Transcript Exploring a Partnership Opportunity

MHA in New York State:
October 26, 2011
Behavioral Health Organization (BHO)
Central Region - NY
THE MAGELLAN HEALTH COMPANIES
Behavioral Health
Specialty Pharmacy Management
Radiology
Medicaid Administration
Mission/Vision
Magellan Health Services is a leading, diversified specialty health care
management organization.
Mission: With a focus on care and respect, we apply clinical expertise to assist
people during challenging times. We deliver innovative solutions to our
customers and collaborate with providers to positively influence the health and
well being of individuals and the affordability of care.
Vision: We are the premier partner in making quality healthcare more affordable,
and innovating to bring clinical excellence into the lives of the people entrusted
to our care.
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Our Principles
At Magellan, we support a philosophy of wellness that focuses on personal
strengths, building hope and offering choices.
Resiliency
We believe that all people have qualities that enable us to rebound from
adversity, trauma, tragedy, or other stresses and to go on with life with a
sense of mastery, competency and hope.
Recovery
We believe that all people living with behavioral health conditions have the
capacity to learn, grow and change, and can achieve a life filled with
meaning and purpose.
Cultural Competency
We work to provide care and services that recognize the diverse
backgrounds of the individuals and families we serve. Our strategies
acknowledge and respect the behavior, ideas, attitudes, values, beliefs and
language of all individuals.
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Magellan’s Medicaid Experience
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Magellan’s Medicaid Experience
Public sector focus – 60+% of Magellan’s Revenue is Medicaid
Manage behavioral health care for 1.5 million Medicaid
members for 8 health plans in 12 States through
subcontracting agreements, including NY
Contract directly in 7 states representing 15 contracts (Arizona,
Florida, Pennsylvania, Iowa, Nebraska, Louisiana & New York), for
2.7+ million members
Pharmacy Benefits Administration Experience in 25 States and DC
Magellan Public Sector Overview
Current Public Sector Programs
State Specific Behavioral Health
Contracts
Covered Membership
15
2.7+ MM
Current Public Sector Service Centers *
Miami, Florida
Bethlehem, Pennsylvania
West Des Moines, Iowa
Newtown, Pennsylvania
Lincoln, Nebraska
Phoenix, Arizona
* Implementing new contracts in Louisiana and
New York – Central Region
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Magellan Core Competencies:
Partnership, Innovation & Transparency
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A Reliance on Partnership
Magellan collaborates with providers, national advocacy organizations,
individuals and their families to design, manage and continually improve
behavioral health systems for government agencies.
Our partners include:
 Service Providers to gain your unique perspective on public sector
consumers' behavioral health needs and resources available to meet
those needs.
 State and County Government Agencies as they build, manage or
transform their public mental health and substance abuse systems.
 Individuals and Families who play a variety of critical roles including
participating on our Program Advisory Boards and Quality
Improvement committees.
 National and Local advocacy organizations which support and
promote behavioral health and wellness for everyone.
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Shared decision-making through partnership
Magellan has a flexible approach to public-private partnerships:
 Operating Committees – Example: Florida PMHPs. Membership
includes stakeholder and managed care representation. Shared
decision-making and accountability for program design and
outcomes.
 Governance Board – Example: Maricopa County, Arizona. Equal
partnership between managed care organization and local
stakeholders. Accountability for program design, oversight and
operations.
 Child Welfare Joint Venture – Example: CBC Partnership, Ltd.,
Florida. Legal relationship between Magellan and child welfare lead
agencies in Florida.
