OnCare Full Stakeholder Meeting

1. OnCareFull Stakeholder Meeting 4/7/14

2. COMMUNITY PROGRESS CHECK

3. COMMUNITY PROGRESS CHECK

4. New Workgroups • Transition Age Youth (Time-limited)- Focusing on the hand-off between the ACCESS Team and Adult SPOA • Training- identifying community training needs and opportunities. Meeting 4/23/14 at Catholic Charities • Cross-systems issues • Anti-stigma/ Community Awareness • CLC • Social Marketing – Meeting 4/23/14 at Catholic Charities • Community Awareness and anti-stigma • Access to Services Contact Bruce Brumfield at bbrumfield@communityalternatives.org

6. Got Art? 2014 • Theme: “Happiness is…” • OnCare will provide funding support to agencies for workshops. Please contact Aishah Rudolph at gotart2014@gmail.com • Submission forms available at www.oncaresoc.org/got-art-2014/

7. Liturgical Praise Dance Jaimelita Hill Jailin Gladney

8. Health Homes and Managed Care Quo Vadimus

9. Agenda • Transition of All Medicaid Funded Services to Managed Care • What is a Health Home? • Lessons Learned from Adult Health Homes • How Will a Children’s Health Home be Different? • How Will the Transition to Health Homes Impact How Services are Delivered? • Time Line for Development • Role of the Family and Youth • Potential Roles for Providers • Hillside/Northern Rivers/HHUNY proposal • Discussion: What should the Community do to get ready?

10. Triple AIM • Improving Care • Improving Health • Reducing Costs

11. Principles of BH Benefit Design • Person-Centered Care management • Integration of physical and behavioral health services • Recovery oriented services • Patient/Consumer Choice • Ensure adequate and comprehensive networks • Tie payment to outcomes • Track physical and behavioral health spending separately • Reinvest savings to improve services for BH populations • Address the unique needs of children, families & older adults

12. Proposed 2016 Children’s Medicaid Managed Care Model For all children 0-20 years old Service Provider Network Required to contract Pediatric Specialty Health Care Providers Pediatric Health Care Providers Children’s Behavioral Health Providers Community Based Providers (e.g., family support/peer services) Foster Care Providers Required to have MOUs and/or working relationships School Districts & CSEs Care Management for All Care Management will be provided by a range of models that are consistent with a child’s needs (e.g., Managed Care Plans, Patient Centered Medical Homes and Health Homes (HH). Health Homes will serve children with the highest level of need. – see page 3) Local Government (LDSS, LGU, SPOA, Probation) Community Services & Support s (non-Medicaid) Regional Planning Consortiums Juvenile Justice/Criminal Justice System *MCOs may opt to contract with other entities (e.g., BHOs) to manage behavioral health benefits

13. NYS Medicaid Behavioral Health Transformation Implementation Timeline 13

14. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME FOR INDIVIDUALS WITH CHRONIC CONDITIONS Designated in the Affordable Care Act Section 2703

15. Managed Care Organizations (MCOs) Health Home Administrative Services, Network Management, HIT Support/Data Exchange • HH Care Coordination • Comprehensive Care Management • Care Coordination and Health Promotion • Comprehensive Transitional Care • Individual and Family Support • Referral to Community and Social Support Services • Use of HIT to Link Services Care Managers Serving Adults Care Managers Serving Children Lead Health Home (To support transitional care) New York State Health Home Model for Children DOH AI/COBRA OASAS/ MATS OCFS Foster Care Agencies and Foster Care System ** Network Requirements Pediatric Health Care Providers OMH TCM (SCM & ICM) Waivers (OMH SED, CAH & B2H) Downstream & Care Manager Partners Access to Needed Primary, Community and Specialty Services(Coordinated with MCO) Pediatric & Developmental Health, Behavioral Health, Substance Use Disorder Services, HIV/AIDS, Housing, Education/CSE, Juvenile Justice, Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services, Early Intervention (EI), and Waiver Services (1915c/i) **Foster Care Agencies Provide Care Management for Children in Foster Care Primary, Community and Specialty Services Note: While leveraging existing Health Homes to serve children is the preferred option, the State may consider authorizing Health Home Models that exclusively serve children.

16. Funding • Many providers transitioning to health homes will continue to bill for services through current methods until transition is complete. • Community based organizations should be ready to contract with managed care organizations to deliver services to those with the most intense needs (1915i). • Managed care will be the payer for all Medicaid service upon full implementation.

