Transcript Regional BHO’s and Health Homes

NEW YORK
CARE COORDINATION PROGRAM:
A VIEW OF CURRENT INITIATIVES
IN THE ERA OF MBHO’S AND
HEALTH HOMES
Bob Long
Co-chair, NYCCP Steering Committee
Commissioner of Mental Health – Onondaga County
What is the NYCCP?
 A multi stakeholder learning collaborative
(counties, peers and families, providers)
 Focused on behavioral health system
improvement
 Data and outcomes driven
 Covers about 3.5 million people in seven NY
counties (Westchester, Erie, Monroe,
Onondaga, Chautauqua, Genesee, Wyoming)
www.carecoordination.org
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Those who cannot remember the past are
condemned to repeat it. ~ George Santayana
What can be learned from
over 20 years of health care
cost control?
www.carecoordination.org
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Lessons Learned: If You
Focus on Costs (Managed Cost)
 Restricts access to services & recovery, e.g.:
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Limited or no behavioral health care benefits
Laborious pre/re-certification processes
Rigidly applied ‘medical necessity’ criteria
Arbitrary service limits (thresholds or caps)
Limited covered services (rehabilitation, peer support,
etc)
 Inadequate provider panel (no choice, delayed access)
 Results in short term savings (‘this fiscal year’ is all that
matters), which leads to…
 Prolonged suffering, higher long term costs & cost
shifting (social services, homeless shelters, police, jails).
www.carecoordination.org
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Lessons Learned: If You
Focus on People (Managed Care)
 Person centered/Family Driven: every plan is
centered on the person’s goals, strengths &
preferences, not just the available services;
service and reimbursement systems are flexible
 The goal is quality of life, not stabilization and
maintenance and not just cost containment
 Recognizes stages of change:
 supports and promotes the person’s ability to make
positive changes in his or her life
 Uses motivational interviewing concepts
 Attends to longer term costs and benefits
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NYCCP Results:
Focusing on People
 Quality of life results:
 Days in hospital down 53%
 Emergency room visits down 46%
 Gainful activity up 31%, including a 51%
increase in completive employment
 Self harm down 54%
 Arrests down 25%
www.carecoordination.org
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NYCCP Results
(under Fee for Service System – i.e. no binding
utilization management)
 Financial Results
 Comparing Case Management and ACT recipients in
NYCCP counties to 6 comparable counties - cost per
recipient in NYCCP Counties is:
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92% lower costs for inpatient
42% lower costs for outpatient
13% lower costs for community support
41% lower costs overall.
 The moral of the story: helping people live more
healthy and productive lives saves money.
www.carecoordination.org
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How do Clinic Reform, PROS and
Ambulatory Reform Move us Forward?
 Improved access to service & greater recovery
focus, e.g.:
 Broader covered services (e.g. Rehabilitation
Services, Outreach & Engagement, Crisis
Intervention)
 Greater integration and flexibility allows the
system to be more person centered:
 More integrated services (e.g. PROS)
 More flexible services (e.g. >1 clinic service in a day)
 Family driven services (ambulatory reform)
www.carecoordination.org
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The future ain’t what it used to be. ~Yogi Berra
What’s next?
www.carecoordination.org
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State: Regional Behavioral
Health Organizations (RBHO’s)
 For recipients who are not enrolled in managed
care (“carve outs”) - all ages, mental health and
alcohol and substance abuse
 Charged with (for two years):
 Coordinating care and managing utilization for
Medicaid behavioral health services
 Approving, coordinating & facilitating continuity and
integration of behavioral health/physical health
services
 Goal: prepare the behavioral health system for
full managed care
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Federal: Health Homes
 Designed to:
 be person-centered systems of care for people
with at least two chronic conditions; one chronic
condition and be at risk for another; or one serious
and persistent mental health condition
 facilitate access to and coordination of the full
array of primary and acute physical health
services, behavioral health care, and long-term
community-based services and supports.
 States can offer health home services in a different
amount, duration, and scope than services provided
to individuals not in the defined health home
population
www.carecoordination.org
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Health Homes (cont)
 Health home services include:
 comprehensive care management - care
coordination and health promotion
 comprehensive transitional care from inpatient to
other settings, including appropriate follow-up;
 individual and family support;
 referral to community and social support services,
if relevant; and
 Meaningful use of health information technology
to integrate service provision
www.carecoordination.org
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NYCCP RBHO/Health Home Vision
 RBHO regions that respect
established affinities - i.e. geographic
preferences for where people receive
their care
 RBHO as ‘superstructure’ for Health
Homes
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RBHO as ‘superstructure’
 Develops/coordinates health homes throughout
the designated region
 Coordinates care and manages utilization for
Medicaid behavioral health services delivered
throughout the region
 Coordinate & facilitate continuity and integration
of behavioral health/physical health services
 Efficiently provide functions (e.g. outreach to
underserved people, education & training,
interface with HMO’s for physical health,
information technology, data analysis/
performance monitoring/CQI) to health homes
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Possible Health Home Structures
within the RBHO
 Health Homes include multiple provider
arrangements
 Single Provider – large provider with a full array of
physical and behavioral health services.
 Provider Network – formal network of providers,
who, in total, provide a full array of physical and
behavioral health services.
 Health home coverage may include:
 Multiple health homes in a single county
 One health home serving multiple counties
www.carecoordination.org
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NYCCP RBHO/Health Home Vision
HH1
Provider
D
Provider
E
Provider
A
HH4
BHO
HH2
Provider
F
Provider
B
Provider
C
HH3
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QUESTIONS?
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