Transcript OnCare Full Stakeholder Meeting

OnCare
Full Stakeholder Meeting
4/7/14
COMMUNITY PROGRESS CHECK
Crisis Services  Increase community awareness of available services
Residential
 Expand work being done on cross-systems discharge
planning
Family-Driven
 Equip families for roles on governing/advisory boards
 Train providers on how to support family leaders
Youth-Guided
 Equip youth for roles on governing/advisory boards
 Train providers on how to support youth leaders
 What Helps/What Harms youth forums
Natural
Supports
 Targeted invitation /mini-event to engage missing
community partners
Transition-Age  Develop paths/protocols that guide transitions from
children and youth services to adult services
Youth
COMMUNITY PROGRESS CHECK
Access to
Services
 Focus on community awareness of services
Cross-Systems  Training for providers and families to prepare for the
implementation and impact of Health Homes
Issues
 Support Promise Zone / School-based Initiatives
School
Partnerships
Anti-stigma /
Community
Awareness
Cultural and
Linguistic
Competence
 Maximize opportunities for community awareness
(presentations, training, web site, etc.)
 Data collection / dashboard that includes diversity
issues
 Community-wide CLC / Diversity training
New Workgroups
• Transition Age Youth (Time-limited)- Focusing on the hand-off
between the ACCESS Team and Adult SPOA
• Training- identifying community training needs and
opportunities. Meeting 4/23/14 at Catholic Charities
– Cross-systems issues
– Anti-stigma/ Community Awareness
– CLC
• Social Marketing – Meeting 4/23/14 at Catholic Charities
– Community Awareness and anti-stigma
– Access to Services
Contact Bruce Brumfield at [email protected]
Got Art? 2014
– Theme: “Happiness is…”
– OnCare will provide funding support to agencies
for workshops. Please contact Aishah Rudolph at
[email protected]
– Submission forms available at
www.oncaresoc.org/got-art-2014/
Liturgical Praise Dance
Jaimelita Hill
Jailin Gladney
HEALTH HOMES AND
MANAGED CARE
QUO VADIMUS
AGENDA
• Transition of All Medicaid Funded Services to Managed
Care
• What is a Health Home?
• Lessons Learned from Adult Health Homes
• How Will a Children’s Health Home be Different?
• How Will the Transition to Health Homes Impact How
Services are Delivered?
• Time Line for Development
• Role of the Family and Youth
• Potential Roles for Providers
• Hillside/Northern Rivers/HHUNY proposal
• Discussion: What should the Community do to get
ready?
TRIPLE AIM
•Improving Care
•Improving Health
•Reducing Costs
Principles of BH Benefit Design
Person-Centered Care management
Integration of physical and behavioral health services
Recovery oriented services
Patient/Consumer Choice
Ensure adequate and comprehensive networks
Tie payment to outcomes
Track physical and behavioral health spending
separately
Reinvest savings to improve services for BH populations
Address the unique needs of children, families & older
adults
11
Proposed 2016 Children’s
Medicaid Managed Care Model
For all children 0-20 years old
Mainstream Medicaid
Managed Care
Organization: Benefit
Package*
Children
All
’s 1915c
Health & Behavior Potential
HCBS
Pharma al Health Children
Waivers
cy
State
’s 1915i (OMH
Expande
Plan
like
and
Services Services
d
OCFS
Benefits
B2H)
Required to
contract
Required to
have MOUs
and/or working
relationships
Care Management for All
Care Management will be provided by a range
of models that are consistent with a child’s needs
(e.g., Managed Care Plans, Patient Centered
Medical Homes and Health Homes (HH). Health
Homes will serve children with the highest level of
need. – see page 3)
*MCOs may opt to contract with other entities (e.g., BHOs)
to manage behavioral health benefits
Pediatric
Health Care
Providers
Service Provider
Network
Pediatric
Specialty
Health
Care
Providers
Children’s
Behavioral
Health
Providers
Community
Based
Providers
(e.g., family
support/peer
services)
Foster
Care
Providers
School
Districts &
CSEs
Community
Services &
Support s
(nonMedicaid)
Local
Governme
nt (LDSS,
LGU, SPOA,
Probation)
Juvenil
e
Justice
/Crimin
al
Justice
System
Regional
Planning
Consortiums
12
NYS Medicaid Behavioral Health
Transformation Implementation Timeline
2015
1
STATE OPTION TO PROVIDE COORDINATED CARE
THROUGH A HEALTH HOME FOR INDIVIDUALS
WITH CHRONIC CONDITIONS
Designated in the Affordable Care Act Section 2703
14
NEW YORK STATE HEALTH HOME MODEL FOR CHILDREN
Managed Care Organizations (MCOs)
Health Home
Lead
Health Home
Primary,
Community and
Specialty Services
Downstream &
Care Manager
Partners
Network Requirements
Administrative Services, Network Management, HIT Support/Data Exchange
(To support
transitional care)
Pediatric
Health
Care
Providers
Care
Managers
Serving
Adults
OMH
TCM
(SCM &
ICM)
HH Care Coordination
 Comprehensive Care
Management
 Care Coordination and
Health Promotion
 Comprehensive Transitional
Care
 Individual and Family
Support
 Referral to Community and
Social Support Services
 Use of HIT to Link Services
Waivers
(OMH
SED, CAH
& B2H)
DOH
AI/COBRA
Care
Managers
Serving
Children
OASAS/
MATS
Access to Needed Primary, Community and Specialty
Services(Coordinated with MCO)
Pediatric & Developmental Health, Behavioral Health, Substance Use
Disorder Services, HIV/AIDS, Housing, Education/CSE, Juvenile Justice,
Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services,
Early Intervention (EI), and Waiver Services (1915c/i)
Note: While leveraging existing Health Homes to serve children is the preferred option, the
State may consider authorizing Health Home Models that exclusively serve children.
