WESTERN REGION BEHAVIORAL HEALTH ORGANIZATON WITH BEACON HEALTH STRATEGIES, LLC

WESTERN REGION BEHAVIORAL HEALTH ORGANIZATONWITH BEACON HEALTH STRATEGIES, LLC AND COORDINATED CARE SERVICES, INC.

QUARTERLY ALL-STAKEHOLDER MEETINGFEBRUARY 29, 2012

NEW YORK CARE COORDINATION PROGRAMWITH BEACON HEALTH STRATEGIES, LLCAND COORDINATED CARE SERVICES, INC.

Western Region Behavioral Health Organization

WRBHO All Stakeholder Meeting

Welcome and IntroductionsKathleen Plum, Ph.D., RN, NPP

Director, Monroe County Office of Mental Health Chair, New York Care Coordination Program

BHO Oversight and Implementation Committee.

New York Care Coordination Program, Inc.

Kathleen Plum, Ph.D., RN, NPP, Director, Monroe County Office of Mental Health, Rochester, NY. Chair, NYCCP BHO Oversight and Implementation Committee. Treasurer, NYCCP Board of Directors.

Patricia Brinkman, LMHC, MBA, Director, Chautauqua County Mental Health Services, Mayville, NY. Chair, NYCCP BHO County Directors Group. Member, NYCCP Board of DirectorsJoe Woodward, CASAC, Executive Director, Housing Options Made Easy Buffalo, NY. Chair, NYCCP Peer Service and Family Support Group. Member, NYCCP Board of Directors.Howard Hitzel, Psy.D. President, Lake Shore Behavioral Health, Buffalo, NY. Chair, NYCCP Provider Group. Co-chair, NYCCP Board of Directors

Adele Gorges, Executive Director

Valerie Way, LCSW-R, Senior Program Associate

Robert Dempsey, Peer/Family Coordinator

Kathy Berthod, Program Assistant

Beacon Health Strategies, LLC

Mark Deasy, Director of Account Operations

John Lee, Program Director for Western Region Behavioral Health Organization

Christine Mangione, Manager for Clinical Operations for Western Region Behavioral Health Organization

Coordinated Care Services, Inc.

Anne Wilder, President, CCSI

Facilitators

Clyde Comstock, Chief Operating Officer, Hillside Children’s Center Rochester, NY, Member NYCCP Board of Directors

Don Kamin, Ph.D., Chief, Clinical & Forensic Services, Monroe County Office of Mental Health

Neilia Kelly, Chief, Policy and Planning, Monroe County Office of Mental Health

Paul McArthur, Administrator, Strong Behavioral Health, Rochester, NY; Member, NYCCP Board of Directors

Today’s Objectives

Learn more about the WRBHO and what we are trying to accomplish together

Provide feedback on your experience with the WRBHO to date

Begin the work of creating effective inpatient/ outpatient transition processes for each region in support of High Need/ High Risks individuals

Get to know others in the region across stakeholder groups- engage in new partnerships

Today’s Agenda

All Stakeholder Meeting – 1:00 pm – 2:00 pmUpdates from the StateWRBHO

News and Updates Review of program goals Review of data being collected and reports to be created

Sub-regional Meeting- 2:15 – 4:00Breakout groups

Provide feedback on your experience with the WRBHO Assess current inpatient /outpatient transition Develop recommendations for improvement and next steps

News and Updates: New York State

NYS Office of Mental HealthThomas Smith, M.DDirector of Operations, NYS Behavioral Health Organizations; Associate Professor of Clinical Psychiatry, Columbia University New York State Psychiatric Institute

NYS OASASSteve Hanson

Acting Associate Commissioner

News and Updates: Western Region Behavioral Health Organization

Activity of WRBHO – As of Week EightTask 1- Volumes, outreach, getting the kinks outTask 2- SED Data submission webinars this weekTask 3- First round to be ready by April 30Task 4 – Meetings and conference calls

Complementary work of NYCCPHealth HomesBHO Phase 2

Why Regional Behavioral Health Organizations?

Opportunity to prepare for a redesigned Medicaid Program in Phase 2: A fully managed system of care.Understand what the current

system looks like.Understand the critical success

factors are related to a Phase 2.Implement needed changes.

Objectives for the Regional Behavioral Health Organizations

Review BH inpatient length of stay for all Medicaid Fee-For Service admissions

Reduce BH inpatient readmission ratesImprove rates of engagement in outpatient

treatment post dischargeBetter understand children diagnosed as SEDReport on performance for the region as a whole

and for providers individually in the regionEncourage cross-systems linkages that will

improve outcomes

WRBHO Data and Reports

Data collected and reports to be generated link back to the goals

Review data elements: inpatient stay info, discharge process info, transition to outpatient info

Review of quarterly reports plannedSample reports

WRBHO Data and Reports

Data collected tie directly to WRBHO goalsRegular reports will describe our region in

terms of strengths, service gaps and opportunities to improve

Reporting and analysis will be done at the regional, sub-regional, county, and provider levels

What Data Are Being Collected?

