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Exposing Community Organizations to Value-Based Payment

Learn how Critical Time Intervention can help community-based organizations implement value-based payment arrangements and reduce avoidable hospitalizations among homeless individuals with Serious Mental Illness.

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Exposing Community Organizations to Value-Based Payment

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  1. Critical Time Intervention as a Means of Exposing Community-Based Organizations to Value-Based Payment Arrangements April 28th 2017

  2. Bronx Partners for Healthy Communities • Our largest 7 primary care partners • Our DSRIP Goals: • Achieve the Triple Aim: Better Health, Better Patient Experience, Lower Cost • Reduce avoidable ED visits and hospital admissions by 25% by 2020 357,424 total attributed patients

  3. SMI, Homelessness & Hospitalization • Homelessness among people with Serious Mental Illness (SMI) is an important and unaddressed issue – contributes to avoidable hospitalization* • Traditional telephonic care-transitions programs rarely work for the precariously-housed with SMI • Recent data* has shown: • Psychiatric hospitalizations among these adults accounted for 26% of all psychiatric hospitalizations in NYC • ~33% of US homeless population includes individuals with SMI *Treatment Advocacy Center and National Coalition on the Homeless

  4. Critical Time Intervention (CTI) Model • Cost-effective, evidence-based practice proven to reduce recurrent homelessness • Developed in early 1980s in NYC, due to rise in homelessness among people with SMI • Supports clients in building community ties and ensuring continuity of care • Time-limited: 9 months, 3 phases • Phase 1: Transition • Phase 2: Try-Out • Phase 3: Transfer of Care

  5. BPHC’s Rationale For Selecting CTI • Bronx Community Needs Assessment, conducted in the DSRIP context, showed homeless New Yorkers tend to be: • Under utilizers of primary care and Health Homes • Frequent users of Emergency Departments • More pronounced amongst the SMI population.* • BPHC estimated ~400 patients with probable homelessness and 4+ visits to ED and/or inpatient setting (10/2013 – 10/2014). • SMI population requires community support to bridge the transition from facility to community and to ensure enduring linkages. • CTI bridges the gap by addressing transitional needs while the patient is still in the hospital, extending the reach of licensed community mental health providers. *National Coalition on the Homeless and NYCDOHMH data

  6. BPHC CTI Program Model • Eligibility Criteria • Diagnosis of a SMI • Hospital stay or ED visit in past 6 months • Eligible for Health Home (HH) • Precariously Housed • Locations of Client Identification • Psychiatric inpatient units • Medical inpatient units • Other programs (HHs, shelters, detox, etc.)

  7. BPHC CTI RFP and Provider Selection • RFP issued to network behavioral health providers • Incorporated value-based arrangement – downside risk tied to failure to achieve reduction in hospital use. • Four organizations selected to each enroll ~ 80 individuals in CTI program: • Coordinated Behavioral Care IPA (CBC) • Visiting Nurse Service of New York (VNSNY) • Riverdale Mental Health Association (RMHA) • SCO Family of Services (SCO) • Organizations hired caseworkers to perform the intervention – providing new job opportunities in the Bronx • Began enrolling patients in January 2017, will continue through end of the year.

  8. CTI and Health Home Collaboration • CTI extends intensive, high-touch care coordination into the community • Promotes successful transition • Complements the HH model during a critical period • Case workers are non-clinical coordinators supervised by a licensed professional • HH care coordinator is encouraged to collaborate with the CTI worker from the beginning. Interactions and billing for HH remains unchanged

  9. DSRIP P4P Measures CTI Can Impact P4P = Pay for Performance

  10. CTI Implementation – Early Challenges

  11. CTI as a Microcosm for VBP Challenges CTI

  12. Thank you!

  13. References • How Many People with Serious Mental Illness are Homeless? Retrieved from: http://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/2596-how-many-people-with-serious-mental-illness-are-homeless • Bronx Community Needs Assessment Report November, 2014 Retrieved from: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/docs/st_barnabas_hosp_dba_sbh_health_system/3.4_st_barnabas_cna.pdf • Epi Data Brief. New York City Department of Health and Mental Hygiene. June 2016, No 71. Retrieved from: https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief71.pdf • Mental Illness and Homelessness. National Coalition for the Homeless, July 2009. Retrieved from: http://www.nationalhomeless.org/factsheets/Mental_Illness.pdf • Homelessness and Housing Retrieved from: https://www.samhsa.gov/homelessness-housing. • Critical Time Intervention: Preventing Homelessness in the Transition from Institution to Community Retrieved from: https://www.criticaltime.org/wpcontent/uploads/2009/04/cti-handout4.pdf • CUCS Institute, Critical Time Intervention (CTI) Presentation Retrieved from: http://www.endhomelessness.org/page/-/files/Critical%20Time%20Intervention%20Presentation.pdf • CUCS Institute, Critical Time Intervention Overview Retrieved from: http://www.endhomelessness.org/page/-/files/Critical%20Time%20Intervention%20Overview.pdf

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