NEW YORK CARE COORDINATION PROGRAM: A VIEW OF CURRENT INITIATIVES IN THE ERA OF MBHO’S AND HEALTH HOMES Bob Long Co-chair, NYCCP Steering Committee Commissioner of Mental Health – Onondaga County
Feb 22, 2016
NEW YORK CARE COORDINATION PROGRAM:
A VIEW OF CURRENT INITIATIVES IN THE ERA OF MBHO’S AND HEALTH HOMES
Bob LongCo-chair, NYCCP Steering CommitteeCommissioner of Mental Health – Onondaga County
What is the NYCCP? A multi stakeholder learning
collaborative (counties, peers and families, providers)
Focused on behavioral health system improvement
Data and outcomes driven Covers about 3.5 million people in seven
NY counties (Westchester, Erie, Monroe, Onondaga, Chautauqua, Genesee, Wyoming)
What can be learned from over 20 years of health care cost control?
Those who cannot remember the past are condemned to repeat it. ~ George Santayana
Lessons Learned: If You Focus on Costs (Managed Cost)
Restricts access to services & recovery, e.g.: Limited or no behavioral health care benefits Laborious pre/re-certification processes Rigidly applied ‘medical necessity’ criteria Arbitrary service limits (thresholds or caps) Limited covered services (rehabilitation, peer
support, etc) Inadequate provider panel (no choice,
delayed access) Results in short term savings (‘this fiscal year’
is all that matters), which leads to… Prolonged suffering, higher long term costs &
cost shifting (social services, homeless shelters, police, jails).www.carecoordination.org
Lessons Learned: If YouFocus on People (Managed Care) Person centered/Family Driven: every plan is
centered on the person’s goals, strengths & preferences, not just the available services; service and reimbursement systems are flexible
The goal is quality of life, not stabilization and maintenance and not just cost containment
Recognizes stages of change: supports and promotes the person’s ability to make
positive changes in his or her life Uses motivational interviewing concepts
Attends to longer term costs and benefits
NYCCP Results:Focusing on People
Quality of life results: Days in hospital down 53% Emergency room visits down
46% Gainful activity up 31%,
including a 51% increase in completive employment
Self harm down 54% Arrests down 25%
NYCCP Results(under Fee for Service System – i.e. no
binding utilization management)
Financial Results Comparing Case Management and ACT
recipients in NYCCP counties to 6 comparable counties - cost per recipient in NYCCP Counties is: 92% lower costs for inpatient 42% lower costs for outpatient 13% lower costs for community support 41% lower costs overall.
The moral of the story: helping people live more healthy and productive lives saves money.
How do Clinic Reform, PROS and Ambulatory Reform Move us Forward? Improved access to service & greater
recovery focus, e.g.: Broader covered services (e.g.
Rehabilitation Services, Outreach & Engagement, Crisis Intervention)
Greater integration and flexibility allows the system to be more person centered: More integrated services (e.g. PROS) More flexible services (e.g. >1 clinic
service in a day) Family driven services (ambulatory
reform)
The future ain’t what it used to be. ~ Yogi Berra
What’s next?
State: Regional Behavioral Health Organizations (RBHO’s) For recipients who are not enrolled in
managed care (“carve outs”) - all ages, mental health and alcohol and substance abuse
Charged with (for two years): Coordinating care and managing utilization
for Medicaid behavioral health services Approving, coordinating & facilitating
continuity and integration of behavioral health/physical health services
Goal: prepare the behavioral health system for full managed care
Federal: Health Homes Designed to:
be person-centered systems of care for people with at least two chronic conditions; one chronic condition and be at risk for another; or one serious and persistent mental health condition
facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care, and long-term community-based services and supports.
States can offer health home services in a different amount, duration, and scope than services provided to individuals not in the defined health home population
Health Homes (cont) Health home services include:
comprehensive care management - care coordination and health promotion
comprehensive transitional care from inpatient to other settings, including appropriate follow-up;
individual and family support; referral to community and social support
services, if relevant; and Meaningful use of health information
technology to integrate service provision
NYCCP RBHO/Health Home Vision
RBHO regions that respect established affinities - i.e. geographic preferences for where people receive their care
RBHO as ‘superstructure’ for Health Homes
RBHO as ‘superstructure’ Develops/coordinates health homes throughout
the designated region Coordinates care and manages utilization for
Medicaid behavioral health services delivered throughout the region
Coordinate & facilitate continuity and integration of behavioral health/physical health services
Efficiently provide functions (e.g. outreach to underserved people, education & training, interface with HMO’s for physical health, information technology, data analysis/ performance monitoring/CQI) to health homes
Possible Health Home Structures within the RBHO Health Homes include multiple provider
arrangements Single Provider – large provider with a full
array of physical and behavioral health services.
Provider Network – formal network of providers, who, in total, provide a full array of physical and behavioral health services.
Health home coverage may include: Multiple health homes in a single county One health home serving multiple counties
NYCCP RBHO/Health Home Vision
BHOHH1
HH2HH3
HH4
16www.carecoordination.org
Provider A
Provider B
Provider C
Provider D
Provider E
Provider F
www.carecoordination.org 17
QUESTIONS?