Harvey Rosenthal NYAPRS Philip Saperia CBHA John Copolla ASAPNYS NJAMHAA Annual Conference April 13 2016 1 A peerled statewide coalition of people who use andor provide community mental health recovery services and peer supports that is dedicated to improving services soci ID: 556940
Download Presentation The PPT/PDF document "NYS Medicaid Redesign: How to Transform ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
NYS Medicaid Redesign: How to Transform a State Health and Behavioral Health System Overnight
Harvey Rosenthal NYAPRSPhilip Saperia CBHA John Copolla ASAPNYSNJAMHAA Annual ConferenceApril 13, 2016
1Slide2
A peer-led statewide coalition of people who use and/or provide community mental health recovery services and peer supports that is dedicated to improving services, social conditions and policies for people with psychiatric disabilities
by promoting their recovery, rehabilitation, rights and community integration and inclusion. 2New York Association of Psychiatric Rehabilitation Services
(NYAPRS)Slide3
AdvocacyTraining
& Technical Assistance Peer Service InnovationsEmployment & Economic Self-Sufficiency Cultural CompetenceMedicaid Redesign Team, Behavioral Health Work Group, Value Based Payment Steering Committeeharveyr@nyaprs.org
www.nyaprs.org
3
New York Association of Psychiatric Rehabilitation Services
(NYAPRS)Slide4
As the umbrella advocacy organization of behavioral health agencies in New York City and environs, the Coalition’s mission is to advocate for, inform, and provide training and technical assistance for these agencies so that they may provide the best possible services with sufficient funding in a favorable regulatory environment.
4Coalition for Behavioral Health AgenciesSlide5
Taken together, these agencies serve more than 350,000 adults and children and deliver the entire continuum of behavioral health care in every
neighborhood. MRT Behavioral Health Work Grouphttp://www.coalitionny.org/
5
Coalition for Behavioral Health AgenciesSlide6
AdvocacyCommunicationsResearch and Information
Learning and Technical AssistanceCollaborative Decision MakingSystem Change Promotion (Center for Rehabilitation and Recovery)Fighting Stigma6Coalition for Behavioral Health AgenciesSlide7
ASAP is committed to working together to support organizations, groups and individuals that prevent and alleviate the profound personal, social and economic consequences of alcoholism and substance abuse in New York State.
ASAP represents the interests of the largest alcoholism and substance abuse prevention, treatment, research and training providers in the country.7Alcoholism and Substance Abuse Providers of New York StateSlide8
ASAP is committed to working together to support organizations, groups and individuals that prevent and alleviate the profound personal, social and economic consequences of alcoholism and substance use disorders in
NYS.http://www.asapnys.org/ 8Alcoholism
and Substance Abuse Providers of New York StateSlide9
Advocacy & Representation in Albany and WashingtonNetworking
Immediate access to industry breaking news Conferences and Training OpportunitiesMRT Behavioral Health Work Group9
Alcoholism
and Substance Abuse Providers of New York StateSlide10
Very high health, social and criminal justice costs with very low outcomesEarly mortality: cardiovascular, respiratory and infectious diseases, diabetes and hypertension
Highest rates of avoidable readmissionsHigh rates of violence victimization, incarceration, homelessness and suicideChange is not Optional10Slide11
High rates of poverty: unemployment and idlenessStigma and discrimination: isolation
Loss of hope, purpose, dignityMagnified exponentially for communities of color and other underserved groupsChange is not Optional11Slide12
Fragmented, Siloed and UncoordinatedUnresponsive: Reactive vs Preventive and DiversionaryUnaccountable: who can we turn to?
Wrong Incentives: volume over valueIllness over Wellness? Wellness over Illness?‘Chronic’ Patienthood over PersonhoodChange is not Optional12Slide13
$54 billion Medicaid program with
5 million beneficiaries20% (1 million beneficiaries) use 80% of these dollars: hospital, emergency room, medications, longtime “chronic” servicesOver 40% with
behavioral health
conditions
20% of those discharged from general hospital BH units are readmitted within 30 days: NYS
avoidable Medicaid hospital readmissions: $
800 million
to
$
1 billion annually
70% with
behavioral health
conditions;
3/5
of these admissions
for
medical
reasons
13
New York State’s Challenge (2011)Slide14
From fee for service to outcome based careDiversion from emergency room and inpatient hospital useSurprise! We are healthcare providers
Buy or Build?14Some MRT MantrasSlide15
Waste and inefficiencies in the system
Winners and losers (not all boats get lifted) Intellectual and administrative bandwidth to manage VBP Quality of care will actually be improvedArthur Webb Group
15
Starting
AssumptionsSlide16
16Slide17
Inpatient - SUD and MH
Clinic – SUD and MHPersonalized Recovery Oriented ServicesAssertive Community TreatmentPartial HospitalizationComprehensive Psychiatric Emergency Program
Targeted Case Management
Opioid treatment
Outpatient chemical dependence rehabilitation
Rehabilitation supports for Community Residences
(phased in in 2016)
17
The Carve-in:
Managed Care Plans Now
O
ffer Medicaid funded BH ServicesSlide18
• Designed for people with more extensive mental
health and/or substance use related conditions• Covers all benefits provided by Medicaid Managed Care Plans, including expanded behavioral health benefits• Also provides additional Home and Community Based Services to help people live better, go to school, work and be part of the community
18
Health and Recovery PlansSlide19
Who’s Eligible for a HARP?
