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THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS

THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS. Presented At The Rehabilitation Summit, NYSRA Saratoga Springs, NY Monday September 16 th , 2013. Jonas Waizer, PhD, Chief for Healthcare Policy FEGS Health and Human Services.

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THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS

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  1. THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS Presented At The Rehabilitation Summit, NYSRA Saratoga Springs, NY Monday September 16th, 2013 Jonas Waizer, PhD, Chief for Healthcare Policy FEGS Health and Human Services

  2. Today’s Themes • Change Is Constant: Who Moved My Cheese • Personal Journey • State Medicaid Redesign • Provider Actions • Challenges • Models • Actions • Next Steps

  3. CHANGE IS CONSTANT: A PERSONAL JOURNEY • 1968 –Autism: Parental Upbringing vs. Neurobiology • 1980’s – Deinstitutionalization vs. Trans-institutionalization • 1990’s – Programs vs. Consumer Centered • Today – F-F-S vs. Managed Care, Service Integration, Risk Sharing

  4. NYSDOH: Special Plans for High-Need Medicaid Populations Total Complex N=976,356 $2,338 PMPM 32% Dual 51% MMC $25.9 Billion

  5. STRATEGIC CHANGES IN NYS HEALTH CARE

  6. SOME PROVIDER CHALLENGES • Maintain Services to Disability Groups - Shifting from FFS to MC • Partnerships and Networks - Forming New Business Models • Risk-Sharing Arrangements – Contracting with MCOs • New Models of Care Coordination - DISCO, HARP, FIDA • Integrating Services - Health, Behavioral Health, SA, Habilitation, etc. • Focus on Outcomes – e.g. Recidivism, Employment, Housing Stability • Focus on Measures - Performance, Health and Quality Metrics • Upgrade EHR - Tracking, Reporting, RHIOs , Customer Centered Services

  7. The Best Way To Predict the Future Is to Invent It Abraham Lincoln Peter Drucker Steve Jobs

  8. FEGS Health & Human Services One of the Nation’s Largest and Most Diversified Nonprofit Health and Human Services Organizations. Mission: To help each person served achieve greater success, independence and dignity at work, at school, at home and in the community. Operating Areas: • Health • Disabilities • Homecare • Housing • Employment • Education • Youth and Families FEGS by the numbers: • 100,000+ New Yorkers Served Annually • $300 Million Annual Budget • 5,000 Staff • 3,000 Interns, Volunteers and Consultants • 350 program locations across New York City, Long Island and Westchester County • 14 Subsidiaries • 1.6 Million Square Feet FEGS Health & Human Services Presentation to: HealthPlus Amerigroup 2

  9. FEGS - New Healthcare Partnerships Managed Special Needs (Simplified View) NYS Medicaid MRT Program (NYS DOH) Managed Care Organizations Medical Payment Risk Arrangements Payment for Care Management Services Developmental Disabilities Homecare Behavioral Health Risk Sharing Partnerships Under MRT IPAs Service Provider Service Provider Continue as Service Providers Service Provider Service Provider Service Provider FEGS Health & Human Services

  10. ACA Structure State Advance of Greater NY, LLC Alliance Care Network, LLC LI Alliance, LLC $ owners Advance Care Alliance, LLC EmblemHealth (MCO) Care management contract Contract for risk sharing, claims payment, IT, back office services ACA IPA Providers

  11. PROVIDER ACTIONS FOR THE 21st CENTURY • Focus on Engagement, Outreach, Adherence (esp. Rx) • Care Coordination for Complex Cases – Keep People at Home • Prepare for Variable Payment Systems: FFS, Case Rates, PMPM • Pilot Innovative Services - e.g. Health Coordination, Employment Support, Residential and Crisis Beds, Self-Directed, etc.) • Partnerships* • IT Upgrades*

  12. PARTNERSHIPS AND NETWORK DEVELOPMENT • Acute Care Partners: Local Hospitals , Urgi-centers • Primary Care Community Partners: FQHCs, Medical IPAs • Specialized IPA: With Other Licensed Providers • Families and Consumers: Promote Governance and Choice • Managed Care Companies for Shared Savings, Shared Risk

  13. IT REQUIREMENTS • Track/Monitor Consumers Inside and Outside the Agency • Import & Export Data (Network Providers, Hospitals, RHIOs) • Link to MCOs for Referral Stream • Collect and Process Standardized Measures, Metrics • Process Data Analytics, Report Cards

  14. NEXT STEPS: FOR PROVIDERS (& GOVERNMENT) • Capitalize IT Upgrades (Inside and Outside) • Train Provider Management and Staff in Risk–Sharing Models • Simplify /Centralize Credentialing • Standardize Measures, Data Analytics, Report Cards • Simplify State Regulations (vis-a-vis MCO Requirements) • Re-invest Resources

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