JONAS WAIZER PhD Chief Operating Officer FEGS Health & Human Services System PAUL LEVINE LCSW Executive Vice President & CEO The Jewish Board Of Family.

JONAS WAIZER PhDChief Operating Officer

FEGS Health & Human Services System

PAUL LEVINE LCSW

Executive Vice President & CEOThe Jewish Board Of Family And

Children’s Services

Sunday, April 22, 2012IAJVS Conference

Houston Texas

National Health Reform, Medicaid Redesign and

Behavioral Health Providers:

A Report on Health Homes

TODAY’S OBJECTIVES

1. Health Care Reform: Trends and

Projections

FEGS and JBFCS

National and New York City Trends

2. What are Health Homes?

Current National Focus on Health Homes

New York State Medicaid Redesign

Health Home – Key Elements

3. Strategies - How Can Providers

Prepare?

New Directions

Next Steps

Q & A

FOR-PROFIT

AllSector Technology

Group, Inc.

HR Dynamics, Inc.

Staff Resources, Inc.

F∙E∙G∙S Home

Attendant Services, Inc.

F∙E∙G∙S Home Care

Services

Jewish Care Services of

LI

NYSD Forsyth Housing

Development Fund Co.

NYSD Housing

Development Fund Co.

NYSD Rombouts

Housing Development Fund Co.

F∙E∙G∙S Holding Corp.

Tanya Towers, Inc.

Waverly Residence, Inc.

NOT-FOR-PROFIT:

Behavioral Health

Developmental

Disabilities- Special Needs

Education and Youth

Employment, Workforce

Development

Family Services

Haym Salomon Division of

the Arts

Home Care

Residential and Housing

WeCARE

Work Services

Overview of F·E·G·S Health and Human Services System

© F·E·G·S 2011

F·E·G·S

New York City and LI – 350 Sites$250 Million Budget ($110 Million

Medicaid)100,000+ Individuals/Year with 300+

StaffBehavioral Health Services to 25,000

Individuals/Year with 650 Staff Specialized Housing Nightly Supports

1200 Residential Clients9 Clinics and 3 Recovery Programs

serve 12,000 Persons with SMICare Management to 5900

Individuals/Year by 160 Staff at $13 Million in Medicaid

Specialized Employment to Persons with SMI

Major Operating Divisions:Adults Living with Mental Illness

Children & Adolescent Services

Jewish Community Services

Counseling Services

Domestic Violence and Preventive Services

Early Childhood & Learning

People Living with Developmental

Disabilities

Professional Learning and Development

Affiliate Organization:The Shield Institute, Inc.

Overview: JBFCS

JBFCS

$190 million combined total budget

175 programs in 77 locations across NYC & Westchester

Serving 65,000 clients annually through mental health, social service, developmental disabilities, child welfare & Jewish community programs

Over 2,300 employees, including 350 social workers, psychologists, MDs, and nurses

Over 800 volunteers, providing $1 million of in-kind services

12,000 individuals served in clinics each year

1,100 children and adults call JBFCS “home” each night

Federal Medicaid Facts: Today

• Nationally: 5% of Patients use 45% of Dollars

• Number of Enrolled Clients from 1006-2006 Rose from 19 to 36 Million

• Same Period: Mental Health Spending Rose from $36 to $58 Billion Annually

• Over 50 Million Americans Still Have No Health Insurance

• Federal Affordable Care Act will Cover 30 Million More Americans with Same Level of Funding

New York State Medicaid Challenge

• Accounts for 40% of State Budget

• Covers 25% of State Population

• Contributes to Annual Budget Deficit

• New Governor Appoints Medicaid Redesign Team of All Stakeholders

• Highlights of Medicaid Reform:• Managed Care for All• Integrate Health, BH, SU• Behavioral Health SNP• IT Across Providers (RHIOs)• Health Home – Care Coordination

Federal and State Medicaid Policies

•Deinstitutionalized State Psych Centers

•Encouraged More State Medicaid

•Expanded Community & Residential

Services

•Offered Managed Care as Option

•Promoted Special Needs Plans

•Separated Disability Groups: BH/DD,

Medical

•Promoted “Targeted” Case Management

Behavioral Health: 1990-2005

Federal Medicaid: Deficit Reduction Act (2005)

•Slowed the Growth in Medicaid Costs

•Mandated Managed Health Care

•Offered Medicaid Diversion Programs

•Shift from Day Services to Recovery

(PROS)

•Stricter Conformance to Federal Rules -

OIG

Behavioral Health: 2005 - 2011

Current Federal Medicaid Policies

•Shrink Medicaid

•Don’t Pay Hospitals for Readmits < 30

Days

•Integrate Health, Behavioral Health, SU

•Mandate Managed Care for All by 2014

•“Health Homes” for Complex Cases, esp.

