ETBHN has operated as an entity under Burke Center, as a fiscal agent, formed by an Interlocal agreement since 1998 between originally 7 independently operated Centers, expanding to 10 Centers in 2009, and possibly 11 Centers before the beginning of 2010. The primary function of ETBHN has been to save each Member Center money by implementing economies of scale, improving quality of services, benchmarking, developing best practices, promoting new business opportunities for the region and for individual Centers, and working collaboratively on projects that were of shared interest to all Centers in the region.

The ETBHN Pharmacy was created in 2004 and continues to be the largest program and most financially rewarding. In addition to the pharmacy, ETBHN has numerous workgroups and committees that are both productive and are used as information sharing sessions to gain ideas and best practices.

The services of ETBHN continue to grow and target areas of Member Center needs, as they arise. In an ever-changing system of change, it is important for ETBHN to continue to grow in new directions as needed by Member Centers, but in line with the mission of the organization.

ETBHN currently has one Executive Director. Other employees include one part time Assistant shared by Burke Center Administration, one pharmacist, three pharmacy technicians, and 4 other pharmacy employees involved in the Patient Assistant Programs, billing, and shipping. Some of the other pharmacy employees are part-time and all are certified pharmacy technicians, in order to assist when necessary in the pharmacy. In addition to these employees, the pharmacy utilizes three PRN pharmacists, as needed, and a temporary service that can supply technicians when staffing is low or a heavy workload is anticipated. This allows us to expand quickly without fear of being understaffed.

ETBHN, also, contracts with one Center for Information Services assistance on an hourly contract and 3.5 employees plus one PRN that complete authorizations for Centers.

The contracted employees have two lines of supervision to follow – one from the ETBHN Executive Director and another from the Center that employs that person, if applicable.

The ETBHN Executive Director reports to the Regional Oversight Committee for direction and supervision. Since Burke Center is the fiscal agent for ETBHN, the CEO of Burke Center serves as immediate supervisor, although the Regional Oversight Committee is truly set up as a Board to oversee the activities of the Executive Director.

ETBHN has the following committees and workgroups that meet on a regular basis:

• Utilization Management Committee
• Regional Planning and Advisory Committee
           Plus project Subcommittees of Center Liaisons
• Pharmacy and Therapeutics Committee
• Business Opportunities Committee
            Grant Workgroup
            Autism Workgroup
            Housing Workgroup
• Information Services Committee

The following are Committee’s and Workgroups that meet on an “as needed” basis:

• CFO Directors
• MH Directors
• IDD Directors
• Called Workgroups for specific projects – MCOT, LPND, Crisis Services, etc…

Called Retreats, Conferences, and Trainings are, also, being held with success. Examples include:

• Board of Trustee Retreats twice a year
• Housing Summit
• ROC Retreats
• Special Presenters for events, such as John Van Camp, Bill Sturdevant, etc…

In addition to the work being completed by the above Committees and Workgroups, the following “menu item” services have been implemented:

• Medical Director Consolidation (4 Centers participating)
• Authorization Consolidation (8 Centers participating)
• CFO Consolidation (planning in progress, but will be 3 Centers starting out participating)
• Shared purchasing of Utility services for eligible Centers

As a whole, the region is implementing a Wide Area Network that will connect all Centers by Intranet for high speed data transmission on secure lines and SharePoint, a Web based application that has made communication of each Committee and Workgroup easier, in addition to the posting of documents, agendas, and calendars – all securely. We have not reached even close to the potential that this will provide.

ETBHN has been gathering the attention of many other Centers. The interest is in the whole package, not just the pharmacy. Currently, there is no region similar to ETBHN that is as active in new projects and programs. We have two new members in the past 4 months and have one more Center that may be actively pursuing membership soon. ETBHN was invited and presented at the National Conference on Mental Health and will be presenting at the Texas Council in June of 2009. This is in addition to the many calls received asking questions about our network and our pharmacy from other Centers in the state of Texas and some from other states seeking information on how we operate.

Not only are Centers interested and joining as full members, but we have actively sought customers for our pharmacy from non-members. Currently, there are three Centers that are not seeking membership, but have interest in the pharmacy services only.

