Transcript Provider Sponsered networks - Florida Alcohol and Drug
Provider-Sponsored Networks
“Building Partnerships”
Presented by… Linda McKinnon, Chief Executive Officer, Central Florida Behavioral Health Network Bob Holm, Regional Substance Abuse Director, Suncoast Region DCF Richard Brown, Chief Operating Officer, The Agency for Community Treatment Services Nancy Hamilton, Chief Executive Officer, Operation PAR
CFBHN Mission
Central Florida Behavioral Health Network
is a not-for-profit organization of community providers incorporated to ensure and enhance an array of behavioral health and other human services needs for the citizens of our communities.
CFBHN History
Linda McKinnon Chief Executive Officer Central Florida Behavioral Health Network
CFBHN History
“Not an overnight sensation!”
1995
No collaboration among providers or between disciplines
1996
Collaboration among mental health providers in Hillsborough and Manatee counties related to pre-paid Medicaid pilot
1997
Collaboration between ADM and substance abuse providers in Hillsborough and Manatee counties to create CFBHN No collaboration between mental health and substance abuse providers DCF contracts with CFBHN to manage funds targeted at SSD and SSI dis-enrolled and intervention services
CFBHN History
1998
Hillsborough County mental health providers join collaboration as vendors DCF contracts with CFBHN for TANF funded services and children’s substance abuse services CFBHN assumes additional administrative responsibilities for outcomes and quality oversight for contracted services
1999
CFBHN joins Florida Behavioral Health Hillsborough County Workforce Board contracts with CFBHN to implement a three-year grant for supportive employment services targeted to the most difficult to employ TANF recipients
CFBHN History
2000
DCF regionalization pilot DCF expands contracts with CFBHN to include substance abuse services for heroin and cocaine abusers and family intervention services DCF contracts with CFBHN to provide services in collaboration with Hillsborough County children’s system of care development grant Sarasota County substance abuse provider and Hillsborough/ Manatee Public schools join collaborative as vendors
2001
G. Pierce Wood Hospital closes Substance abuse and mental health providers in Hillsborough County collaborate to address needs of substance abusing persons with serious mental illness
CFBHN History
2002
CFBHN Board membership expanded to include 19 substance abuse and mental health non-profit providers in 9 counties comprised of Suncoast Region and District 14 Family intervention services expanded to Pinellas, Pasco and Sarasota counties CFBHN contracts to operationalize COSIG Grant in Hillsborough County TANF-funded services expanded to Pasco County CFBHN contracts to provide substance abuse aftercare services in Suncoast Region
CFBHN History
2003
CFBHN contracts for TANF-funded services throughout Suncoast Region and District 14 (Polk, Highlands and Hardee counties) DCF contracts with CFBHN to provide TANF oversight functions in Suncoast Region and District 14 Family intervention services expanded to District 14 SAMH Program Office contracts with CFBHN to provide services targeted to persons with co-occurring disorders and operationalize COSIG Grant in Hillsborough County CBC contracts with CFBHN to provide children’s mental health services in Hillsborough, Manatee and Sarasota counties CFBHN awarded ASO development pilot for District 8 (Charlotte, Lee, Collier, Hendry and Glades counties)
CFBHN History
2004
DCF Suncoast Region contracts with CFBHN to provide substance abuse prevention for adults DCF District 14 contracts with CFBHN to develop service strategies for persons with co-occurring disorders CFBHN identified to operationalize Robert Wood Johnson Resources for Recovery Grant throughout Suncoast Region CFBHN operationalizes substance abuse elder care pilot CFBHN implements diversion services for CBC District 8 DCF initiates start up contract for SB1258 ASO pilot
CFBHN History
Current FY2004-2005 Contract
DCF Suncoast contracts with CFBHN to manage all substance abuse treatment services and funding DCF initiates single contract with CFBHN for contract administration, management and oversight functions for substance abuse treatment throughout Suncoast Region
The Purchaser’s Role
Bob Holm Regional Substance Abuse Director Suncoast Region DCF
DCF’s Strategy
What the Purchaser Wants
Evaluate, integrate and re-engineer system of care into a seamless and easily navigated system Ability to achieve uniform clinical policies and best practice throughout Network Uniform data collection used to drive quality improvement initiatives Resource maximization and cost effectiveness Increased access to care Simplification and non-duplication of contracting and oversight functions to allow for effective use of limited staff
The Purchaser’s Role
Moving the System Forward
State and District SAMH plan development Needs assessment Defining population eligibility Utilization standards Service allocation projection Financing strategies ASO and service system design Contract development ASO contract performance and oversight Regulation and licensing Review and approval of quality and systems improvement initiatives and plans Technical assistance to managing entity Review and approval of contracts with network providers
Reengineering Substance Abuse Treatment
RWJ Resources for Recovery Grant
Suncoast Region and CFBHN named as a pilot in Grant
Medicaid Maximization:
Contract requires 10% increase in Medicaid revenues earned for substance abuse treatment throughout CFBHN providers
Testing of Flexible Payment Methodologies:
prospective payment methodologies Grant funds moved to CFBHN to allow greater flexibility for services to more adequately meet consumer needs and to test strategies for case rates and other
Increased Access to Care:
for residential services and increased access to detoxification services Contract requires reduction of wait lists
Contracting with Networks
Currently using a hybrid performance contracting mechanism designed to increase and move towards flexibility and accountability.
