NYAPRS 7th Annual Executive Seminar on Systems Transformation April 27 - 28, 2011 Adele Gregory Gorges, Executive Director New York Care Coordination Program.

NYAPRS 7th Annual Executive Seminar on Systems Transformation April 27 - 28, 2011 Adele Gregory Gorges, Executive Director New York Care Coordination Program Delivering Recovery-Focused Treatment Services in a Managed Care Environment

www.carecoordination.org 2

New York Care Coordination Program 3 Multi-county, multi-stakeholder collaborative to improve outcomes for those with serious behavioral health issues Formed in 2000, operational in mid-2002 six western and central counties, with support from the NYS Office of Mental Health, project management through Coordinated Care Services, Inc. (CCSI). Partnership with Beacon Health Strategies, LLC in 2009 for managed care. Expanded in 2010 to include Westchester County 3,000 enrollees at any one time

NYCCP Strategic Plan for System Transformation 4 Structures Participatory process for governance Data access, analysis and reporting capacity Platform for disseminating best practices Initiatives Culture change to a person-centered, recovery-focused system of care Care coordination Physical health integration Finance reform Pay for performance Managed behavioral health Conserve dollars for behavioral health Use dollars flexibly Information

ACT 1: Laying the Foundation 5 Transformation initiatives lay the foundation for recovery-focused managed care Collaborative processes Person-Centered Practice Care Coordination Health integration Data driven to promote wellness

Guiding Principles for Person-Centered, Recovery-Focused Services, Developed by the Peer and Family Advisory Group of the WNYCCP, 2007 6 The goal is recovery, not just stabilization and maintenance.Hope is necessary and recovery is possible for everyone.Every individual is unique; every recovery different.People have prompt access to compassionate care and services. The system is flexible, wherever possible, to support the persons recovery. Every plan for recovery is centered on the persons goals, strengths, and preferences -- not the availability of a particular program or service.

7 Guiding Principles (cont.) Natural supports, outside the mental health system, are explored and encouraged. Family support is valued and included when appropriate. There is a partnership between individuals and their treatment team, care coordinators, service providers, and their peers and family members, when appropriate. Individuals are educated to make informed choices about their health care and recovery. Peers (people in recovery) are included and involved at all levels in the organization. Everyone is treated with dignity and respect; differences in culture, belief, or language are valued.

Creating a Person-Centered, Recovery-Focused System of Care 8 Education and training Onsite mentoring Online resources recoveryskillbuilder.com Webinars Focused modules MonitoringIncentives

Care Coordination 9 From traditional Case Management to new Care Coordination practice with recovery focus, person- centered tools, methods, approaches Pilots of care coordination with varying intensity and duration, in varying settings, and in partnership with Managed Medicaid HMOs Additional competencies: for integrated care coordination for persons with complex needs

Person-Centered, Recovery-Focused Care Coordination adds value 10 Better quality 46% decrease in emergency room visits per enrollee* 53% reduction in days spent in a hospital* 78% of enrollees report dealing more effectively with problems (2009 Enrollee Survey) Better outcomes 31% increase in gainful activity* 54% decrease in self harm among enrollees* 53% reduction in harm to others* Lower costs 2008 Medicaid mental health costs for Care Coordination populations in NYCCP vs. comparison counties: (OMH August 2010) 92% lower for inpatient services 42% lower for outpatient services 13% lower for community support physical health savings would be additional. $5,541 lower average cost person * 2009 Periodic Reporting Form Analysis

11 Of Erie and Monroe mental health users, the top 10% in total cost represent 63% of Medicaid hospital and residential spending yet only a quarter of the top 10% were enrolled in available Care Coordination programs ACT ICM SCM DATA DRIVEN: Medicaid claims analysis shows need to refocus community care coordination on the right MH consumers Note: Analysis of all 2007 claims for Medicaid recipients 18 or over, with any mental health claim, excluding individuals with any OMRDD or nursing home claim. 11

ACT 2: NYCCP in Partnership with Beacon Health Strategies, LLC for Managed Fee for Service 12 Complex Care Management Intensive, short-term service for individuals with highest needs -- serious mental illness, complex medical needs, top 10% in total costs. Average length of stay of 6 months. Melds Person-Centered Practice as an underpinning for the initiative AND a managed care focus on an episode of care and movement to recovery. Teams provider-based Complex Care Coordinators (ICM) with MBHO based Complex Care Managers. Identified care coordinators are trained for delivery of care coordination in a short term model with a focus on physical as well as behavioral health care Identified MBHO care management staff required to be trained in Person- Centered Practices On the ground, in the community Care Coordinators plus office based CMSA-lead, office based Care Managers with significant physical health and behavioral health experience

Complex Care Management (cont.) 13 Grounded in supporting individuals to attain recovery goals related to life objectives living, working, socializing. Empowers individuals through development of skills for self- management of physical and behavioral health symptoms Supports individuals in building an integrated, coordinated team of providers of choice Enhances the use of Peer Support services and other natural supports in the community. As generally available in the community, but also purchased using wrap around dollars if necessary for program enrollees. (e.g. Compeer Peer Wellness Coaches for the Well Balanced Program)

Learning through Collaboration 14 Managed care learned about person-centered practice NYCCP providers, peers and counties learned that the managed care tools and skills are helpful in promoting recovery Focusing efforts on high cost/high need individuals can produce dramatic outcomes