ETBHN must be prepared to, not only, expand our services in all areas, but be financially ready to take on new Centers for pharmacy business. Attachment A contains a spreadsheet for financial growth that takes into account the positions needed, as described below, for FY10 along with projected revenue and expenditures of adding new Centers to the pharmacy.

With the vision of creating cost efficiencies, growing new business opportunities, and improving quality of our services, ETBHN is quickly becoming what was envisioned many years ago. We have added new Centers, created new ventures, and are saving money for all Members. The goal now is to increase our current functions and become even more efficient in realizing our vision.

The following plan will allow us to, not only, continue to provide the services that are now available, but to increase our ability to expand our functions. In order to truly realize this vision, we need to invest our excess revenue wisely. With so many changes in our environment from external funding sources and contract demands, ETBHN should be able to truly assist Members in meeting these challenges. While most every aspect of our services has increased, there are some activities that are not as active as before. For example, we no longer have discipline specific meetings on a regular basis or have some of the quality management initiatives that we once had. These were often seen as just meetings for the sake of meetings, but important information is shared in these meetings. This is something that would be useful to Center staff as they plan and try to meet new demands. With new technology, we can begin to have these meetings in less costly ways. Also, the menu option plan could be more fully utilized. There is no reason that we could not have more voluntary consolidations when it is cost and quality effective.

In order to accomplish new initiatives, though, we need to move forward with our investment. We have a truly unique collaboration that could serve as a state and national model in how to effectively reduce costs, increase our business opportunities, and deliver more quality services to our consumers. In the economical climate that we face at this time, this is more important than any time in recent history.

While it is overwhelming at times, this is an exciting time, as well. The following is an outline of what is needed for ETBHN to continue the work that has started and how to fund that work.

New Structure and Additions

(Salaries are for a full year)

New	Function	Rational
ETBHN Business Manager	Will oversee and advise Executive Director of budget issues Will attend ROC meetings and present financials Work with Executive Director on any financial endeavors and planning for consolidations Be a part of Business Opportunities Committee with Executive Director Monitor all ETBHN Contracts Assist with projects and programs, as needed	This position will add a needed business/accounting in-house expertise to ETBHN.This will assist in planning future consolidations and projects, contract monitoring, and business opportunities.
ETBHN Pharmacy Business Manager	Oversee Pharmacy Operations Position would work on staffing issues Supervisory issues Along with Pharmacist, this position would advise ETBHN Executive Director of pharmacy needs Plan and project ETBHN Pharmacy financial operations Market Pharmacy	This position will provide the needed separation between the ETBHN Executive Director and the Pharmacy, while still giving the Executive Director final authority of pharmacy operations. This position would report to the ETBHN Executive Director, concentrate on staffing, planning, supervisory duties, problem solving between pharmacy and Centers, taking the P&T leadership role and making sure reports are generated that are needed. In addition, it would be the lead on projects that were requested by the ROC on pharmacy data – such as the recent one presented on medication costs vs. hospitalization.
Part Time Assistant ETBHN Part Time Assistant:	Take minutes in meetings not covered by current Administrative Assistant Assist all ETBHN staff with administrative needs	ETBHN currently shares an Administrative Assistant with Burke Center; however her time is filled with other duties from many departments. This position would simply supplement that position. The administrative assistance by the current person would continue for ROC meetings, Board Retreats, and RPNAC meetings. The schedule will be determined by the meetings and events, as needed. As ETBHN grows, the demands on this position will grow. Currently, the Executive Director is hampered in the ability to arrange and coordinate new committees and subcommittees. In order to really grow our Network, this position is needed.
New Committee Structure	Yet to be determined	To be discussed at next retreat
Continue contract with Spindletop for I.S. needs (already accounted for in current ETBHN financials and in projections in Attachment A)	Assist with expansion of Wide Area Network to new Centers Assist with technology needs of ETBHN staff, including Assist with any new endeavors, such as telemedicine Assist with Sharepoint growth and implementation Research new ideas and assist with implementation	This contract is currently in place, but needs to be renewed. It is accounted for in the current financial picture and projected financials. It is a very important piece of ETBHN being able to move forward and advance.