OCFS
Foster
Care
Agencies
and Foster
Care
System **
**Foster Care
Agencies Provide
Care Management
for Children in
Foster Care
1
FUNDING
• Many providers transitioning to health homes will
continue to bill for services through current methods
until transition is complete.
• Community based organizations should be ready to
contract with managed care organizations to
deliver services to those with the most intense needs
(1915i).
• Managed care will be the payer for all Medicaid
service upon full implementation.
MANAGED CARE AND HEALTH HOMES
• MCOs can retain up to three percent of the Health
Home fee and pass the rest through to the Health
Home unless additional services have been
negotiated
• MCOs will continue to manage all in-plan services
for Health Home members but will contract with
Health Home care managers to coordinate services
MANAGED CARE AND HEALTH HOMES
• MCOs contracting for Health Home services must
use NYSDOH designated Health Homes
• MCOs assign patients to Health Homes based on
eligibility lists. Patients that already receive TCM will
be assigned to Health Homes by their current TCM
program.
MANAGED CARE AND HEALTH HOMES
• MCOs and Health Homes share responsibility for
outcomes for patients that are assigned to Health
Homes
• MCOs will share member Protected Health
Information (PHI) with the Health Home that
provides services. MCOs will follow special
guidelines for sharing PHI of vulnerable individuals.
MANAGED CARE AND HEALTH HOMES
• MCOs do not assign existing TCM patients to Health
Homes, converting TCM programs assign their
members to the Health Home that will best meet
the member's needs and preserve the care
management relationship.
• MCOs will work through Health Homes to
coordinate care and share data with TCM
programs on behalf of members in existing TCM
slots.
• Health Homes must utilize the MCOs contracted
network of providers for services in the benefit
package. MCOs may expand provider networks
based on Health Home member need.
LESSONS LEARNED FROM
ADULT HEALTH HOMES
• New reimbursement models means a new care
model is necessary.
• Going from direct care to coordinating care is a
challenge in the adult system, but is consistent with
High Fidelity Wrap.
• Care management providers converting to Health
Homes need a wider set of skills to serve expanded
eligibility groups (Behavioral Health, Substance
abuse, and physical health conditions).
• Relaxed regulations for TCM services (and
potentially waiver) provide more flexibility but
increase compliance issues.
LESSONS LEARNED FROM
ADULT HEALTH HOMES
• Transitions in levels of care are sometimes more difficult,
since caseload and reimbursement models potentially
reduce the intensity available in care management
services.
• IT requirements are significant.
• No advantage to being a health home in the short term
Funding does not cover startup costs.
Cost of building infrastructure is prohibitive (NYCCP).
• Long term - more potential opportunities for
collaborations and partnerships.
LESSONS LEARNED FROM
ADULT HEALTH HOMES
• Productivity vs. outcomes – current reimbursement
models for care management incentivize delivery of
services over the outcome of the service delivery.
• Service Providers need different skills to work as part of a
network with shared responsibility for outcomes:
 Contracting
 Collaboration
 Information sharing
 Coordinated care planning
• Cross systems work and accessibility of physical health
services is critical.
• The complexity of the children's services system will be a
challenge (juvenile justice, education, foster care, etc.)
WHY A CHILDREN'S HEALTH HOME?
