to realize is that we can’t think like other Community Services Boards, because our payer mix is different, the funding sources we have relied upon are different, and we have to take a different view of how strong and stable those funding sources are,” Coe said. “So we’re needing to try to take a little more control of our own destiny.”

Facing destiny through innovation

For Coe, controlling Colonial’s own destiny means two things—arming employees with skills and exploring new revenue streams.

About four years ago, Coe began to realize that senior-management personnel possessed most of the skills and expertise on budgeting, cost containment, regulatory knowledge, and program planning. Middle management, by and large, had not been trained in this area.

“Up to that point, all of those core business functions were held by a very few people, and many of our middle managers did not have expertise in those and had not been developed in those areas,” Coe said.

Coe embarked on a mission to transfer this knowledge from senior-management levels to middle-management levels. A group was created named QuILT (Quality Improvement Leadership Team) that concerned itself with training middle management in areas that included health and safety planning, disaster preparedness, licenser issues, data management, human rights, regulatory issues, etc.

“We’ve taken the time over the last few years when we’ve had budget cuts and we’ve had cutbacks and we’ve had to close some programs and restructure some programs to reposition ourselves for the next generation of healthcare, and much of that has been done through the middle-management restructuring and development program,” Coe said.

When it comes to increasing revenue streams, Colonial has created a private entity, Colonial Health System, Inc., whose purpose is to move Colonial into business lines that are not traditionally operated by community mental health centers. Coe hopes that this can generate dollars from completely different sectors, especially with the increasing Medicaid challenges posed by healthcare reform.

“We’re really looking to begin leveraging different aspects of healthcare revenue into our community,” Coe said. “It is possible to position yourself strategically and squeeze every penny at the same time.”

-by Pete Fernbaugh

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