ACT 3: Managed Care and Health Homes 15 NYCCP wants to build on what we have learned about the effectiveness of: Collaborative processes Person-centered, recovery-focused approaches Complex Care Management in collaboration with Beacon Health Strategies Can be an effective core for Specialty Behavioral Health Homes Focuses HR/HN populations and episodes of care Can be expanded through repurposing of care coordinators/targeted case managers and added MBHO capacity Maximizes resources through shorter lengths of stay in care coordination and effective linkage with providers of choice Effective linkage to a provider of choice for a health home can lead to enhanced self management skills, timely health promotion and prevention services, early intervention, and mind-body health

NYCCP RBHO/Health Home Vision RBHO HH1 HH2HH3 HH4 Provider A Provider B Provider C 16

Functions of RBHO as superstructure 17 Develop/coordinate health homes throughout the designated region. Coordinate care and manage utilization for Medicaid behavioral health services delivered throughout the region. Approve, coordinate & facilitate continuity and integration of behavioral health/physical health services within Health Homes and between Health Homes in the region. Provide back office functions (e.g. data analysis) for the network of affiliated health homes. Functional overlap comparison:

Functional Overlap Comparison REGIONAL BEHAVIORAL HEALTH ORGANIZATION OPERATIONS SPECIALTY BEHAVIORAL HEALTH HOME SUPPORT FUNCTIONS Provider network development, contracting and credentialing Same, for subset that are Health Home Providers N/A Training for provider based Health Home Care Coordinators Preauthorization of services and utilization review N/A Complex Care ManagementSame, for Health Home enrollees Medical Oversight of utilization review and case management Same, for case management only Claims payment (preferred)Same 18

Comparison of Functions (cont.) REGIONAL BEHAVIORAL HEALTH ORGANIZATION OPERATIONS SPECIALTY BEHAVIORAL HEALTH HOME SUPPORT FUNCTIONS Data submission to New York State, including to the EMedNY system, as required by New York State Same, as per for Health Home Client Outcomes and Quality monitoring Same, as per for Health Home Claims data analysis for case finding purposes Same, as per for Health Home ReportingSame, as per for Health Home Provider and Recipient Dispute Resolution Same, as per for Health Home Coordination of care with Health Maintenance Organizations in which individuals are enrolled Same, as per for Health Home 19

Comparison of Functions (cont.) REGIONAL BEHAVIORAL HEALTH ORGANIZATION OPERATIONS SPECIALTY BEHAVIORAL HEALTH HOME SUPPORT FUNCTIONS Coordination of care with HMOs in which individuals are enrolled Same Coordination of care with Health HomesCoordination of care with RBHO Use of the FlexCare information system to manage RBHO program operations; Same, for Health Home program operations Use of the FlexCare System for Care Management Use of the FlexCare System for Care Management and Care Coordination (enable provider care coordinators, individual recipients, NYCCP, and local governmental units to view case management records of individuals in the RBHO.) 20

Target Populations for Specialty Behavioral Health Homes 21 Adults with Serious Mental Illness Children with Serious Emotional Disturbance Adults and Children with Serious Chemical Dependency + Co-Occurring Chronic Physical Illness

Model for Direct Services to Specialty Behavioral Health Home Enrollees 22 Health Home Services: Care Coordination will be provider-based and include working with individuals to develop a comprehensive person- centered service plan. As necessary, it will include coordinating comprehensive transitional care from inpatient to other settings, including appropriate follow-up; arranging individual and family support; and arranging referral to community and social support services. The RBHO based Comprehensive Care Manager will provide consultation as appropriate.

Model for Direct Services to Specialty Behavioral Health Home Enrollees 23 Levels for designated Health Home services Basic Level Care Coordination Services - all individuals identified as meeting the criteria for SMI/SED or Serious Chemical Dependency established by NYS OMH, OASAS, and DOH. Likely provided within Clinic Regulations, not requiring discrete care coordinators. Facilitates flow. Intensive Care Coordination Services Intensive Care Coordinators will provide time limited services, for the subset of individuals needing more intense service at a point in time. Criteria for this level will take into account multiple factors including service utilization and costs. Additional to care coordination provided as part of the Basic Level Care Coordination Services specified above. Data analysis suggests an ability to meet the need for Intensive Care Coordination Service through repurposing existing TCM dollars.

Model for Direct Care Services: Treatment, Health Promotion, Community Support 24 The Behavioral Health Home Provider provides behavioral health services, and a basic level of Physical Health services on site, in close collaboration with the individuals Primary Care Physician. Specialty Behavioral Health Home Core Team Mental Health or Chemical Dependency Primary Therapist (PT) Nurse Practitioner or Primary Care Physician onsite at Specialty Behavioral Health Home Care Coordinator (CC) - with appropriate qualifications and training for integrated, person-centered work and a team reflecting the need for peer experience and cultural and linguistic competency

Model for Direct Care Services: Treatment, Health Promotion, Community Support 25 Behavioral Health Treatment Providers will contract with Primary Care Providers, particularly FQHCs with NCQA Level 3 Certification as Person-Centered Medical Homes. They will also collaborate with independent Primary Care Physician practices serving individuals in the Health Home. Health Promotion, Inpatient, Pharmacy, Specialist, Rehabilitation as referred and per the Person-Centered Service Plan Communication will be supported by Beacon IT and RHIOs and facilitated by the Care Coordinator Community Supports Peer support services Housing, social services and community supports will be provided as specified in the Person-Centered Treatment Plan

For more information 26 Adele Gregory Gorges Executive Director, New York Care Coordination Program C/O Coordinated Care Services, Inc. 1099 Jay Street, Building J, Rochester, NY 14611 585-613-7656 [email protected] www.carecoordination.org

NYAPRS 7th Annual Executive Seminar on Systems Transformation April 27 - 28, 2011 Adele Gregory Gorges, Executive Director New York Care Coordination Program.

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