SSI Recipient ACT, TCM, PROS, PMHP in past year30+ days of psych hospitalization, 3+ admissions or 3+ month stays in OMH housing over the past 3 years60+ days in OMH psych centerIncarceration w BH treatment past 4 years2+ SUD ER visits, detox stays for SU related inpatient stays
19Slide20
Have both Medicaid and Medicare Live in a nursing home
Are in a Managed Long Term Care Plan Are under age 21 Have services from the Office for People with Developmental Disabilities (OPWDD)20
Who’s Not Eligible for HARPs?Slide21
AetnaCapital District Physicians Health PlanExcellus Health Plan.
Fidelis Care New York MVP Health Care$2,500 PMPM21Health Plans in Broome CountySlide22
Health homes are ‘a home for your healthcare” Everyone gets a care coordinator who conducts an
assessment and works with each individual to develop their own goal and service plan which are intended to be shared electronically with all providers and social services that support themHealth home responsibilities include: Active engagement24-7 responseFocus on well coordinated discharge and treatment planning
22
HARP Beneficiaries’ Care is
Managed via Health HomesSlide23
• To Get Connected to the Future
• Part of an Integrated Care Team • Access to Referrals • Electronic Data Sharing • Outcome Focused and Accountable • Positioned for Managed Care: Health Homes are Organizing Networks Which Will Contract with MC Companies
•
Behavioral Health Providers Bring Vital Services to
Networks
23
Health Homes
Advantages for ProvidersSlide24
• Integrated Care •
Help with Navigating the Health Care System Better Access Better Coordination • Wellness and Person Centered • Skills to Stay Healthy
24
Health Homes
Advantages for BeneficiariesSlide25
Rehabilitation
Psychosocial RehabilitationCommunity Psychiatric Support and Treatment (CPST)Residential Supports/Supported Housing
Habilitation
Crisis Intervention
Short-Term Crisis Respite
Intensive Crisis Intervention
Mobil Crisis Intervention
Educational Support Services
NYS
Home and Community Based Services Option:
Medicaid Will Now Pay for
(Post Health Home Assessment: )
Support Services
Family Support and Training
Non- Medical Transportation
Individual Employment Support Services
Prevocational
Transitional Employment Support
Intensive Supported Employment
On-going Supported Employment
Peer and Family Supports
Self Directed Services
25Slide26
=
Physical and/or behavioral health care provider, including HCBS
Health and Recovery Plan (HARP)
w
ith a BHO
Health and Recovery Plan (
HARP)
Health and Recovery Plan (HARP
)
with a BHO
Health Home
Team
OMH
Health Home
Team: Provider Network
Health Home Team
Health Home Team
NYS Medicaid Redesign Response:
Managed Integrated BH & Medical Care
26
STATE MEDICAID AGENCY DOH
OASAS
26Slide27
Arms Acres Conifer Park Greater Binghamton Health Center Arms Acres
Southern Tier AIDS ProgramUnited Health Services The Family and Children's Society 27United Health Services
Southern Tier Health HomeSlide28
Broome County Mental Health Department Volunteers Of America YMCA
Twin Tier Home Health Binghamton Housing Authority Broome County Council Of Churches Broome County Department Of Social Services Broome County Lift Broome County Office For The Aging 28
United Health
Services
Southern Tier Health HomeSlide29
CASACommunity Hunger Outreach WarehouseMental Health Association Of Southern Tier
Professional Home Care Addictions Center Of Broome County Alcoholics Anonymous American Cancer Society Fairview Recovery Services Holliswood Hospital 29United Health
Services
Southern Tier Health HomeSlide30
Mothers And Babies Perinatal Association Narcotics Anonymous Opportunities For Broome
Rehabilitation Support Services Retired And Senior Volunteer Program Salvation Army Serafini Transportation Corporation SOS Shelter Southern Tier Healthlink30
United Health Services
Southern Tier Health HomeSlide31
7 days from inpatient discharge to outpatient appointment30 days to filled prescription
Depression screening and follow up31Beyond HEDIS Outcome MeasuresSlide32
Participation in employment
Enrollment in vocational rehabilitation services and education/trainingImproved or Stable Housing statusAccess to and use of Peer SupportLonger Community tenure, Decreased Hospital ReadmissionsDecreased Criminal justice involvementImprovements in functional status
Cultural & Linguistic Competence, Engagement
HCBS Outcome Measures:
Social Determinants of Care
32Slide33
What impacts health outcomes?