17. Managed Care and Health Homes • MCOs can retain up to three percent of the Health Home fee and pass the rest through to the Health Home unless additional services have been negotiated • MCOs will continue to manage all in-plan services for Health Home members but will contract with Health Home care managers to coordinate services

18. Managed Care and Health Homes • MCOs contracting for Health Home services must use NYSDOH designated Health Homes • MCOs assign patients to Health Homes based on eligibility lists. Patients that already receive TCM will be assigned to Health Homes by their current TCM program.

19. Managed Care and Health Homes • MCOs and Health Homes share responsibility for outcomes for patients that are assigned to Health Homes • MCOs will share member Protected Health Information (PHI) with the Health Home that provides services. MCOs will follow special guidelines for sharing PHI of vulnerable individuals.

20. Managed Care and Health Homes • MCOs do not assign existing TCM patients to Health Homes, converting TCM programs assign their members to the Health Home that will best meet the member's needs and preserve the care management relationship. • MCOs will work through Health Homes to coordinate care and share data with TCM programs on behalf of members in existing TCM slots. • Health Homes must utilize the MCOs contracted network of providers for services in the benefit package. MCOs may expand provider networks based on Health Home member need.

21. Lessons Learned from Adult Health Homes • New reimbursement models means a new care model is necessary. • Going from direct care to coordinating care is a challenge in the adult system, but is consistent with High Fidelity Wrap. • Care management providers converting to Health Homes need a wider set of skills to serve expanded eligibility groups (Behavioral Health, Substance abuse, and physical health conditions). • Relaxed regulations for TCM services (and potentially waiver) provide more flexibility but increase compliance issues.

22. Lessons Learned from Adult Health Homes • Transitions in levels of care are sometimes more difficult, since caseload and reimbursement models potentially reduce the intensity available in care management services. • IT requirements are significant. • No advantage to being a health home in the short term • Funding does not cover startup costs. • Cost of building infrastructure is prohibitive (NYCCP). • Long term - more potential opportunities for collaborations and partnerships.

23. Lessons Learned from Adult Health Homes • Productivity vs. outcomes – current reimbursement models for care management incentivize delivery of services over the outcome of the service delivery. • Service Providers need different skills to work as part of a network with shared responsibility for outcomes: • Contracting • Collaboration • Information sharing • Coordinated care planning • Cross systems work and accessibility of physical health services is critical. • The complexity of the children's services system will be a challenge (juvenile justice, education, foster care, etc.)

24. Why a children's Health Home? • Children’s needs are different and require a different approach • Nationally, 2/3 of children in intensive care coordination are also served by other systems (OCFS, OPWDD, SED, etc.) • The complexity of the systems require sophisticated system of care knowledge and linkages. • Children have families who must to be involved. Threats to family capability posed by poverty, behavioral health issues or substance abuse can create health care problems in children that may be life-long and irreversible.

25. Why a children's Health Home? • Co-morbid physical health conditions are considerably less in children – consequently cost savings are in cross-system utilization and prevention of more serious future problems, not in short term medical cost reduction. • Diagnosis in children is not as good a cost predictor as it is in adults. Functional and behavioral challenges are more critical. (CANS-NY may have a role here.) • ACES (Adverse Childhood Experiences Study) demonstrates that increased trauma events have a life-long effect on needs, outcomes, and, therefore, costs. • Permanency matters – children need robust family networks to thrive; building those networks requires a deliberate process.

26. DOH Principles for Serving Children in Health Homes and Managed Care • Ensure managed care and care coordination networks provide comprehensive, integrated physical and behavioral health care that recognizes the unique needs of children and their families • Provide care coordination and planning that is family-and-youth driven, supports a system of care that builds upon the strengths of the child and family • Ensure managed care staff and systems care coordinators are trained in working with families and children with unique, complex health needs • Ensure continuity of care and comprehensive transitional care from service to service (education, foster care, juvenile justice, child to adult) • Incorporate a child/family specific assent/consent process that recognizes the legal right of a child to seek specific care without parental/guardian consent • Track clinical and functional outcomes using standardized pediatric tools that are validated for the screening and assessing of children • Adopt child-specific and nationally recognized measures to monitor quality and outcomes • Ensure smooth transition from current care management models to Health Home, including transition plan for care management payments

27. CONSISTENT WITH doh Principles We recommend a different Care Management Approach • “Families as care managers”: Parents/caregivers should be coached and supported to manage their children’s health and wellness. • “Family-Finding”: When children have no permanent adult in their lives, we recommend Family Finding to develop a lifetime network of support. Whencaregivers are not able to manage their children’s care on their own, Family Finding could be used to develop a network of natural supports to provide the necessary support to those caregivers.