Contract used to define ASO functions and Network requirements and is defined differently by local districts/region
Administrative Services Organization:
“An independent operating entity organized for the purpose of managing and assessing a network of human service providers and provider agencies, to include but not limited to, quality improvement, clinical management, network management, data management, revenue maximization and integration of systems.” (As described in District 8 ASO contract)
Suncoast-Specific Terms
Managing Entity -
An entity that manages the delivery of behavioral health services
Network Provider -
An entity that contracts with the Managing Entity to provide services to clients that are funded through the contract with the department (subcontractor)
System of Care -
Behavioral health services developed into an integrated network to provide services to substance abuse and mental health clients
Contract Requirements
The ASO…
Is responsible for the administration and provision of services Must ensure that network providers will provide services as specified in the system of care plans identified for each county in the Network Operational Plan Must ensure services described are provided throughout the contract period
Contract Requirements
The ASO…
Must ensure that the number of persons served, as required by contract, are served with outcomes Must establish a client grievance procedure that assures that all grievances not resolved at the provider level are referred to the managing entity
Contract Requirements
The ASO is responsible for…
All mandated outcomes,electronic data submissions and performance improvement initiatives Incident reporting Assuring emergency preparedness of its providers Provider financial and audit requirements Billing and invoice validation
ASO Contract Responsibilities
Unique to Suncoast Region
The ASO is responsible for…
Management of wait lists for all substance abuse services Reduction of wait list for residential treatment services Evaluation of Region’s detoxification system Increase of Medicaid billing and reimbursement for substance abuse treatment services by 10% Implementation of substance abuse services to the elder care pilot Implementation of co-occurring service capability throughout provider network
Lessons Learned from Purchaser
Communication is Key!!
Need to clearly define what is being purchased Need to understand and articulate the role of the purchaser Requires partnership of all stakeholders Requires commitment of local SAMH Program Office and state SAMH Program Office Requires transfer of administrative responsibilities, dollars and staff Need to identify barriers and work toward resolving issues Requires ability to assess readiness of Network to assume responsibilities
Building the Network Governance Structure
Richard Brown Chief Operating Officer The Agency for Community Treatment Services acts
The Agency for Community Treatment Services
CFBHN
Suncoast & District XIV 9 counties 19 members (providers) 4 Regional Councils District VIII 5 counties 8 members 5 providers 1 CBC 2 consumer representatives
Governance Structure
All corporate generated documents need to reflect succinctly
….
”who you are and what you are to do”
CFBHN Descriptors
Not-for-profit Provider sponsored network Administrative Service Organization Aspiring to become: Single Managing Entity
Corporate Documents
Articles of Incorporation Bylaws Business Plan Board Policies Member Agreements Vendor Agreements Etc.
Policy Content
Reflect commitment to community driven, consumer centered care: Increased accessibility Continuous care approaches Integration with other systems
Scope of Fund Administration
Select substance abuse funds All substance abuse funds Select substance abuse & select mental health All substance abuse & select mental health All substance abuse & mental health Other (or) “Lines of Business”
Purchase Relationships
ADM Substance Abuse ADM Mental Health AHCA Community Care Provider(s) Local / Governmental Community Care Provider(s)
Membership
Most congruent structure for a Provider Sponsored Network would reflect major providers of the anticipated
“Lines of Business”
Substance Abuse Mental Health Insurance
Single Managing Entity
Eligibility
(Factors for Membership Decisions)
Accreditation Financial Buy-in to Membership Current Contractor for Anticipated “Lines of Business” Medicaid Provider Demonstrated ethics & conformance with requirements of Member / Vendor Agreements In good standing with current funders
Governance Decisions
Financing ASO Infrastructure Earn & Build Staffing Grants (OPS) FCO Grants Membership Fee(s) Member / Vendor Dues
Governance Decisions
Build & Buy Claims Management Human Resources / Personnel Call Center Information System & MIS Management Auditing / Monitoring Etc.