Source: Schroeder, Steven A. We Can Do Better – Improving the Health of the American People. N Engl J Med 2007;357:1221-833Slide34
Full addiction treatment coverage could result in $398 savings per-member per-month (PMPM) in Medicaid spending
Medical costs were $311 lower PMPM than for people who needed but did not receive treatmentTreatment > 60 days can save $8,200 in healthcare/productivityLikelihood of being arrested decreased 16%; likelihood of felony conviction dropped by 34%34Outcome Data is KeySlide35
Individuals in MAT use half of the health care resources; pregnant women had shorter hospital stays for addiction treatment (10 days vs. 17.5 days)MAT was associated with fewer inpatient admissions for alcohol dependence cases, and the total health care costs were 30% less
Medical costs decreased by 33% for Medicaid patients over three years following their engagement in treatmentBecky Vaughn VP of Addictions National Council for Behavioral Health35
Outcome Data is KeySlide36
$7.1 billion over 5 years for DSRIP$650 million to play for Home and Community Based Services
36NYS Medicaid WaiverSlide37
Promotes community-level collaborations that improve the quality and outcomes of care, while achieving a 25%
reduction in avoidable hospital use from 2015-20. Safety net providers are expected to collaborate to implement innovative projects focusing on system transformation and population health improvement. All DSRIP funds will be based on performance linked to achievement of project milestones.
37
Delivery System Reform Incentive
Payment Program (DSRIP)Slide38
DSRIP leadsUrgent Care CentersBuying primary care practices
Building or buying community behavioral health services?38Giving DSRIP Funds to Hospitals….to Keep People out of Hospitals?!ReinventionsSlide39
Performing Provider Systems are networks of providers that collaborate to implement DSRIP projectsEach PPS must include providers to form an entire continuum of care
HospitalsHealth HomesSkilled Nursing Facilities (SNF)Clinics & FQHCsBehavioral Health ProvidersHome Care Agencies
Other Key Stakeholders
Community health care needs assessment based on multi-stakeholder input and objective data
Building and implementing a DSRIP Project Plan based upon the needs assessment in alignment with DSRIP strategies
Meeting and Reporting on DSRIP Project Plan process and outcome milestones
25 Performing Provider Systems
39Slide40
Project
DescriptionPPSs Involved3.a.i
Integration of primary care and behavioral health services
25
3.a.ii
Behavioral health community crisis stabilization services
11
3.a.iii
Implementation of Evidence-Based Medication
Adherence Program (MAP) in Community Based Sites for Behavioral Health Medication Compliance
2
3.a.iv
Development of Withdrawal Management (e.g. ambulatory detoxification, ancillary withdrawal services)
capabilities and appropriate enhanced abstinence services within community-based addiction treatment programs
4
3.a.v
Behavioral Interventions Paradigm (BIP) in Nursing
Homes
1
4.a.i
Promote mental, emotional
and behavioral (MEB) well-being in communities
2
4.a.ii
Prevent Substance Abuse and other Mental Emotional Behavioral Disorders
1
4.a.iii
Strengthen Mental Health and Substance Abuse Infrastructure across Systems
13
Key Mental Health Projects in DSRIP
40Slide41
Integration of primary care and behavioral health services (required of all 25 PPSs)
16 PPSs also included: Community crisis stabilization servicesTransitional SupportsActivation Medication adherence programs Withdrawal Management Behavioral Interventions in Nursing Homes
41
Behavioral Health ProjectsSlide42
Also known as: Southern Tier Rural Integrated Performing Provider System, Inc., STRIPPS, United Health Services Hospitals, Inc.