28. Care Coordination Approach • “Hi-Fidelity Wraparound”. For those children and youth with the highest need, the caseload must be low enough to allow fidelity to the Wrap-around model. For all children, practice should be informed by Wrap principles: Family Voice and Choice; Team based; Natural Supports; Collaboration; Community-based; culturally Competent; Individualized Strengths based; Persistence; and Outcome based • Multi-disciplinary team. The team will be multi-disciplinary to allow the right expertise at the right time. Family and youth peer supports should be available for every family’s team.

29. Care Coordination Approach • Assessment of Acuity must take family structure and functioning into account. The strength and resources of the family system will impact how much time and energy will go into care management to meet the child’s needs. • Model must build on the strengths of the child and family. Staff must be trained and have the time to write a “Strengths, Needs and Culture Discovery” (or other similar document) with the family. The assessment tool must ensure engagement by supporting the family to tell their story in a way that honors their culture, history and vision.

30. Care Coordination Approach • Family driven, youth guided planning and care coordination. Model must allow the time and provide staff with the skills and tools (e.g. Family Development Plan) necessary to let youth and families to guide their plan and develop goals that meet their needs, consistent with system priorities • Funds for stabilization. Current case management models include funds to address immediate concrete needs that must be addressed before a child and family can concentrate on (physical and behavioral) health issues. The new system must include access to flexible dollars and a ensure robust service network.

31. Care Coordination Approach • Adopt child-specific and nationally recognized measures to monitor quality and outcomes. CANS-NY might be the best we can do but we recommend exploring other measures as well.

32. Managed Care Organizations (MCOs) Health Home Administrative Services, Network Management, HIT Support/Data Exchange • HH Care Coordination • Comprehensive Care Management • Care Coordination and Health Promotion • Comprehensive Transitional Care • Individual and Family Support • Referral to Community and Social Support Services • Use of HIT to Link Services Care Managers Serving Adults Care Managers Serving Children Lead Health Home (To support transitional care) New York State Health Home Model for Children DOH AI/COBRA OASAS/ MATS OCFS Foster Care Agencies and Foster Care System ** Network Requirements Pediatric Health Care Providers OMH TCM (SCM & ICM) Waivers (OMH SED, CAH & B2H) Downstream & Care Manager Partners Access to Needed Primary, Community and Specialty Services(Coordinated with MCO) Pediatric & Developmental Health, Behavioral Health, Substance Use Disorder Services, HIV/AIDS, Housing, Education/CSE, Juvenile Justice, Early and Periodic Screening Diagnosis and Treatment (EPSDT) Services, Early Intervention (EI), and Waiver Services (1915c/i) **Foster Care Agencies Provide Care Management for Children in Foster Care Primary, Community and Specialty Services Note: While leveraging existing Health Homes to serve children is the preferred option, the State may consider authorizing Health Home Models that exclusively serve children.

33. 10.16.13

34. Proposed 2016 Children’s Medicaid Managed Care Model For all children 0-20 years old Service Provider Network Required to contract Pediatric Specialty Health Care Providers Pediatric Health Care Providers Children’s Behavioral Health Providers Community Based Providers (e.g., family support/peer services) Foster Care Providers Required to have MOUs and/or working relationships School Districts & CSEs Care Management for All Care Management will be provided by a range of models that are consistent with a child’s needs (e.g., Managed Care Plans, Patient Centered Medical Homes and Health Homes (HH). Health Homes will serve children with the highest level of need. – see page 3) Local Government (LDSS, LGU, SPOA, Probation) Community Services & Support s (non-Medicaid) Regional Planning Consortiums Juvenile Justice/Criminal Justice System *MCOs may opt to contract with other entities (e.g., BHOs) to manage behavioral health benefits

35. HHUNY/Hillside/Northern River’s Children’s Health Home Proposal A family Driven Care Management ModelEmpowering and Equipping families and children to manage their own Health and wellnessWe will organize a strong network of down-stream care management organizations in counties across the upstate region, as well as a large network of service providers who wish to work with the families and The Health Home to improve health and wellness for this vulnerable population.

36. HHUNY/Hillside/Northern River’s Children’s Health Home Proposal • The Hillside/Northern Rivers Children’s Health Home will adapt infrastructure created by HHUNY and its Adult Lead Health Homes • We will hold regional information meetings throughout Upstate NY. The first meeting will be held on May 1, 2014 at 10:30 at Hillside’s Work Scholarship Connection Office in Syracuse.

37. Discussion What should our community do to get ready for Children’s Health Homes and Medicaid Managed Care?

38. WRAP UP • OnCare Evaluation Team staff changes • No May Stakeholder meeting • Got Art?—May 6 from 4-6 pm at the MOST • Hillside Regional Health Home session—May 1 at 10 am at Hillside Work Scholarship Connections THANKS FOR COMING!