Patient and inpatient provider Identifiers: BHO Activity – Time frames for completion, etc.Episode of Care CharacteristicsContent of Discharge PlanWas an appointment for outpatient MH/SUD

treatment part of the discharge plan?Indicator that physical health care needs

requiring post hospital follow up were identified:Consumer Family InvolvementAdult AOTSPOA Application

Quarterly Reports Designed to Answer Key Systems Questions

Monitor, Review and Assess Use of Behavioral Health Inpatient Care Who is receiving care at the highest level? Are the individual’s needs being identified and

addressed? Are individuals being connected with care post-

discharge? Why are individuals being readmitted to inpatient

care? How many admissions are classified as “long stay” –

and what resources are lacking in communities such that longer stays are required?

Quarterly Reports will be Designed to Answer Key Systems Questions

Children’s Outpatient SED Tracking Who is being diagnosed as SED? Where are children/youth with SED receiving

outpatient care?Cross-System Linkages

What types of cross-systems linkages are needed for individuals receiving inpatient behavioral health care? What types of linkages are needed with physical health

care services? Are they happening?

Quarterly Reports will be Designed to Answer Key Systems Questions

Provider Profile Reports Display data, at the provider level, on key descriptive

and performance dimensions: Demographic and clinical characteristics Provider / WRBHO staff interaction Length of stay Connection to outpatient care

Reports will include comparisons to regional average and track changes over time

Sample Report – Inpatient Episode

Sample Report – Outpatient Engagement

Sample Report – Length of Stay

Charge for the Sub-Regional Meetings

Work together via facilitated discussions to:

Provide feedback concerning your experience with the WRBHO

Begin the development of a cross-system plan to impact inpatient /outpatient transitions

….As you have your sub-regional discussions, please

consider the following information being provided by

John and Chris…..

Practices that Support Effective Inpatient to Outpatient Transitions

Some facts:Only 42% of initial appointments following

psychiatric hospitalization are kept nationally. Missed appointments increase the likelihood of re-hospitalization and increase costs of outpatient care. (Kreyenbuhl, Nossel, & Dixon, 2009).

Between 25% and 50% of patients who miss mental health appointments disengage from treatment entirely (Killaspy, 2007).

Practices that Support Effective Inpatient to Outpatient Transitions

Some facts…Dropping out of treatment after a

psychiatric hospitalization increases the likelihood of re-hospitalization from 1 in 10 to 1 in 4 (Mitchell & Selmes, 2007).

Keeping one outpatient appointment reduces the risk of re-hospitalization (Nelson, Maruish, & Axler, 2000).

Practices that Support Effective Inpatient to Outpatient Transitions –

What Works….• A pre-discharge transition interview

with the patient to identify and address barriers to attendance.

• Patient telephone contact pre-discharge with the outpatient provider.

• Communication about the patient’s discharge plans between inpatient and outpatient clinicians.

Practices that Support Effective Inpatient to Outpatient Transitions –

What Works….• Return to their previous outpatient

provider… unless the individual prefers another provider or when specific clinical needs would suggest an alternative.

• Scheduling appointments within a few days of hospital discharge.

• Reminder letters or phone calls from the outpatient provider regarding scheduled appointments.

Sub-regional Meetings

Four Sub-Regions:Chautauqua Region- Goes to Board RoomErie Region - Stays in AtriumFinger Lakes Region – Goes to Emerald roomMonroe Region- Goes to Chrystal Room

You decide the sub-region to join

Sub-regional MeetingsWhat to Expect

Breakout by region, with large regions splitting into smaller groups of approximately 15. Facilitator and scribe for each group. Each group will: Provide feedback on their experience with the

WRBHO Discuss the current inpatient/outpatient transition

process: what is working well?, What should work better?, What are the barriers to making it better?

Identify the three things most important things to change

Discuss what key stakeholder groups should be asked to do in order to achieve the desired change

Decide upon three steps to take between now and the next meeting

Sub-regional MeetingsWhat to Expect

Each group will report back to the sub-regional group prior to the end of the session.

Each sub region will provide feedback on the usefulness of the sub-region structure for future meetings.

Information collected will be transcribed and sent out to all participants after the meeting

Find your rooms!

FYI.. Each sub-region has a lead facilitator. If there is confusion…. seek

them out:Chautauqua: Christine Mangione

Erie: John LeeFinger Lakes: Val WayMonroe: Anne Wilder