Discussing the Options

1. Discussing the Options CBH Meeting- May 31, 2012 Jennifer Ternay JLS Advisory Group, Inc.

2. Research and Interviews New York

3. New York • Regional Behavioral Health Organizations • Operational in Jan 2012 for 4 regions and fifth region live in Feb 2012 • Joint contracts with Office of Mental Health and Office of Alcoholism and Substance Abuse Services • Phasing in over three years • Expanded scope moving to risk

4. NY RBHO – Limited Scope • Concurrent review of inpatient stay • Reduce unnecessary readmissions • Improve rate of engagement after discharge • Gather information about clinical conditions of children with SED treated in OMH licensed specialty clinic • Provider profiling • Facilitate cross-system linkage

5. Pharmacy and FFS • Carved into MCO • Formulary problems • MCO can’t implement payment for APGs

6. Implementing APG • Ambulatory Patient Group (APG) • Referred to as “Government Rates” • Target date: 7/1/12 • Limited number of codes • Blended and phased in • Allows for multiple services on the same day

7. NY Health Homes • Provide or subcontract for all services • Responsible for services by subcontractor • Allows for administrative role as health home without providing any actual services • State plan amendment (SPA) effective Jan’12 • Outcomes to be measured – see SPA at http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/nys_health_home_spa_draft.pdf http://www.health.ny.gov/health_care/medicaid/ program/medicaid_health_homes

8. Highlighted Requirements • Describe relationship and communication between dedicated CM and treating clinicians • P&Ps and contracts to support collaboration and define roles and responsibilities • 24/7 availability of care manager • System to track and share patient information and care needs; monitor outcomes and change care as needed • P&Ps to support transition and notification to/from higher levels of care

9. Highlighted Requirements • P&Ps and contracts with community-based resources • Data through regional health information organization/qualified entity • Accountable for reducing avoidable health care costs (preventable hospital admission/readmission and avoidable ER) • Accountable for timely follow-up post discharge and improving patient outcomes

10. Health Information Technology Initial standards • Plan of care for every patient • Follow-up on tests, treatments, services and referrals • Health record accessible to team for population management and identification of gaps in care • Use regional health information organization

11. Financing • PMPM is risk-adjusted based on region, enrollment volume, case mix and eventually, patient functional status • Two rates • Case finding group - outreach and engagement • Active care management – paid in 2 installments with second paid once pre-set state quality metrics are met • Single SMI/SED rates - $148/$189/$385 • Shared savings opportunities

12. Home Health Reality • Implementation not going well • Other lobbying entities want to block community mental health agencies • New York is fast track but never on time • Children not allowed to be excluded by CMS but in reality the adults are the priority • Struggling to define options for children

13. Discussing the Issues Next Steps

14. Issues to Discuss • ASO vs. MBHO • Leveraging CMEs • Health homes • Data on substance abuse services • Non-Medicaid services • MH-SA integration • Bi-directional care (Herb’s 5/24 email)

15. Conclusions and Next Steps