Transcript Board of Trustees

Cathy Pope
Chief Executive Officer
Mental Health Programs in the
1115 Waiver Process
June 5, 2013
Crossroads Conference 2013
Lubbock, Texas
1115: WHY
BACK STORY
2012 roll-out of Medicaid Managed Care in Texas
had unintended consequences upon the
Upper Payment Limit (UPL) Program for Hospitals
1115: WHY
Directed by Senate Bill 7 (82nd Session,)
The Texas Health and Human Services Commission (HHSC)
Submitted an 1115 Demonstration Waiver application to
The Centers for Medicare and Medicaid (CMS)
1115: The Basics
1115 is a LOCAL initiative
Regional Health Partnerships and designated regional
Anchors serve to coordinate the development and
implementation of regional health plans
Regional plans are reflective of
LOCAL solutions designed to reduce
Cost and improve Outcomes
1115: Top 5 Community
Center Projects
Integrate Physical and Behavioral Health Care
30
Crisis Stabilization Services
23
Evidence-based Interventions for a Target
Population
22
Expand Community-based Behavioral Health
Services in Underserved Areas
12
Whole Health Peer Support for Persons with
Mental Health/Substance Use Disorder
9
1115 IDD Crisis
Services
LYNN RUTLAND
EXECUTIVE DIRECTOR
MHMR SERVICES FOR THE CONCHO VALLEY
Permian Basin
Community Centers
Larry Carroll
Executive Director
Kristen Daugherty
Executive Director
Extended Observation Unit
(EOU)
1115: Projects for People
with IDD
20 Centers have identified projects that
focus on serving people with Intellectual
and/or Developmental Disabilities
1115 IDD Crisis
Services
LYNN RUTLAND
MHMR SERVICES FOR THE CONCHO VALLEY
1115 IDD Projects
• 28 Specific 1115 Projects
Across Texas
• 44 Additional Mental
Health 1115 Projects that
are not specific, but
include IDD
• IDD Projects within the
West Texas Region:
Betty Hardwick, Concho
Valley, Emergence
Health Network, Helen
Farabee, StarCare
Specialty Health, Texas
Panhandle, West Texas
Centers
Specific 1115 IDD Projects
• Crisis Response Team
• Crisis Stabilization Respite
• Dual Diagnosis Clinic
• Drop in Skills Training Program
• Behavior Day Treatment Program
• Health & Wellness Program
• Autism Day Treatment & Behavior Support
Outreach
• Therapeutic Intervention for Infants & Toddlers
at Risk
1115 IDD Crisis Projects
• The primary focus for 1115 IDD funding is projects
to address the growing need for Crisis Support
Services for individuals with a dual diagnosis of
Intellectual & Developmental Disabilities (IDD) /
Autism Spectrum Disorders (ASD) and Mental Illness
who may experience a psychiatric/behavioral crisis or
significant life transition that presents a risk for
institutional placement or a loss of their current home
in the community.
• The objective of these services would be to prevent
inappropriate use of Emergency Rooms, Jails, or
Psychiatric Hospitals, when the need for service can
be effectively met in a more natural, less restrictive,
and less costly setting.
New Model of Service
• This new model of care will provide wrap-around
services for the individual that includes Psychiatric
Services, On-Call Crisis Response Teams and a
Crisis Respite Facility.
• Recipients would have access to a team of
professionals: Psychiatrist, Psychiatric Nurse
Practitioner, RN, LPC/LPA, Behavioral Specialists,
and Skills Trainers to assess needs, identify resources,
link to a network of resources within the team and
through contracted providers, and assure services are
provided that will appropriately de-escalate the crisis
in the community when possible.
New Model of Service
• The team will develop
strategies to build skills
of individuals and
competency of their
support network to
address the individual’s
future needs more
adequately, targeting
crisis prevention.
• While this model of
care is not designed to
replace natural support
systems or formal
residential care
systems, it is
specifically targeted to
insert a new support
for individuals in
between these systems
and institutional care or
loss of current home
environment.
Permian Basin
Community Centers
Larry Carroll
Executive Director

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Crisis Services in community, hospitals, jails
Psychiatric Evaluations
Medication Services
Intensive Community Rehabilitative Services
Counseling
Mental Health Deputies
Mental Health First Aid training

Bi-Polar Disorder, Major Depression,
or Schizophrenia
◦ 34% are Medicaid Eligible
◦ 44% are indigent
Over half do not have a primary care
physician
Severe Mental Illness

People with Severe Mental Illness (SMI) have
a life expectancy of 25 years less than people
without SMI.

A significant number of those with SMI do
not receive adequate primary treatment for
medical conditions.

They instead consume costly emergency
department services for medical conditions
that could have been managed by primary
care outpatient physicians.

PBCC will start providing primary care
services in our outpatient clinics next year
as a part of a new Medicaid waiver program

We see approximately 1200 people in our
Midland and Odessa clinics

20.3% of Long-Term Diabetes

44.4% of Chronic Obstructive
Pulmonary Disease (COPD)

High rates of chronic disease

High costs associated with preventable
admissions

Shortage of health care professionals

Recruiting and training licensed
providers

Overall shortage of Primary Care
Physicians in the Permian Basin
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Data gathering and analysis

Proving up Economic Evaluations

Cost Effective Analysis
◦ 480 persons served x $18,852 =
$9,048,960 annually
◦ or $36,195,840 over 4 years

Cost Utility Analysis
◦ Quality Adjusted Life Years = $32,160,000
over 4 years
Kristen Daugherty
Executive Director
Extended Observation Unit
(EOU)
•
Community Need
•
Target Population
•
Regional Goal
•
Project Goals
•
Implementation
•
Care delivery gaps
•
Wait times for bio-psychosocial services
•
Inpatient bed shortage
Total population = 4,380
Predominantly Hispanic (82%)
Bio-psychosocial needs
Paso Del Norte Health Foundation
o 2012 Regional Strategic Health Framework Report
Priority Area 2
o Mental Health and Behavioral Health/Wellness
Regional Goal
o Enhance and expand access to behavioral health services and
alternatives
1.
Access to behavioral health services
2.
 inappropriate systems of care
3.
 hospital ER use for psychiatric care
2012-16 Time-line
Phase I
Milestone activities
1. Convene stakeholder meetings
2. Conduct mapping and gap analysis (plan)
3. EOU site, design and construction
4. Services planning and implementation
5. Crisis alternative utilization
6. Utilization best practices and solutions
July
2012
Jan
2013
Phase II
Sept
2013
April
2014
Phase III
March
2015
Feb
2016
Cathy Pope
Chief Executive Officer
QUESTIONS?
June 5, 2013
Crossroads Conference 2013
Lubbock, Texas