Counties served: Broome, Chemung, Chenango, Cortland, Delaware, Schuyler, Steuben, Tioga, TompkinsAttribution for Performance: 102,386Total Award Dollars: $224,540,27542
Care
Compass NetworkSlide43
Integrated Delivery SystemDevelopment of Community Based Health Navigation ServicesPatient Activation
Evidence-Based Strategies for Disease ManagementCOPD Preventative Care and Management43ProjectsSlide44
30 Day Care Transitions for Chronic Diseases, including BH Conditions
Integration of Behavioral Health and Primary CareStrengthen Mental Health and Substance Abuse Infrastructure, Prevention and Targeted InterventionsCrisis Stabilization44ProjectsSlide45
Home CareIndependent Living CenterAddiction CenterNursing and Rehabilitation Center
Primary CareCounty Health DepartmentsCounty Office for AgingHospice and Palliative Care45Provider GroupsSlide46
HospitalsVocational RehabilitationServices for People w Developmental Disabilities
Health HomesCompeerPharmacies46Provider GroupsSlide47
Hospice and Palliative CareTherapeutic CommunitiesSenior Living Center
Suicide Prevention And Crisis ServiceUnited Cerebral Palsy AssociationVisiting Nurse Service YMCA47Provider GroupsSlide48
Lakeview Mental Health Services, Liberty ResourcesMental Health Association of the Southern Tier
Northeast Parent and Child Society Onondaga Case Management ServicesParsons Child And Family CenterPhoenix HousesPlanned ParenthoodRehabilitation Support Services48
Behavioral Health ProvidersSlide49
What are Value Based Payments (VBPs)? An approach to Medicaid reimbursement that rewards value over volume
Incentivizes providers through shared savings and financial risk Directly ties payment to providers with quality of care and health outcomesA component of DSRIP that is key to the sustainability of the ProgramValue Based Payment
49Slide50
Required to ensure ‘long term sustainability of DSRIP investments”By waiver Year 5 (2019),
all MCOs must employ non-fee-for-service payment systems that reward value over volume for at least 80-90% of their provider payments50Value-Based Payment ReformSlide51
Required to ensure that “value-destroying care
patterns” (avoidable admissions, ED visits, etc) do not simply return when the DSRIP funding stops in 2020 If VBP goals are not met, overall DSRIP dollars from CMS to NYS will be significantly reduced51Value-Based Payment ReformSlide52
Accountability and Risk Go Together
52Slide53
To share in savings, you eventually need to take on risk…Partnering with other providers is essential to being able to take on risk
We need to join forces with other providers to have enough cash reserves to take on Level 2 risk, which applies 90% of the savings to reward effective providers. 53VBP: Sharing in the SavingsSlide54
NYAPRS proposes to provide peer bridger services aimed at helping people with ‘serious’ mental health and addiction related conditions to
:Reduce avoidable emergency room and inpatient visits by 40%Increased self-management and participation with chosen medications, services and supportsStages: Outreach & Engagement, Crisis Stabilization, Wellness Self Management, Community ConnectionsNYAPRS has successfully applied this model within a managed care contract to reduce hospital use by 48% and Medicaid spend by 47%54
Value-Based
Propositions
An exampleSlide55
OMH HCBS services added to the list of SDH interventions
All Level 2 and 3 plans or providers must address at least one social determinant and contract with at least 1 CBO NYS must provide infrastructure dollars and technical assistance for community based providers55Value Based Payment Work Groupssome f
inal
recommendationsSlide56
VBP outcomes should include recovery and social determinant related ones Strong emphasis on cultural competence
Buy not BuildPosition our members for gain sharing56Value Based Payment Work Groups
some f
inal
recommendationsSlide57
Uncapped Member Incentive Programs
Creation of an Expert Group for Achieving Cultural Competence in Incentive Programs Use of Patient Reported Outcomes (PRO)Expansion of ombuds programPlan for how best to communicate VBP to consumers/members57
Value Based Payment Work Groups
some f
inal
recommendationsSlide58
Goal: Overall improvement in health and well being Care management: Engage, control, process
Data warehouse: Know the people you serve and capture the information Quality: know your value Cost: Dig into the cost of delivery—small margin world Risk: Understand your tolerance level Tools: Build them—IT, clinical measurement Collaborate!
Arthur
Webb Group
58
VBP Implications for
ProvidersSlide59
Partnerships
With each otherHealth HomesWith PPSsMCOsFQHCsPrimary Care ProvidersIPAsMSOs59Slide60
More people will be servedGetting a better bang for the buck
There will be painFewer providersMajor consolidation across the spectrumMembership in major networksSafety net support will be a must Arthur Webb Group
60
In Five Years From Now…Slide61
Transitional funding: Start up, HIT, Capital InfrastructureManaged Care Technical Assistance Center
https://www.health.ny.gov/health_care/medicaid/redesign/: webinars, whiteboards, reports61MRT ResourcesSlide62
CBHA, ASAP, NYAPRS: Advocacy, Education, TA
Member agencies: attain good positioning in health home and DSRIP networks, offer relevant and reliable value propositions, raise level of infrastructure (contracting, billing, compliances) and workforceRecovering people: be prepared to make informed choices!; New health home assessment, plan and selection of recovery and HCBS services; use of self-directed care dollars and ‘patient incentives’
62
Homework