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Partnering with providers
•91% provider satisfaction with the accuracy of claims paid, nationally
•Over 90% of PS claims received electronically for even faster payment
• 93% provider satisfaction with the contracting/credentialing process
•Average application processing time 45 days or less
• Uniform Credentialing Data Source (CAQH), online re-credentialing
applications or paper applications accepted
•Local contract manager to service providers within the state
• 90% provider overall satisfaction with the services provided by
Magellan, nationally
• Local network and provider relations team dedicated to support
recruitment and servicing providers within the community
• Comprehensive suite of Web self-service tools available at:
www.MagellanHealth.com/provider
•Customized websites for State programs
• Free online trainings and CEUs for in-network providers
• Web-based outcomes assessment tools and reporting to
monitor patient progress
•Provider relations plan geared to meeting provider needs
• Access to corporate discounts on office supplies
Prompt
Pay
Ease of
Credentialing
and
Contracting
Accessibility
Key Advantages
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Focus on Innovation and Community
Reinvestment
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Public Sector Innovations
 Recovery and Resiliency Initiatives
 Self-Directed Care (first program of its kind in the U.S.)
 Peer Support Whole Health
 MY LIFE Youth Empowerment Initiative
 MY Fest Youth Outdoor Arts and Community Festival
 Homeless/Housing and Vocational Support Programs
 Web-Based Programs and Services
 Free National Webinars on Recovery and Resiliency-related topics in
conjunction with ACMHA
 Free Resiliency & Recovery E-Learning Center at
www.MagellanHealth.com/Training (www.magellanhealth.com/training)
 Customer & Provider Dashboards (www.magellanofaz.com)
 Children’s System of Care Programs
 Focus on Wraparound Services for At-Risk Youth
 Building Bridges collaboration
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Magellan and the Building Bridges Initiative Host Two Webinars
Focused on Residential Programs – Oct. 27 and Nov. 10
 Magellan and the Building Bridges Initiative (BBI) are partnering to provide two national
webinars for staff, families, youth and advocates served by residential programs and their
community counterparts.
 Thursday, Oct. 27, 1 - 2:30 p.m. Eastern time*: Successfully Engaging Youth and
Families - Join a panel of family members, youth and advocates who will share what
works for engaging youth and families served by residential programs and their community
counterparts. If you have ever struggled to partner with families and/or youth, you will gain
understanding about how to change and/or improve your strategies.
 *10 a.m. – 11:30 p.m. Pacific time, 11 a.m. – 12:30 p.m. Mountain time, Noon – 1:30 p.m.
Central time
 Thursday, Nov. 10, 1 - 2:30 p.m. Eastern time*: Fiscal Strategies that Support the
Building Bridges Initiative Principles - Join a panel of knowledgeable fiscal
professionals, as well as representatives from entities that have changed outcomes based
on successful fiscal strategies, to increase your knowledge base about a range of fiscal
strategies that support positive outcomes.
 *10 a.m. – 11:30 p.m. Pacific time, 11 a.m. – 12:30 p.m. Mountain time, Noon – 1:30 p.m.
Central time
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Public Sector Innovations (Continued)
 Wellness Initiatives
 Smoking Cessation
 Health & Wellness Assessments
 Cultural Competency Programs
 Organizational Self-Assessments and Trainings
 Cultural Competency Plans at Every Service Center
 Clinical Programs
 Pre-Risk Predictive Modeling
 Primary Care Physician Consult Line
 Medical/Behavioral Integration Programs (e.g., Pennsylvania HealthChoices
HealthConnections) and Health Home Pilot Initiatives in IA and AZ
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Peer Initiatives
Peer experience is valued and integrated at all levels of our Public Sector
programs
•
Peer specialists work in our care management centers and national team
•
Peer-provided services and supports through our provider network
•
Partnerships with peer-operated organizations in communities we serve
•
Promotion of mutual self-help and support groups as a vital resource for recovery
Peer Support as an evidence-based practice is implemented through
approaches that work
•
•
•
•
Peer Crisis Navigators help link people to services to prevent ongoing crisis involvement (AZ)
Peer Connections and other bridger-type programs help people coming out of hospitals (PA and FL)
Peer specialists trained to provide crisis support (IA)
Peer Support Whole Health – rolling out across all Public Sector programs.
– Currently in place in Maricopa, Pennsylvania, and Iowa.