• Children’s needs are different and require a
different approach
 Nationally, 2/3 of children in intensive care coordination are
also served by other systems (OCFS, OPWDD, SED, etc.)
 The complexity of the systems require sophisticated system
of care knowledge and linkages.
• Children have families who must to be involved.
Threats to family capability posed by poverty,
behavioral health issues or substance abuse can
create health care problems in children that may
be life-long and irreversible.
WHY A CHILDREN'S HEALTH HOME?
• Co-morbid physical health conditions are considerably less in
children – consequently cost savings are in cross-system
utilization and prevention of more serious future problems, not
in short term medical cost reduction.
• Diagnosis in children is not as good a cost predictor as it is in
adults. Functional and behavioral challenges are more critical.
(CANS-NY may have a role here.)
• ACES (Adverse Childhood Experiences Study) demonstrates
that increased trauma events have a life-long effect on
needs, outcomes, and, therefore, costs.
• Permanency matters – children need robust family networks to
thrive; building those networks requires a deliberate process.
25
DOH PRINCIPLES FOR SERVING CHILDREN IN
HEALTH HOMES AND MANAGED CARE
• Ensure managed care and care coordination networks provide
comprehensive, integrated physical and behavioral health care
that recognizes the unique needs of children and their families
• Provide care coordination and planning that is family-and-youth
driven, supports a system of care that builds upon the strengths of
the child and family
• Ensure managed care staff and systems care coordinators are
trained in working with families and children with unique, complex
health needs
• Ensure continuity of care and comprehensive transitional care from
service to service (education, foster care, juvenile justice, child to
adult)
• Incorporate a child/family specific assent/consent process that
recognizes the legal right of a child to seek specific care without
parental/guardian consent
• Track clinical and functional outcomes using standardized pediatric
tools that are validated for the screening and assessing of children
• Adopt child-specific and nationally recognized measures to monitor
quality and outcomes
• Ensure smooth transition from current care management models to
Health Home, including transition plan for care management
payments
26
CONSISTENT WITH DOH PRINCIPLES WE
RECOMMEND A DIFFERENT CARE MANAGEMENT
APPROACH
• “Families as care managers”: Parents/caregivers
should be coached and supported to manage
their children’s health and wellness.
• “Family-Finding”: When children have no
permanent adult in their lives, we recommend
Family Finding to develop a lifetime network of
support. When caregivers are not able to manage
their children’s care on their own, Family Finding
could be used to develop a network of natural
supports to provide the necessary support to those
caregivers.
27
CARE COORDINATION APPROACH
• “Hi-Fidelity Wraparound”. For those children and youth
with the highest need, the caseload must be low
enough to allow fidelity to the Wrap-around model. For
all children, practice should be informed by Wrap
principles: Family Voice and Choice; Team based;
Natural Supports; Collaboration; Community-based;
culturally Competent; Individualized Strengths based;
Persistence; and Outcome based
• Multi-disciplinary team. The team will be multidisciplinary to allow the right expertise at the right time.
Family and youth peer supports should be available for
every family’s team.
28
CARE COORDINATION APPROACH
• Assessment of Acuity must take family structure and
functioning into account. The strength and resources of
the family system will impact how much time and
energy will go into care management to meet the
child’s needs.
• Model must build on the strengths of the child and
family. Staff must be trained and have the time to write
a “Strengths, Needs and Culture Discovery” (or other
similar document) with the family. The assessment tool
must ensure engagement by supporting the family to tell
their story in a way that honors their culture, history and
vision.
29
CARE COORDINATION APPROACH
• Family driven, youth guided planning and care
coordination. Model must allow the time and provide
staff with the skills and tools (e.g. Family Development
Plan) necessary to let youth and families to guide their
plan and develop goals that meet their needs,
consistent with system priorities
• Funds for stabilization. Current case management
models include funds to address immediate concrete
needs that must be addressed before a child and family
can concentrate on (physical and behavioral) health
issues. The new system must include access to flexible
dollars and a ensure robust service network.
30
CARE COORDINATION APPROACH
• Adopt child-specific and nationally recognized
measures to monitor quality and outcomes. CANSNY might be the best we can do but we
recommend exploring other measures as well.
