Regional BHO’s and Health Homes
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Transcript Regional BHO’s and Health Homes
Health Homes: What Are They and What Might They Look Like
NYAPRS 29th Annual Conference
September 14, 2011
Adele Gregory Gorges
Executive Director, New York Care Coordination Program, Inc.
New York Care Coordination Program
Multi-county,
multistakeholder
collaborative
to improve
outcomes for
those with
serious
behavioral
health issues
formed in
2000 – six
western and
central
counties with
support from
NYS OMH
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Operational
in mid-2002
–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
2011
Conditional
Award for
Managed
Behavioral
Health
Organization
procurement
for Western
Region
NYCCP
partnering
with Beacon
Health
Strategies
and CCSI
NYCCP Strategic Plan for
System Transformation
Structures
Initiatives
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• Participatory process for governance
• Data access, analysis and reporting capacity
• Platform for disseminating best practices
• Culture change to a person-centered, recovery-focused system of
care
• Care coordination
• Peers services
• Physical health integration
• Finance reform
• Pay for performance
• Managed behavioral health
• Conserve dollars for behavioral health, use dollars flexibly,
access and use information
Timelines for System Transformation
4
Phase 1:
• 2002 - Laying the foundation for transformation
• Collaborative processes, care coordination, person-centered
practices, recovery focus, peer services, physical health awareness,
data driven
Phase 2:
• 2009 - Partnership with Beacon Health Strategies, LLC
• Managed care readiness
• Complex Care Management
Phase 3:
• 2011 - RBHO’s and Health Homes
• Western Region Behavioral Health Organization
• Health Home Application to be submitted
What have we learned that should
inform what Health Homes look like?
Listen to the customer……
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Guiding Principles for Person-Centered, Recovery-
Focused Services, developed by the Peer and Family
Advisory Group of the WNYCCP in 2007
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
person’s recovery.
Every plan for recovery is centered on the person’s goals,
strengths, and preferences -- not the availability of a particular
program or service.
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Guiding Principles for Person-Centered, Recovery-Focused Services
(continued)
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.
7
What have we learned that should
inform what Health Homes look like?
Listen to the customer……
Person centered, recovery focused care coordination
produces better outcomes for individuals, and lower costs for
payers
8
Person-Centered, Recovery-Focused
Care Coordination adds value
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
9
• 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 per person
* 2009 Periodic Reporting Form Analysis
N=31
Medicaid (other
than hospital)
Incarceration
State Hospital
Total
2007- 2008
Pre-Enrollment
$ 822,119
$ 870,260
$ 592,150
$ 2,284,529
2008-2009
1 year after
$ 535,634
$ 410,860
$ 129,850
$ 1,076,344
Savings $
$ 286,485
$ 459,400
$ 462,300
$ 1,208,185
Savings %
35%
53%
78%
53%
In addition, there was a significant decrease in days of homelessness and an increase in
attendance at chemical dependency treatment programs.
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What have we learned that should
inform what Health Homes look like?
Listen to the customer
Person centered, recovery focused care coordination
produces better outcomes for individuals, and lower costs for
payers
Getting those outcomes requires new knowledge, new skills,
a new culture – and that is hard work
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It took a massive effort to develop the new
knowledge, new skills and the new culture
needed for person-centered, recovery-focused
care coordination
Changing the system to meet the needs of individuals
rather than expecting individuals to fit into existing
systems
It will take an equally massive effort to move to
from Targeted Case Management to Health Home
Care Coordination
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Starting in 2003 and continuing…..
1
3
Education
and training
Onsite
mentoring
Monitoring
Focused
modules
Feedback
Incentives
P4P
Online
practice
recoveryskillbuilder.
com
Webinars
What have we learned that should
inform what Health Homes look like?
Listen to the customer
Person centered, recovery focused care coordination
produces better outcomes for individuals, and lower costs for
payers
Getting those outcomes requires new knowledge, new skills,
a new culture – and that is hard work
The Targeted Case Management work force is well positioned
to make a successful transition to Health Home Care
Coordination
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Pilot with Monroe Plan for Medical Care
Teamed Community Based Intensive Case Managers with
Office Based Managed Care Plan Case Managers
What we learned
The collaboration was effective in finding and serving
individuals with serious mental health concerns and serious
medical conditions
The cultures of behavioral health providers and physical health
providers are VERY DIFFERENT - we need to learn to speak
each other’s language
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NYCCP/Beacon Model for
Complex Care Management
Teams provider-based Targeted Case Manager
with MBHO based Complex Care Managers
Intensive, flexible/episodic, focusing on physical
and behavioral health care for individuals with
highest needs -- serious mental illness, complex
medical needs, top 10% in total costs.
