Environmental Changes Impacting MH/DD/SAS Service Providers in NC

1. Environmental Changes Impacting MH/DD/SAS Service Providers in NC Tara Fields, COO Benchmarks

2. Benchmarks Association of nearly 90 provider agencies advocating for quality services for children, adults and families, actively involved in all levels of system change and development • Legislative and Lobbying Support • Policy and Rules Development • Key Committee and Meeting Attendance • LME/MCO/DHHS/National Partnerships • Grant Projects that Support Mission • Provider Support and Problem Resolution • Advocacy for People Receiving and Providing Services • High and Low Level Information Sharing • High and Low Level Provider Training

3. National Trends • Integrated Health Care - Behavioral health integrated in overall health management via policy, practice, and science to improve consumer services and outcomes • Political acceptance (and stakeholder competition) for pay-for-value reimbursement • Managed Care and ACO expansion – cost controls • In 1995 only 29.45% of Medicaid under managed care • By 2012 up to 74.2% of Medicaid under managed care • Payer focus on reducing health care cost for high need/complex consumers • 5% of U.S. population used the largest portion of the health care budget • 95% of US population need to be prevented from becoming high cost complex consumers OpenMinds 2014

4. National Trends • Internet brings transparency to provider fees and provider performance • Consumer Choice – provider reputation matters! • Consumer Health Ratings.com • Healthgrades.com • Technology is changing the nature of services • New science driving behavioral health changes • Telemedicine, E Health, Remote Monitoring OpenMinds 2014

5. National Trends • Reduction of residential use and length of stay • Movement to more community-based and in-home care-HCBS, DOJ Settlement • Focus on prevention, quality and aftercare-CMS Core Competencies • Outcome oriented programming • Trauma-informed environment, when applicable, and trauma specific treatment • Co-occurring services

6. National Trends • Using technology for service efficiencies and metric based management • Partnering to capture markets • Closing outdated services and creating/transforming services for new marketplace • Increased use of competitive bidding for state and county services OpenMinds 2014

7. National Trends • CMS Core Competencies for Direct Service Workers (DSW) • DSWs include staff working with people in: • Aging • I/DD • Behavioral Health • Physical Disabilities

8. National Trends • ICD 9 to 10 Transition • MCO testing begins in June • Provider testing will begin in July and August • Statewide Training will rollout in July and August • IT Section • Clinical Section • Be ready for new billing October 1, 2015

9. North Carolina Trends • Home and Community Based Services Transition Plan (HCBS)-Submitted to CMS March 16, 2015http://www.ncdhhs.gov/hcbs/ • Applies to Innovations and CAP/DA Waiver-Residential Supports, Supported Employment, Day Supports and Adult Day Health • Timeline for implementation-NC is aiming for full implementation by March 2018. CMS mandates no later than March 17, 2019 • Pilot for self-assessment to begin shortly

10. North Carolina Trends • Innovations Waiver • IDD Stakeholder Group • http://www.ncdhhs.gov/dma/lme/Innovations.html • Service definition updates/rewrites: • Community Supports and Living • Day Supports • Assistive Technology • Respite • Residential Components • Community Guide

11. North Carolina Trends • Long Term Supports Service • Report to GA in April • MCO/LME Fund Reserve through June 30and beginning of next fiscal year • B3 Service Definition • I/DD Supports Waiver-Residential Component (expands slots by 1,000 each over three years) • i option • 1115 opportunities • Medicaid Reform

12. North Carolina Trends • L.S vs Wos Settlement • Innovations Waiver Recipients • Person Centered Service Planning • Rights under due process and Medicaid

13. North Carolina Trends • North Carolina Chapter for Direct Support Professionals • Applied for Articles of Incorporation • Preliminary By-laws Written • Once 501 (c) 3 is established, we will select and orient our Board • 3 events for stakeholders • 1 large event and celebration for DSPs in September

14. NC Environmental Changes Reality Check • NO new money • Less money in the system than before vs increase in need and federal requirements • System reform to reduce current level of spending

15. NC Environmental Changes LESS MONEY • North Carolina spending on Medicaid claims has declined overall by 11.6% on a per member per month (PMPM) basis since 2008. • PMPM for each MCO will decrease – Cardinal at over $50 million less annually for PMPM in 8 years

16. NC Environmental Changes LESS MONEY • ACOs or private managed care coming to NC to manage health costs (House-ACOs and Senate – Private Managed Care) • Significant pressure for integration of care • Industry driving toward performance indicators – embracing a “medical model”

17. What does this mean for NC agencies • Right sizing of the provider industry • RFPs • Contract Restrictions • Contract Terminations • Utilization Starvation • The number of providers in the system are reducing dramatically and will continue for the next 24-36 months.

18. What does this mean for agencies • Greater competition for services • Enhancing expectations of quality and outcomes • Capacity to measure Return on Investment • Must be able to gauge and initiate what is the customer need

19. What should you do? • Pay close attention to changes happening at the federal and state level. Attend meetings, secure training, get ahead of the curve by communicating with and training your staff and families. • Strategically plan to increase your economy of scale and quality service delivery • Implement systems that collect and measure your outcome and quality data • System should be able to generate reports that you can share with payers • Remain nimble to adjust to system maturation • Learn how to measure and prove ROI to rise above competition • Join an association or chapter and participate! Share your concerns, your solutions and ideas, garner information and plan accordingly for success.

20. What should you do? • Know unit costs and cost drivers – and then streamline operations aggressively • Manage unit costs to optimize margins where possible • Set thresholds for discontinuing service lines • Revenue maximization initiatives for current services • Create business development strategies for current market to increase revenue and diversify revenue streams in the short term

21. What should you do? • Manage cash aggressively ‐‐ cash flow is key issue in time of change • Secure additional financing • Expand private pay services and diversify funding streams • Metrics‐based management – and metrics informeddecision making • Nimbleness and a change‐ready executive team

22. Preparing for the future • Envision your future role in health and human service system – and services offered • Market positioning and service lines • Branding for communication to stakeholders • Marketing and business development plan • Financial resources needed • Operational infrastructure design • Imagine you are a large provider/business…..how do you advertise and market your services? Ask your team…

23. Preparing for the future • Provide a unique (different from your competition) array of offerings/systems that customers/payers want and need. Talk with your team about what makes you better. • Have the ability to work within a value based reimbursement system • Ensure thatpayers and prospective clients know your organization’s name (reputation) and associates it with value (market mind) • Meet payer and customer expectations through excellent services and data specific outcomes • Capture a significant portion of the market segments you seek

24. Questions? • IIH 8 to 12 ratio • NCI training • ADACTS (SA to MCOs) • Psychiatric Nurse Practitioner Certification • Foster Care Bills Proposed • Cardinal Contract (Financial Audit) • Unmanaged visits calendar year to fiscal • CQL • CCNC • CNDS/CDW • Eligibility • County of Origin • IRIS/NCTOPPS • Concerns that need resolution from the group • Monitoring • Audits • Reports • Other

25. Tara Fields, COO Office: 919-828-1864 tfields@benchmarksnc.org www.benchmarksnc.org Please take a moment to visit Paige Wiggs, Renate Macchirole, and Laura Fleming at our booth!