Governance Decisions
Targeted Reserve Fund Development A.
Capital Equipment B.
C.
Research & Development Financial Security D.
E.
F.
Risk Management Insurance Licensure Innovations
Governance Sticking Points
Large vs. Small Agencies Mental Health vs. Substance Abuse Comprehensive Providers vs. Niche Providers Local vs. Remote Headquarters Inclusiveness: Members, Vendors, Purchasers, Stakeholders & Consumers Right of First Refusal Market Share Protections
Sticking Points – cont.
Non-compete vs. Notification of Intentions
ASO vs. Provider Status
TOOLS Towards Focus of Effort & the Attainment of Inclusiveness
Business Planning
System of Care Planning
Ah Right…It’s time for extreme makeover!!
“We will know that we have arrived when the ASO readily matches consumers benefit to provider payments & providers are free to focus on matching consumer needs to services consistent with their progress in recovery”
Building Administrative Capacity
Linda McKinnon Chief Executive Officer Central Florida Behavioral Health Network
Building Administrative Capacity
The Role of the ASO
Provider network development and management Planning Customer service Quality management Utilization management Information management Financial management Training and education; best practice development Systems integration Resource development
Current Organizational Structure
Defined by Functional Roles
Tampa Office Linda McKinnon
Chief Executive Officer
Marcia Monroe Director
Provider Services Kay Doughty
Manager Specialty Services
TBH
Manager Adult Services
TBH
Manager Children’s Services (On Hold) Paula Pressler-Tash Director
Quality Management/ Utilization Management
Rebekah Bickling
Executive Assistant/ Admin Supervisor/ HR Liaison
Mary Herkert Director
Network Operations
Sue Webber Director
Finance Ibelice Rivera
Quality Specialist
TBH
Quality Specialist Laura Cronk
Quality Manager/ Data Operations Analyst Ioan Fernandez
Data Specialist
TBH
Quality Specialist
Yenny Hernandez
Data Specialist
Jimmie Adams
Admin Assistant/ Receptionist
Laura Gross
Administrative Assistant
Brandi Mason
Administrative Assistant
TBH
Admin Assistant (On Hold)
Jan Burton
Manager Contracts
Kathy Way
Manager Contracts TBH
Manager Information Systems (On Hold) TBH
IS Technician (On Hold)
Collaborating for Excellence in Behavioral Health Services TBH
Accountant Lisa Main
Fiscal Supervisor Lisa Thomas
Fiscal Assistant August 16, 2004
Current Organizational Structure
Defined by Functional Roles
District 8 Office Linda McKinnon
Chief Executive Officer
Nancy Rossback Receptionist/Admin Asst Brian Mogosky Director Rick Sanefski QI Manager Jennifer Formica Data Specialist Susan Lang Consumer Affairs Manager
Collaborating for Excellence in Behavioral Health Services
August 16, 2004
Building Administrative Capacity
Quality Management
Performance Improvement Program Evaluation
– Specialized reports, outcomes improvement, best practice identification, outlier review, customer satisfaction
Performance Compliance
- Corporate service validation, regulatory compliance and oversight, clinical pathway compliance
Utilization Management
oversight - Clinical UM development and
Outcome/Data Management
tracking and reporting - Data and outcome validation,
Technical Assistance and Training Accreditation
Building Administrative Capacity
Provider Services
Credentialing and profiling Clinical systems development Best practice implementation Technical assistance Product development Service development Provider information and orientation Management of training resources Consumer, stakeholder, purchaser and provider satisfaction Complaints and grievance
Building Administrative Capacity
Financial Management Financial reporting and forecasting requires tracking, analysis and reporting of the following:
Rate Setting and development methodologies Provider allocations Cost accounting system Revenue maximization strategies/ internal resource management Funding utilization and cash flow analysis Agency reconciliation Accounts payable and receivable Budget development and management Insurance Board communication
Building Administrative Capacity
Administrative Services
Information systems and data management Information system development and technical assistance Management reporting support Contract development, negotiation on and compliance Revenue maximization Provider resource management Medicaid maximization Grant development Risk mangment Facility management
Building Administrative Capacity
IS Capabilities - Lessons Learned
Identify information system needs early on and be willing to invest in them!!
