Bob Long Co-chair, NYCCP Steering Committee Commissioner of Mental Health – Onondaga County

1. Bob Long Co-chair, NYCCP Steering Committee Commissioner of Mental Health – Onondaga County New York Care Coordination Program:A View of Current Initiatives in the Era of MBHO’s and Health Homes

2. 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

3. What can be learned from over 20 years of health care cost control? Those who cannot remember the past are condemned to repeat it. ~ George Santayana www.carecoordination.org

4. 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

5. Lessons Learned: If YouFocus 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

6. 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

7. 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

8. 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

9. The future ain’t what it used to be. ~ Yogi Berra What’s next? www.carecoordination.org

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. NYCCP RBHO/Health Home Vision Provider D Provider A Provider E Provider B Provider F Provider C www.carecoordination.org

17. www.carecoordination.org

18. Questions? www.carecoordination.org