Regional BHO’s and Health Homes
Download
Report
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
2
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
3
Lessons Learned: If You
Focus on Costs (Managed Cost)
Restricts access to services & recovery, e.g.:
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
4
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
www.carecoordination.org
5
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
6
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:
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
7
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
8
The future ain’t what it used to be. ~Yogi Berra
What’s next?
www.carecoordination.org
9
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
www.carecoordination.org
10
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
11
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
12
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
www.carecoordination.org
13
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
www.carecoordination.org
14
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
15
NYCCP RBHO/Health Home Vision
HH1
Provider
D
Provider
E
Provider
A
HH4
BHO
HH2
Provider
F
Provider
B
Provider
C
HH3
www.carecoordination.org
16
www.carecoordination.org
17
QUESTIONS?
www.carecoordination.org
18