Achieved average length of stay of 6 months at
the intensive level.
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Characteristics of NYCCP/Beacon CCM
Grounded in supporting individuals to attain recovery goals
related to life objectives – living, working, socializing.
Empowers individuals through development of skills for selfmanagement 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)
17
NYCCP/Beacon Complex Care Management can
be an effective core for Health Homes
Focuses HR/HN populations and episodes of care
Based on transition from Targeted Case Management to a practice
equivalent to that of a Health Home Care Coordinator
Maximizes resources through shorter lengths of stay in higher
levels of 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
Melds Person-Centered Practice as an underpinning for the
initiative AND a managed care focus on an episode of care and
movement to recovery.
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What have we learned that should
inform what Health Homes look like?
Listen to the customer
Person centered, recovery focused care coordination produces
better outcomes for individuals, and lower costs for payers
Getting those outcomes requires new knowledge, new skills, a
new culture – and that is hard work
The Targeted Case Management work force is well positioned to
make a successful transition to Health Home Care Coordination
Peer services will be a key to success for Health Homes
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Peer services will be a key to success for
Health Homes
Experience of the NYCCP/Beacon Complex
Care Management Model
Critical resource within this model
Referral to peer services developed from 2002 to
the present
NYAPRS Peer Bridger Model
NYAPRS collaboration with Optum for CIDP
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What have we learned that should
inform what Health Homes look like?
Listen to the customer
Person centered, recovery focused care coordination produces
21
better outcomes for individuals, and lower costs for payers
Getting those outcomes requires new knowledge, new skills, a
new culture – and that is hard work
The Targeted Case Management work force is well positioned to
make a successful transition to Health Home Care Coordination
Peer services will be a key to success for Health Homes
The Behavioral Health treatment providers are well positioned to
be a part of an integrated behavioral/physical health service
system
Options for Behavioral Health Provider
participation in Health Homes
Partner with Primary Care Based Health Home providers
Contracted specialty provider for
Individuals with chronic serious mental illness who choose a
primary care based health home provider
Individuals with serious chemical dependency and cooccurring chronic medical issues who choose a primary care
based health home provider
Contracted basic level services provider for behavioral health for
individuals who qualify for Health Home by virtue of multiple
chronic medical and/or chemical dependency issues and have
chosen a primary care based health home provider
Provide Specialty Behavioral Health Home service
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Target Populations for Specialty
Behavioral Health Homes
Adults with Serious Mental Illness
Adults with Serious Chemical Dependency + Co-Occurring
Chronic Physical Illness
Deferred
Children with Serious Chemical Dependency + CoOccurring Chronic Physical Illness
Children with Serious Emotional Disturbance
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Model for Specialty Behavioral Health Home
Team Composition
Core Team
Individual and family as appropriate
Mental Health or Chemical Dependency Primary Therapist (PT)
Nurse Practitioner or Primary Care Physician onsite at Behavioral Health
Home Provider
Care Coordinator - with appropriate qualifications and training for
integrated, person-centered work and a team reflecting the need for peer
experience and cultural and linguistic competency
Plus
Psychiatrist
Primary Care Physician or Nurse Practitioner
Other specialty providers as appropriate
Plus Consulting Members of Team
Pharmacist
Managed Care Plan Case Manager
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What have we learned that should
inform what Health Homes look like?
Listen to the customer
Person centered, recovery focused care coordination produces
25
better outcomes for individuals, and lower costs for payers
Getting those outcomes requires new knowledge, new skills, a
new culture – and that is hard work
The Targeted Case Management work force is well positioned to
make a successful transition to Health Home Care Coordination
The Behavioral Health treatment providers are well positioned to
be a part of an integrated behavioral/physical health service
system
Peer services will be a key to success for Health Homes
BHO’s can add value to Health Home development
Interface of BHO and Health Homes
BHO will facilitate transitions from Inpatient to
Health Home
BHO will provide data that can be used for
practice improvement
BHO will provide forum for stakeholder
participation and operations
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For more information
Adele Gregory Gorges
Executive Director, New York Care Coordination Program, Inc.
C/O Coordinated Care Services, Inc.
1099 Jay Street, Building J, Rochester, NY 14611
585-613-7656
[email protected]
www.carecoordination.org
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