New Jersey Stakeholder Group Meeting January 20 2012 Allison Hamblin CHCS Behavioral Health System Reform Why Such a Hotbed of Activity Its all in the numbers Top 5 drives 50 of Medicaid spending ID: 577575
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State Models of Medicaid/Behavioral Health Collaboration
New Jersey Stakeholder Group Meeting
January 20, 2012
Allison Hamblin,
CHCSSlide2
Behavioral Health System Reform:
Why Such a Hotbed of Activity?
It’s all in the numbers…
Top 5% drives 50% of Medicaid spendingHalf of beneficiaries with disabilities have BH comorbidityAddition of mental illness and substance use disorder to chronic medical population is associated with 3-4x increase in costs25 years of lost life expectancy associated with serious mental illness, primarily due to physical health issuesYet, most of these individuals receive services through fragmented, uncoordinated systems
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*Sources: RG Kronick et al., “The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions.” Center for Health Care Strategies, October 2009; C. Boyd, et al. “Clarifying
Multimorbidity
for Medicaid Programs to Improve Targeting and Delivery of Clinical Services.” Center for Health Care Strategies, December 2010. Slide3
Impact of Mental Illness & Substance Use Disorders on Cost and Hospitalization for People with Diabetes
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SOURCE: C. Boyd et al.
Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services. Center for Health Care Strategies, December 2010. Slide4
The National Landscape
General trend away from fee-for-service toward managed systems of care
Efforts to promote integration at both the system level and at the point of care
Aligned incentivesInformation exchangeAccountable care homesSignificant variation in approach4Slide5
A Range of Approaches to Reform
State
System Design
TennesseeIntegrated MCOsPennsylvaniaFinancial alignment across MCOs/BHOs
ArizonaIntegrated BHO linked to BH Home
New YorkASO to BHO/Integrated BHO5Slide6
Pennsylvania’s Approach
Separate
capitated
systems: MCOs and BHOsRegional pilots to promote integration for individuals with SMICreated Shared Incentive Pool tied to Performance MeasuresProcess: Integrated health profiles, real-time hospital notificationOutcomes: ED visit and hospital admission ratesDesignated accountable care home6Slide7
New York’s Approach
Separate approaches based on level of BH need
Mild to moderate: MCO continues to include BH services
Higher acuity: movement from FFS to managed carePhased implementationASO in 2011Capitated managed care in 2013Geographic variationNYC: Integrated BHO/SNPElsewhere: BHOLinkage to health home
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Common Elements to Promote Integrated Care
Aligned financial incentives (e.g., to coordinate, reduce hospitalizations, etc)
Information exchange
Clear policy guidance on privacy issuesAccountable care homesMultidisciplinary care teamsCompetent provider networksMechanisms for assessing and rewarding high-quality care 8