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The consumers have wanted a process outside of this. This mega—coordination group (that Commissioner Brown has proposed) could be under or over mental health. It is a good idea to not duplicate the coordination of services. He made reference to the complaints of the UNC Hospital emergency room where people are coming in for medication checks because their prescriptions have run out and they cannot get in to see a psychiatrist and they show up in the emergency room. This could be solved with a contract. Commissioner Gordon asked how Tom Maynard would imagine this would all work. She said that as she understands it, right now the State provides certain services through institutions and then the county provides services. The county both manages and provides the services. The change is that some of the beds at the State level are going to be eliminated and then at the county level, there is going to be a separation between the management and the delivery of services. She asked about the economy of scale. She said that it looks like the providers will remain and that OPC is going to have to divest itself of some of its provision of services. She said that the question that was brought up last night is if you have more of these smaller entities, then OPC will lose its economy of scale. Tom Maynard agreed with Commissioner Gordon. He is worried about economy of scale also. He thinks in most cases we can divest effectively, but they are worried about the possible duplication of infrastructure at a lower level. They have thought about how to make available a service organization function where the LME might extend to non-profits the services that they might need. Commissioner Gordon asked if there was a certain amount of money that the public sector will pay to the non-profits. Another question is where everyone is going to live with reduced beds at the State level. Tom Maynard said that the answer is not to create group homes for everybody coming out of an institution. It is dreadful to put them in rest homes. The only answer is to have them go to independent living situations with the appropriate resources. He said that the kind of support that the mentally ill need typically varies from day to day. When needed, there can be crisis beds available. There must be flexible services, but you have to be able to pay for it. Sometimes there can be roommates, but typically finances come up short. If there is a strong core of support services, then there can be lots of people in relatively light duty living situations without around the clock support. You have to be able to respond to emergencies immediately, and if patients know that, then their confidence increases. Commissioner Gordon asked how much it would cost to put the people in the new situation and if it would cost more than now and if the services would be better, the same, or worse. Tom Maynard said that the base level of funding does not change with the reform. He referred to a handout and how much money we can free up with this new model of care. There are two local things they can control. One is to shift non-priority population savings to priority. If they were to not serve those who had low priority services and only focus on high priority services, they could free up as much as a million dollars. He does not recommend doing this. He thinks that they can free up a million dollars by redirecting some of the priority population money and by recycling the services going to non-priority populations. He said that the non-priority populations are very small and most of the people they are serving are in very serious need. Regarding where they would go for the money to serve those in the institutions, he said that it would not solve the problem by transferring money from the institutions. He said that there should be bridge money for the transition. There may not be enough money from the institutions to cover the need and the only possible solution to the problem is to change the Medicaid plan. The State has said that they would create a new rewrite of the