Transcript Slide 1

Collaborative undertaking by counties, providers and consumers,
with support from OMH and project management by CCSI
Shared goal of promoting recovery and conserving resources for the
support of children with serious emotional disturbance and adults
with serious mental illness.
Formed in 2000, operational in mid-2002 – six western and central
counties, including Chautauqua, Erie, Genesee, Monroe, Onondaga,
Wyoming. Expanded in 2009 to include Westchester County.
Implemented care coordination in diverse urban and rural counties.
2,800 enrollees at any one time
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NYCCP Specialty Care Management
Improves Outcomes and Costs
Better quality
• 46% decrease in emergency room visits per enrollee*
• 53% reduction in days spent in a hospital*
• 78% of enrollees report “dealing more effectively with problems” (2009 Enrollee
Survey)
Better outcomes
• 31% increase in gainful activity*
• 54% decrease in self harm among enrollees*
• 53% reduction in harm to others*
Lower costs
• 2008 Medicaid mental health costs for Care Coordination populations in NYCCP vs.
comparison counties: (OMH August 2010)
• 92% lower for inpatient services
• 42% lower for outpatient services
• 13% lower for community support Physical health savings would be additional.
• $5,541 lower average cost person
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* 2009 Periodic Reporting Form Analysis
NYCCP has identified unmanaged populations as a driver of
continuing high costs and refocused, community based,
specialty care coordination as a component of the solution.
Of Erie and Monroe mental health users, the
“top 10% in total cost” represent 63% of
Medicaid hospital and residential spending…
100%
22,836
80%
60%
$69.1M
…yet only a quarter of the “top 10%” were
enrolled in available Care Coordination
programs
100%
100%
80%
Other Erie
and Monroe
County MH
Consumers
60%
40%
40%
20%
20%
Not Enrolled
Enrolled
Top 10%
0%
• ACT
• ICM
• SCM
0%
Note: Analysis of all 2007 claims for Medicaid recipients 18 or over, with any mental health claim,
excluding individuals with any OMRDD or nursing home claim.
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NYCCP Keys to Success
Culture change to a focus on Recovery
Person-centered practices, planning, and services
Coordination of physical health, behavioral health and social support services
Continuous quality improvement and performance measurement
Specialty care management grounded in understanding of complex needs of individuals with
serious mental illness and co-occurring physical health conditions
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Recommendations: Specialty Health Homes
NYCCP is proposing a scalable model for specialty
health homes for individuals with serious mental illness,
based on the NYCCP keys to success . (Detailed
proposal will be submitted.)
Specialty health homes should be a central component
of any Medicaid managed care program, ensuring true
integration of physical health, behavioral health and
social services for people with serious mental illness.
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Recommended Requirements for Managed
Care Organizations (Detailed proposal will be submitted)
Work cooperatively with county mental health departments on local service planning, provider contracting,
coordination of Medicaid and non-Medicaid funding of services for SED children and SMI adults.
Collaborate with community behavioral health providers on person-centered assessment, service planning,
coordination and monitoring of care.
Support formation of partnerships between physical health and behavioral health providers interested in providing
health home services to persons with SMI.
Assure that people with SMI have access to needed physical health services.
Maintain percentage level of financial support for behavioral health care to all populations.
Actively involve behavioral health providers, consumers, and family members in development and oversight of
managed service systems.
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