Behavioral Health Homes

1. Behavioral Health Homes John J. White LPC, LCADC, ACS Office of the Medical Director Division of Mental Health and Addiction Services

2. New Medicaid Services • Health Homes are not a residential service • Health Homes are a “home” for all of the information and coordination of all the medical and behavioral care an individual receives

3. Development of a Health Home Model • The foundation of a Health Home is the Person Centered Medical Home • The Health Home expands the service array of the Person Centered Medical Home and targets specific patient population(s) • It is designed to serve those service recipients most in need of coordinated and comprehensive care

4. Development of a Health Home • Health Homes focus on wellness, disease management, prevention, and care coordination to improve individuals’ care. • Health Homes are designed to avoid fragmented care that leads to unnecessary use of high end services. (Emergency room visits, inpatient hospital stays, etc.) • Health Home services are expected to improve client outcomes, improve client satisfaction, and decrease overall costs

5. Services of a Health Home • Three “Buckets” of Service in a Behavioral Health Home • Medical Care – delivered by the BHH or another provider • Behavioral Health Care - delivered by the BHH or another provider • Health Home Services Included in the Behavioral Health Home Rate • Comprehensive Care Management • Care Coordination • Health Promotion • Individual and Family Support Services • Comprehensive Transitional Care • Referral to Community and Social Support Services

6. Services of a Behavioral Health Home • Medicaid Medical Services and Behavioral Health Services will not change • Behavioral Health Home enrollees maintain their current Medical and Behavioral Health Benefits • No change to the match for these services for the state • Consumer can maintain current provider(s)

7. Development of a Behavioral Health Home Model • For Medicaid, Behavioral Health Homes must be delivered to individuals with 2 chronic medical conditions, one chronic medical condition with risk of another or Serious Mental Illness (SMI) • NJ has chosen to focus on individuals with SMI who are at risk of high utilization

8. New Medicaid Services • States can elect to add Behavioral Health Home Services to their current Medicaid State Plan • States can also elect to add Behavioral Health Home Services to the Alternative Benefit Plan • NJ has added Behavioral Health Home services to both plans

9. Behavioral Health Homes in NJ –Eligible Consumers • Medicaid Eligible • SMI and at risk of increased utilization of medical and behavioral health care services • SMI defined by DHS • Used The Chronic Illness and Disability Payment System (CDPS) to determine risk status • List of qualifying Diagnosis on the DHS website • http://www.state.nj.us/humanservices/dmhas/initiatives/integration/hh.html

10. Behavioral Health Homes in NJ-Eligible Providers • Licensed Mental Health Agencies • Completion of a DMHAS-sponsored Learning Community • Certified by DMHAS • Accredited within 2 years • Co-located within 3 years • Located and serving residents of the county(ies) approved by Medicaid and CMS

11. Health Homes in NJ- BHH Team • Required: • Nurse Care Manager (RN or APN) • Care Coordinator (LSW, LPN) • Health and wellness educator (preferably a peer) • (Psychiatric and primary care consultation) • Two additional team members: Nutritionist Hospital Liaison Peer Support Staff Diabetes Educator Pharmacist Exercise Specialist Case Managers Dietician Holistic Healer Additional Nurse or Social Worker Others as approved by DMHAS

12. Behavioral Health Homes in NJ- Phases of Intensity • Engagement/outreach (3 months): • Outreach • Engage • Assess • Begin care plan • Active (24 months): • Provision of all health home services • Focus on self management, community connection and support system • Maintenance (indefinite as needed): • More able to self manage with fewer interventions

13. Behavioral Health Homes in NJ-Wellness Approach • Everyone on the team pays attention to body/mind connection • Look for interconnections (asthma and anxiety, diabetes and depression) • Use skills in behavioral planning to support self/family management and health behavior change • The “down stream” work of the health home is paramount • Wellness is everyone’s work!

14. Health Homes in NJ-Implementation • Implementing county by county • Bergen County – July 2014 • Mercer County – October 2014 • Atlantic County – April 2016 • Cape May- April 2016 • Monmouth – April 2016

15. Behavioral Health Homes in NJ-Implementation Certified Accredited • Atlantic County • Jewish Family Services • Atlanticare • Bergen County • Vantage Health • Mercer County • AAMH • Monmouth County • Hackensack Meridian • Stress Care • Atlantic County • Helping Hand Behavioral Health • Bergen County • Care Plus • Mercer County • Oaks Integrated Care • Catholic Charities • Monmouth County • CPC Behavioral Health • Easter Seals

16. CT-R for Peer Supports • Recovery-oriented Cognitive Therapy (CT-R) is an evidence-based treatment focused on engagement, achievement of goals, and elimination of obstacles for people diagnosed with serious mental illness. • CT-R combines the person-centered and hopeful spirit of a recovery orientation with solid clinical evidence, treatment protocols, and supported dissemination and implementation. • Over the past year, the New Jersey Division of Mental and Addiction Services, The Aaron T. Beck Psychopathology Research Center at the University of Pennsylvania and Rutgers University Behavioral Health Care have been working with 4 behavioral health homes to learn and implement CT-R.

17. Behavioral Health Homes in NJ-Outcomes • Metrics needed are detailed in “Core Set of Healthcare Quality Measures for Medicaid Behavioral Health Home Programs” provided by CMS. • Focus is on reducing ER visits, inpatient hospitalizations, and improving overall health • An annual data report will be submitted to CMS by NJ Medicaid after compiling data from provider EHRs and Medicaid claims data.

18. For More Information Executive summary and full report are available to download at: www.integration.samhsa.gov

19. Questions? ???