Erie County HEALTHCARE REFORM

1. March 2012 Erie CountyHEALTHCARE REFORM

2. HEALTHCARE REFORM IN ERIE COUNTY Change is rapid and will occur with or without local design efforts ECDMH is developing a local approach to healthcare reform Value must be demonstrated before next managed care RFP for BH: 6-12 months

3. HEALTHCARE REFORM VISION SOC: Organized system of care Risk Based Model: People are served who are at imminent risk of deeper system penetration, e.g. arrest or incarceration, hospitalization, homelessness, death, etc. are served CTI: Critical Time Interventions characterize the service system Barriers: Barriers to care are removed CQI: Data driven decision-making will shape the system

4. SOC CORE SERVICES Care coordination as defined by Health Homes Targeted Case Management will use a CTI model with ALOS of 6 months Housing Adult clinics Inpatient ER SPOA: Integrated for housing & TCM Under reform, these services need to be time limited, using a CTI tenets to move people through the formal system to natural supports and greater self-management

5. PHILOSOPHY OF CARE Person centered approach Risk reduction focus Access to the �5 Rights� : Right service at the right time for the right person for the right length of stay for the right outcome Critical Time Intervention as an Evidence Based Practice, use of CTI tenets Dignity to fail

6. LOCALLY DRIVEN SOC Populations: ECDMH will develop a model to determine people who are on a path for use of deep end services, & they will be the priority populations Practice: Efficacy of practice, e.g. CTI, Access: Timely access to needed services Data: Metrics that reflect the value of locally driven systems of care & build on the promising practices of local provider models

7. COUNTY CHANGES DATA: Increased use of data and analytics POPULATIONS AT RISK: Identification of populations on a risk trajectory using claims data & predictive model SPOA: Integrated SPOA that looks at housing & care coordination needs of the person Training on EBPs: CTI CONTRACTS: County contracts will include outcomes & meaningful metrics to support system change UM: Utilization management reviews of care coordination and housing for new SPOA referrals

8. SPOA Changes Integrated SPOA manages housing and CTI/care coordination Applications will be submitted electronically Risk scores will be calculated automatically based on the information submitted Applications will be classified as emergent, urgent & routine Emergent applications will be referred within 1 business day Urgent applications will be referred within 2 business days Routine applications will be referred within 3 business days Providers with openings will not be able to decline referrals & will admit the consumer per the same timeframes listed above �

9. CULTURE CHANGE IN SERVICES DELIVERED Consumers: Information to make informed choices for greater self-management and independence Better prepared for transitions Fuller participation in the community Awareness that provider relationships may be different and lengths of stay in treatment may be shorter Experience hope for recovery through skill training

10. CULTURE CHANGE IN SERVICES DELIVERED Providers Address barriers that block consumer access Focus on immediate risk not long-term support Increase skill training so consumers can ask for what they need when they need it Increase use of natural supports for consumers Actively educate consumers regarding life choices related to living independently, getting a job, etc. so that consumers can make informed choices about how to fully participate in the community

11. PROVIDER ROLE Work interdependently in the system of care Risk based service management Address imminent risks or bend the trajectory of risk Ease transitions from one level of care to another Remove barriers to care Refocus on critical interventions to diminish imminent risk rather than focus on long term supports Use harm reduction models Use early intervention & prevention models

12. COMMUNICATION Process will include stakeholder input and active participation in system design Learning communities will be formed as part of an ongoing CQI and training process System performance will be shared with stakeholders Culture change in service delivery will be reviewed as part of an open CQI process

13. SYSTEM OUTCOMES Improved community service options Decreased use of residential services Measurable clinical outcomes Consumer satisfaction Measures of engagement & timely access Measures of fidelity to practice Erie County achieved these outcomes with the children�s system of care and will build on that model to achieve the same for adults.

14. ADULT SYSTEM OF CARE Includes health homes serving Medicaid recipients & high risk individuals, e.g. incarcerated or in the holding center Focuses on services, not programs per APGs Facilitates access to care Enhances engagement of individuals by providing care coordination in the ER or on inpatient Pilots projects for high risk individuals Addresses risks & barriers Decreases dependence on the formal service system Maintains a safety net for consumers Supports transition of individuals to increased community participation & employment