31
NEW YORK STATE HEALTH HOME MODEL FOR CHILDREN
Managed Care Organizations (MCOs)
Health Home
Lead
Health Home
Primary,
Community and
Specialty Services
Downstream &
Care Manager
Partners
Network Requirements
Administrative Services, Network Management, HIT Support/Data Exchange
(To support
transitional care)
Pediatric
Health
Care
Providers
Care
Managers
Serving
Adults
OMH
TCM
(SCM &
ICM)
HH Care Coordination
 Comprehensive Care
Management
 Care Coordination and
Health Promotion
 Comprehensive Transitional
Care
 Individual and Family
Support
 Referral to Community and
Social Support Services
 Use of HIT to Link Services
Waivers
(OMH
SED, CAH
& B2H)
DOH
AI/COBRA
Care
Managers
Serving
Children
OASAS/
MATS
Access to Needed Primary, Community and Specialty
Services(Coordinated with MCO)
Pediatric & Developmental Health, Behavioral Health, Substance Use
Disorder Services, HIV/AIDS, Housing, Education/CSE, Juvenile Justice,
Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services,
Early Intervention (EI), and Waiver Services (1915c/i)
Note: While leveraging existing Health Homes to serve children is the preferred option, the
State may consider authorizing Health Home Models that exclusively serve children.
OCFS
Foster
Care
Agencies
and Foster
Care
System **
**Foster Care
Agencies Provide
Care Management
for Children in
Foster Care
3
Anticipated Schedule for Enrolling Children in Health Homes
Review Health Home Children’s Model with
Stakeholders - MRT Children’s Work Group,
HH-MCO Work Group
Collaborate with Stakeholders to Refine
Health Home Model and Develop Health
Home Application for Children
Applications for Health Homes Serving
Children Made Available
Due Date for Submission of Applications for
Health Homes Serving Children
Health Home State Agency Team Review
and Approval of Applications
Develop and Distribute Health Home
Assignment /Eligibility Lists for Children
October 2013
November 2103 March 2014
April 2014
May 2014
August 2014
October 2014
November –
December 2014
Begin Enrolling Children in Health Homes
January 2015
Behavioral Health Services for Children in
Managed Care
January 2016
10.16.13
33
Proposed 2016 Children’s
Medicaid Managed Care Model
For all children 0-20 years old
Mainstream Medicaid
Managed Care
Organization: Benefit
Package*
Children
All
’s 1915c
Health & Behavior Potential
HCBS
Pharma al Health Children
Waivers
cy
State
’s 1915i (OMH
Expande
Plan
like
and
Services Services
d
OCFS
Benefits
B2H)
Required to
contract
Required to
have MOUs
and/or working
relationships
Care Management for All
Care Management will be provided by a range
of models that are consistent with a child’s needs
(e.g., Managed Care Plans, Patient Centered
Medical Homes and Health Homes (HH). Health
Homes will serve children with the highest level of
need. – see page 3)
*MCOs may opt to contract with other entities (e.g., BHOs)
to manage behavioral health benefits
Pediatric
Health Care
Providers
Service Provider
Network
Pediatric
Specialty
Health
Care
Providers
Children’s
Behavioral
Health
Providers
Community
Based
Providers
(e.g., family
support/peer
services)
Foster
Care
Providers
School
Districts &
CSEs
Community
Services &
Support s
(nonMedicaid)
Local
Governme
nt (LDSS,
LGU, SPOA,
Probation)
Juvenil
e
Justice
/Crimin
al
Justice
System
Regional
Planning
Consortiums
34
HHUNY/HILLSIDE/NORTHERN RIVER’S
CHILDREN’S HEALTH HOME PROPOSAL
A FAMILY DRIVEN CARE MANAGEMENT MODEL
EMPOWERING AND EQUIPPING FAMILIES AND CHILDREN TO
MANAGE THEIR OWN HEALTH AND WELLNESS
We will organize a strong network of down-stream
care management organizations in counties across
the upstate region, as well as a large network of
service providers who wish to work with the families
and The Health Home to improve health and wellness
for this vulnerable population.
HHUNY/HILLSIDE/NORTHERN RIVER’S
CHILDREN’S HEALTH HOME PROPOSAL
• The Hillside/Northern Rivers Children’s Health Home
will adapt infrastructure created by HHUNY and its
Adult Lead Health Homes
• We will hold regional information meetings
throughout Upstate NY. The first meeting will be held
on May 1, 2014 at 10:30 at Hillside’s Work
Scholarship Connection Office in Syracuse.
DISCUSSION
What should our community do to get ready
for Children’s Health Homes and Medicaid
Managed Care?
WRAP UP




OnCare Evaluation Team staff changes
No May Stakeholder meeting
Got Art?—May 6 from 4-6 pm at the MOST
Hillside Regional Health Home session—May 1
at 10 am at Hillside Work Scholarship
Connections
THANKS FOR COMING!