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State Models of Medicaid/Behavioral Health Collaboration

State Models of Medicaid/Behavioral Health Collaboration. New Jersey Stakeholder Group Meeting January 20, 2012 Allison Hamblin, CHCS. Behavioral Health System Reform: Why Such a Hotbed of Activity?. It’s all in the numbers… Top 5% drives 50% of Medicaid spending

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State Models of Medicaid/Behavioral Health Collaboration

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  1. State Models of Medicaid/Behavioral Health Collaboration New Jersey Stakeholder Group Meeting January 20, 2012 Allison Hamblin, CHCS

  2. Behavioral Health System Reform: Why Such a Hotbed of Activity? • It’s all in the numbers… • Top 5% drives 50% of Medicaid spending • Half of beneficiaries with disabilities have BH comorbidity • Addition of mental illness and substance use disorder to chronic medical population is associated with 3-4x increase in costs • 25 years of lost life expectancy associated with serious mental illness, primarily due to physical health issues Yet, most of these individuals receive services through fragmented, uncoordinated systems 2 *Sources: RG Kronick et al., “The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions.” Center for Health Care Strategies, October 2009; C. Boyd, et al. “Clarifying Multimorbidity for Medicaid Programs to Improve Targeting and Delivery of Clinical Services.” Center for Health Care Strategies, December 2010.

  3. Impact of Mental Illness & Substance Use Disorders on Cost and Hospitalization for People with Diabetes SOURCE: C. Boyd et al. Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services. Center for Health Care Strategies, December 2010.

  4. The National Landscape • General trend away from fee-for-service toward managed systems of care • Efforts to promote integration at both the system level and at the point of care • Aligned incentives • Information exchange • Accountable care homes • Significant variation in approach

  5. A Range of Approaches to Reform

  6. Pennsylvania’s Approach • Separate capitated systems: MCOs and BHOs • Regional pilots to promote integration for individuals with SMI • Created Shared Incentive Pool tied to Performance Measures • Process: Integrated health profiles, real-time hospital notification • Outcomes: ED visit and hospital admission rates • Designated accountable care home

  7. New York’s Approach • Separate approaches based on level of BH need • Mild to moderate: MCO continues to include BH services • Higher acuity: movement from FFS to managed care • Phased implementation • ASO in 2011 • Capitated managed care in 2013 • Geographic variation • NYC: Integrated BHO/SNP • Elsewhere: BHO • Linkage to health home

  8. Common Elements to Promote Integrated Care • Aligned financial incentives (e.g., to coordinate, reduce hospitalizations, etc) • Information exchange • Clear policy guidance on privacy issues • Accountable care homes • Multidisciplinary care teams • Competent provider networks • Mechanisms for assessing and rewarding high-quality care

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