Requires identification of software functional needs for: - Network management functions - Claims processing functions - GL linkage and financial functions - Member services functions - Care access functions - Care management and utilization management
Building Administrative Capacity
Executive Services
Board development Regional council development Purchaser relations Advocacy Legal Marketing Human resources Oversight of all Network and ASO operations
Building Administrative Capacity
Lessons Learned
Identify potential conflicts of interest (an ASO is not a provider) Be prepared to perform once you have got what you asked for – greater flexibility has its own set of requirements Don’t over-commit Be prepared to act on opportunism quickly Understand the implications on providers Develop a strong relationship with the Board This is a partnership with all stakeholders and requires open communication and trust ASOs are not “one size fits all”
Nancy Hamilton Chief Executive Officer Operation PAR
PAR
Provider/Member’s View
Two-Hatters in Provider Sponsored Networks CFBHN
“We have met the enemy & he is us”
Pogo
Keep this in mind …..ALWAYS!!
Holy Cow…What will become of us…will we survive???
I’m so confused…what to do…get on the bus…or find my self hitchhiking later??
Contracting thru The ASO
Opportunities Challenges Flexibility Sharing expertise Sustainability Giving up control to gain some control over the unpredictability of politics Respond to the needs of the community Improve quality of services
Our invoices will now be matched to the information in the data warehouse. The network is not going to hold up invoices for the first couple of months (good) but could be problematic in the future Investing in the network meant reduction in revenues – invest today for potential higher returns later staff – scary, hard to explain to Board &
Testimony – the CFO
Renegotiating contract – reduced tedious financial reports required in the past. At negotiation, all reimbursement rates were increased to the model rate, less the admin. rate, which resulted in increased rates for most of our services Contract was restructured to allow us more flexibility to spend dollars among cost centers.
Don’t have to go through contract amendments to move dollars around End of the year, the network was able to re allocate funds due to lapse dollars. Since PAR was over-producing units in some of the cost centers, we were able to share in this reallocation – Next year who knows
Testimony – VP of IS
ASO must have an excellent data system & provide “value added” or this is just an extra expense to providers/partners within the ASO. I don’t think I can emphasize this enough.
The data system MUST be easy to use & not place additional demands on the providers; one thing providers do NOT need is additional demands or requirements.
Offer an IS system for those smaller agencies & providers that do not have any IS system at all.
well like HR, etc.
This could be just client services & state reporting or it could be for other functions as
IS should be involved strategically (like at CFBHN) & involved in the process assuming there is the appropriate staff to do so.
This will produce better IS systems and processes & since ASOs move great amounts of data, it is so important that we have IS systems that minimize paper movement & increase
automation.
Re-engineering
(infrastructure, conceptually, & philosophically) Budgeting Data Management Q.I.
HR / Credentialing Billing / Reporting Business / Strategic Planning System of Care Planning
ASO Expectation
Reflect commitment to community driven, consumer centered care:
Increased accessibility
Continuous care approaches
Integration with other systems
Clinical
Client Centered - Assessment & Treatment
Consumer Satisfaction
Matching & Prioritization
Waiting List Management
Sticking Points
Large vs. Small Agencies
Mental Health vs. Substance Abuse
Comprehensive Providers vs. Niche Providers
Local vs. Remote Headquarters
Inclusiveness: Members, Vendors, Purchasers, Stakeholders & Consumers
Right of First Refusal
Market Share Protections
Eligibility
(Factors for Membership Decisions)
Accreditation
Financial Buy-in to Membership
Current Contractor for Anticipated “Lines of Business” Medicaid Provider
Demonstrated ethics & conformance with requirements of Member / Vendor Agreements
In good standing with current funders
One Big Happy Family???
•
Young & Old – Big & Small
•
Naive & Jaded
•
Quiet & Noisy
•
Unique Personalities
•
Conflict / Resolutions
•
In it for the long haul / Recommitment
•
Agree to Disagree
•
Safety in numbers / One for all – all for one Sometimes the needs of the many outweigh the needs of the few or the one…other times?
Mr. Spock
For more information… Contact:
Richard Brown The Agency for Community Treatment Services 4612 North 56 th Street Tampa, FL 33610 813-246-4899 phone <> 813-621-6899 fax [email protected]
Nancy Hamilton Operation PAR 6655 66 th Street North Pinellas Park, FL 33782 727-545-7564 phone <> 727-545-7584 fax [email protected]
Bob Holm Department of Children and Families SAMH Program Office 11351 Ulmerton Road, Suite 329 Largo, FL 33778 727-518-3271 phone <> 727-588-3618 fax [email protected]
Linda McKinnon 719 US Highway 301 South Tampa, FL 33619 813-740-4811 phone <> 813-740-4824 fax <> 813-389-8179 cell [email protected]
Thank you for your attendance and participation!!