October 17, 2023
Greetings Everyone,
We’re having very nice autumn here in Helena. It’s always nice when we’re spared an early storm, and when Fall lingers in the capital city. The trees are dropping their leaves after showing us their vivid colors the last few weeks all over town. Halloween is right around the corner. Hunting season isn’t far behind. Work proceeds: the exterior of the new Montana Heritage Center is nearly completed; signage now graces the new buildings on the old mall site (Opportunity Bank Operations Center and Benefis Specialty Care Center). And the Carroll College Fighting Saints football team is 6-0!
We had a very interesting program last week from the FUSE Project team (FUSE stands for Frequent Users of Systems Engagement). Our guest this week is Justin Murgel, CEO of PureView Health Center. Mr. Murgel is a Helena native and a graduate of the University off Montana Western at Dillon. Justin and PureView have been on the FUSE Team since its beginning nearly two years ago.
After two years the FUSE Project is showing positive results. St. Peter’s Health is keeping track of key indicators in their area of expertise. Emergency Room visits by FUSE participants have been reduced by over 50%. There are similar results for ambulance transports, MCRT (Mobile Crisis Response Team) responses to mental health crisis situations, hospital admissions and admissions to the Behavioral Health Unit. The most significant impact of the FUSE is its beneficial impact upon people’s lives. But, there are also financial results to consider. According to St.Peter’s, the estimated annual ‘savings’ from the FUSE interventions are $1.3 million. That’s real money around here. In addition the FUSE, along with other measures adopted recently, is keeping people out of the criminal justice system, and out of the Lewis and Clark county Detention Facility. Emily McVey estimates that the reductions in the jail population ‘saved’ L&C county approximately $50,000 the last six months, and $60,000 for the six months prior to that. Again, that’s real money around here.
‘Savings’ however is an elusive term for what the FUSE Project and this community have achieved. You can go over the state budget (House Bill 2) with a fine tooth comb and never see the word ’savings.’ Showing ‘savings’ is difficult for many reasons. It’s probably just as well that generally accepted accounting principles do not allow for ‘savings’ as part of the calculus. The direct ‘cause and effect’ is hard to demonstrate. There are compounding variables that make it difficult to isolate and quantify ‘savings.’ In addition, these ‘savings’ do to all show up in one place or at one time in either the state or the county budgets. For example, while St. Pete’s might have ‘saved’ $1.3 million, the real ‘saving’ is most likely to the state of Montana's Medicaid Program. For the services not rendered at the hospital due to FUSE, St. Pete’s is either billing Medicaid or providing uncompensated care. Also, the money ‘saved’ is typically plowed back into the services provided, whether it’s PureView, the Detention Center or St.Pete’s.
This accounting and budgetary reality has been an item of vexation to me for quite awhile. What are the 'savings’ from Vocational Rehabilitation? Low Income Energy Assistance? Head Start? Welfare Reform? Medicaid Expansion? I recall the chair of the House Appropriations Committee saying to me once: “I wish we had all the money you people have been saving. If we had that money we wouldn’t be facing a $250 million budget shortfall right now.” That kind of logic is hard to argue with. So, we are left with the challenge of demonstrating the effectiveness and efficacy of something like the FUSE, or of any number of other programs working these issues. The answer, if there is one, isn’t going to be found by by redoing the state budget and accounting system. That simply is not going to happen. The answer, if there is one, will be found in the deeper understanding local and state leaders gain by learning more about the programs in place, the people they serve and the work they do.
We learned quite a bit last week, and will learn even more from Mr. Murgel this week. Please plan to join us this Thursday on the 6th floor of the Montana Club. Or, zoom into Hometown Helena from the comfort of your own home or office. You’ll be glad you did.
Jim Smith
406-949-1002
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