MI

•Quality Measures, Outcomes and

Incentives

•IT Revolution and RHIOs

NYS

Governor’s Medicaid Redesign Team

National Medicaid Reform: 2011 - 2013

Which Clients are Eligible for a Health Home?

People with Medicaid who have:

One Serious And Persistent Mental Health Condition

- OR -

At Least Two Chronic Medical Conditions

- OR –

One Chronic Medical Condition and At-Risk For Another

Chronic Conditions  Include:

Mental Illness

Substance Use Disorder

Asthma

Diabetes

Heart disease

Obesity/ Overweight (BMI over 25)

HIV/AIDS

Hypertension

Why Health Homes?

CMS Gives States Incentives to Establish Health Homes that will:

Create Special Plans for Medicaid “Heavy

Users”

Pay 90% of Care Coordination for this Group

Integrate Medical and Behavioral Health

Engage Consumers, Forge Joint Care Plans

Identify Primary MDs, Specialists (MSWs)

Reduce Healthcare Costs and Improve

Outcomes

How Do Health Homes Reduce Cost and Improve

Outcomes?

Lower rates of emergency room admissions

Reduce hospital re-admissions &

admissions

Reduce Polypharmacy

Decrease reliance on long-term care

facilities

Improve wellness, access, quality of life

Medicaid HEDIS indicators - Schizophrenia

What is a Health Home?

Not a Place, Facility or Medical Home

A Model of Care Coordination Across Providers

Adds Payment for the Care Coordination

A Formal Provider Network with Shared Responsibility that includes Medical, Mental Health and Substance Use

Focuses on Essential Services

Links Providers via Shared IT & Information

Partners with Consumers and Families

Develop a Shared Coordinated Care Plan

Promote “Loyalty” to Service Providers

What Benefits Do Health Homes Provide to Clients?

Assess Full Range of Health Needs

Integrated Service Plans and Flow of Information by Multiple Providers

Promote Health Literacy

Learn to Manage Chronic Illnesses Like Diabetes, Asthma, Hypertension.

Receive Same or Next Day Appointment

Support For Weight Loss, Smoking Cessation, Exercise, Recovery Services.

Provide 24/7 Access To “Help Line”

Supported Employment (TBD)

Health Home Provider Networks Include:

Mental Health and Substance Abuse Service Providers

Other Community Based Organizations

Primary MDs or Practice Groups, or..

Medical Health Clinics (FQHCs)HospitalsManaged Care OrganizationsExisting Management providers Social Service and Residential

AgenciesSupported Employment Agencies

How Does Care Coordination Work?

A Care Coordinator :Documents a common care planNegotiates the Plan with the member, family & providersOversees access to all of the services an individual needsTracks for Adherence to Plans, Prescriptions

A Provider Network:Signs HIPAA agreements and contracts.Shares electronic health information for real time coordinationCommits to shared outcomes: client wellness, fewer visits emergency rooms and hospitals.

What is the Provider Role?

Fast Access - accept referrals immediately.

Collaborate in CCP - integrated care plan.

Look at and Upload IT data with prompt notification of clinic or ER visit, Hospital admission, discharge, etc. 

Participate in assertive transitional care planning, to ensure needed services/ supports are in place.

Provide data for reporting clinical quality metrics to NYS.

Use best practices and participate in Health Home QA activities.

How Can Providers Prepare

The Best Way to Forecast The Future Is

to Invent It

George Bernard Shaw and Steve Jobs

How A Group of New York Providers Responded

• Built On Past Relationships

• Acquired Expertise through a Federal Pilot: The Chronic Illness Demonstration Project

• Political Advocacy

• Investment of Staff Time and Capital Funds

Coordinated Behavioral Care, Inc.

Community Providers Transforming Behavioral Health Care

Provider Assets

Client Loyalty

Capacity to Impact Hospital Performance Metrics Direct Outpatient Aftercare Divert Re-hospitalization Divert ER Overuse

Residential Beds & Crisis Beds: ER Diversion

Track Record in Case Management and Community Coordination

Specialized Mental Health Clinics and Recovery Programs

Intent to Build Medical Homes

Shared Interest in Becoming a SNP

CBC Inc.Building Shared Infrastructure

Central CBC Provides or Arranges for:GovernanceApplications, LicensesContracts: MCO and ProvidersProvider Network RelationsMarketing/PRCore Policies & Procedures, Best PracticesCall Center: 24/7 CapacityCentral IT Billing, Data AnalyticsTechnical Assistance & ConsultingLearning Collaborative: How to be an MCO

Next Steps

Remain Providers during “Change”

Integrate Health and BH, SUAccept MCO Capitation

ContractsLearn Business of Managing

RiskLink to IT Exchanges Retrain Staff to Think OutcomesDevelop Data AnalyticsWork in Progress