Jami Snyder Associate Commissioner Texas Medicaid and CHIP Services Department NAMD Fall Meeting November 7 2017 Texas Approach Texas Medicaid maintains four distinct product lines and contracts with 20 MCOs that offer a full continuum of services including behavioral health services ID: 792367
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Slide1
Behavioral Health Integration in Texas
Jami Snyder, Associate Commissioner
Texas Medicaid and CHIP Services Department
NAMD Fall Meeting
November 7, 2017
Slide2Texas Approach
Texas Medicaid maintains four distinct product lines and contracts with 20 MCOs that offer a full continuum of services, including behavioral health services
Behavioral health (BH) fully integrated into product lines as services and supports were carved in to managed care
Integrated products include:
STAR
STAR+PLUS
STAR Kids
STAR Health
Slide3Stakeholder Engagement
Commitment to stakeholder engagement
BH Advisory Committee comprised of members, MCO representatives, and providers
Provide routine guidance on critical policy and programmatic changes aimed at enhancing member experience
Recommendations incorporated into solicitations, contracts and policy guidance, as appropriate
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Slide4Contractual Mandates
Ongoing effort to strengthen contract requirements
Enhanced oversight of MCOs that delegate function to Behavioral Health Organizations (BHOs)
Service Coordination requirements for STAR Kids and STAR+PLUS products
Targeted case management
BH hotline standardsNetwork adequacy standards for outpatient BH services and psychiatristsDelivery system reform expectations
Slide5Quality Management
Track and report on 15 BH specific quality measures
Targeted quality measures integrated into the Pay for Quality program
Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medication (STAR+PLUS)
Potentially preventable visits (STAR, STAR+PLUS, CHIP)
Implementation of performance improvement projects focused on coordination effortsCare transitions
BH and family support services for caregivers
Self directed care for individuals with mental illness
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Slide6Follow-Up After Hospitalization for Mental Illness Within 7 Days
Slide7Antidepressant Medication Management
Slide8Home Health Pilot
Serves individuals with serious mental illness and at least one other chronic health condition
Go-live on 9/1/2017 (two year pilot)
Health homes must comply with principles for patient-centered medical homes
Two sites established using Certified Community Behavioral Health Clinic pilot
Tropical Texas & Burke Center
Co-located primary care physician model and warm hand off model employed
Qualitative and quantitative evaluation of performance in coordinating continuum of services
Slide9Delivery System Reform
Focus on provision of BH services and care coordination among DSRIP project participants
Twenty-five percent of 1200+ DSRIP projects have a BH focus
Specific areas of focus/intervention
Preventing unnecessary utilization
Improving access through availability of mobile clinics and after hours careEnhancing BH crisis stabilization services
Integrating BH and physical health at point of service
Slide10Challenges/Opportunities
Development of more robust, targeted quality metrics
Continued focus on coordination and alignment among MCOs that subcontract with BHOs, including integrated staffing models
Ongoing evaluation of MCOs’ integration efforts, evaluating distinctions in need between product lines, populations, etc.
Continued work with policy makers who have historically championed integration initiatives
Maximize capacity of structural integration within Health and Human ServicesAdvance need for strategic approach to use of available resources
Slide11Questions?
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