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Innovative Product Features
Maricopa
AZ
Newtown
PA
Lehigh PA
Iowa
Peer Support Training on Whole Health
strategies
X
X
X
X
Youth Leadership Strategy and Festival
(MYLIFE)
X
X
X
Outcomes Tool – Consumer Health
Inventory
X
X
X
PCP Consultation Line
X
Telehealth
X
Innovative Features
Autism Treatment Evaluation/Checklist
Nebraska
Florida
X
X
X
X
X
X
X
X
X
X
X
X
Crisis Intervention Teams
X
X
X
Reward for Quality
X
X
X
X
Collaboration with Physical Health Plan
X
X
X
X
Suicide Prevention Training
X
Strategies for Reduced Utilization of
Residential Treatment for Children
X
X
X
X
X
X
Cultural Competency Action Plans
X
X
X
X
X
X
X
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BHO Overview/Approach
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Our Approach
 We propose a person-centered/strength-based approach that incorporates
feedback we have received from local providers, advocates, and other
stakeholders and fully responds to The Offices’ priorities for utilization
management, timely access to care, services coordination, outcomes
measurement, cost containment, and holistic/integrated care.
 As a national leader with 20 years of experience in providing BH managed care
services, our commitment to building resilience and facilitating recovery in
the lives of the children and adults we serve is the foundation of all of our
services from reviewing, managing, and reducing unnecessary inpatient
care to the creation and use of diversion and community-based
alternatives.
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Program Goals
Monitor behavioral health inpatient length of stay
Reduce unnecessary behavioral health inpatient hospital days
Reduce behavioral health readmission rates
Improve rates of engagement in outpatient treatment post
discharge
Improve understanding of the clinical conditions of children
diagnosed as having a Serious Emotional Disturbance (SED)
Profile provider performance
Test metrics of system performance
Establish relationships with key system stakeholders
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Required Program Tasks
Task 1:
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Monitor, review and assess the use of behavioral health inpatient care
Concurrent review of hospital admissions for BH
Monitor discharge planning activities and ambulatory follow-up
Enhanced discharge planning for individuals identified by the State as disengaged from care
Enhanced discharge planning for individuals who are readmitted
Enhanced discharge planning for individuals with 3 or more detox admissions
Task 2: Children’s 0utpatient SED tracking
 Track children newly diagnosed having a SED by Specialty Clinics
 Report monthly to State
Task 3: Provider profiling
 Quarterly provider profiles
 Share information with stakeholders
 Biannual meetings with stakeholders to provide information
Task 4: Facilitate cross-system linkage
 Meet quarterly with stakeholders
 Encourage IP providers to develop linkages with health homes
 Develop relationships with health homes
 Assure discharge plans address individuals’ physical health needs
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Additional Capabilities
 Define, engage and link cohorts of disengaged or high risk
individuals to appropriate treatment
 Review outpatient engagement for post-discharge follow-up care
 Suicide prevention
 Reduce costs for people with high cost physical and behavioral
health conditions
 Behavioral health emergency department diversion/inpatient
diversion
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Operational Details for Central
 Implementation efforts have been underway since late September, recruiting
staff, etc.
 Magellan is actively working with OMH & OASAS to finalize the contract and the
parameters of the program (expected to ne completed in early November)
 Magellan, OMH and OASAS will create multiple opportunities to meet with
stakeholders and providers to address all questions and concerns regarding the
implementation of the Behavioral Health Organization
 Magellan will then begin reaching out to providers and other stakeholders to start
developing our relationships, with formal provider trainings in December.
 Magellan’s office will be located in the One Park Place building at 300 South
State Street in Syracuse. Our telephone number will be 800-424-4299.
 Magellan is developing a web site specific to Central New York that will be
available after December 1. The web address is www.magellanofnewyork.com
 Please contact Deb Happ, VP of Operations, at 443-622-6704 in the short-term.
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Thank you!
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