OnCare Full Stakeholder Meeting

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OnCare Full Stakeholder Meeting. 4/7/14. COMMUNITY PROGRESS CHECK. COMMUNITY PROGRESS CHECK. New Workgroups. Transition Age Youth (Time-limited)- Focusing on the hand-off between the ACCESS Team and Adult SPOA - PowerPoint PPT Presentation

Transcript of OnCare Full Stakeholder Meeting

OnCare Full Stakeholder Meeting

OnCare Full Stakeholder Meeting4/7/14

COMMUNITY PROGRESS CHECKCrisis ServicesIncrease community awareness of available servicesResidentialExpand work being done on cross-systems discharge planning Family-DrivenEquip families for roles on governing/advisory boardsTrain providers on how to support family leadersYouth-GuidedEquip youth for roles on governing/advisory boardsTrain providers on how to support youth leadersWhat Helps/What Harms youth forumsNatural SupportsTargeted invitation /mini-event to engage missing community partnersTransition-AgeYouth Develop paths/protocols that guide transitions from children and youth services to adult servicesCOMMUNITY PROGRESS CHECKAccess to ServicesFocus on community awareness of servicesCross-Systems IssuesTraining for providers and families to prepare for the implementation and impact of Health HomesSchool PartnershipsSupport Promise Zone / School-based InitiativesAnti-stigma /Community AwarenessMaximize opportunities for community awareness (presentations, training, web site, etc.)Cultural and Linguistic CompetenceData collection / dashboard that includes diversity issuesCommunity-wide CLC / Diversity trainingNew WorkgroupsTransition 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 CharitiesCross-systems issuesAnti-stigma/ Community AwarenessCLCSocial Marketing Meeting 4/23/14 at Catholic Charities Community Awareness and anti-stigma Access to Services Contact Bruce Brumfield at bbrumfield@communityalternatives.org

Got Art? 2014Theme: 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/Liturgical Praise DanceJaimelita Hill Jailin Gladney

Quo VadimusHealth Homes and Managed Care8AgendaTransition of All Medicaid Funded Services to Managed CareWhat is a Health Home?Lessons Learned from Adult Health Homes How Will a Childrens Health Home be Different?How Will the Transition to Health Homes Impact How Services are Delivered?Time Line for DevelopmentRole of the Family and YouthPotential Roles for ProvidersHillside/Northern Rivers/HHUNY proposalDiscussion: What should the Community do to get ready?

9Triple AIMImproving CareImproving HealthReducing Costs1011Person-Centered Care managementIntegration of physical and behavioral health servicesRecovery oriented servicesPatient/Consumer Choice Ensure adequate and comprehensive networksTie payment to outcomesTrack physical and behavioral health spending separatelyReinvest savings to improve services for BH populationsAddress the unique needs of children, families & older adultsPrinciples of BH Benefit DesignWhat does BH mean? Behavioral Health?11Proposed 2016 Childrens Medicaid Managed Care ModelFor all children 0-20 years old

Required to have MOUs and/or working relationships

Service Provider Network*MCOs may opt to contract with other entities (e.g., BHOs) to manage behavioral health benefitsCare Management for AllCare Management will be provided by a range of models that are consistent with a childs 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)

Required to contractPediatric Health Care ProvidersCommunity Based Providers (e.g., family support/peer services)Pediatric Specialty Health Care ProvidersChildrens Behavioral Health ProvidersFoster Care ProvidersSchool Districts &CSEsCommunity Services & Support s (non-Medicaid)Regional Planning ConsortiumsLocal Government (LDSS, LGU, SPOA, Probation)Juvenile Justice/Criminal Justice System1212 NYS Medicaid Behavioral Health Transformation Implementation Timeline13

13STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME FOR INDIVIDUALS WITH CHRONIC CONDITIONSDesignated in the Affordable Care Act Section 27031414New York State Health Home Model for Children15Health HomeAdministrative Services, Network Management, HIT Support/Data ExchangeHH Care CoordinationComprehensive Care ManagementCare Coordination and Health PromotionComprehensive Transitional CareIndividual and Family Support Referral to Community and Social Support ServicesUse of HIT to Link Services

Lead Health HomeDownstream &Care Manager Partners Primary, Community and Specialty Services Managed Care Organizations (MCOs)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.**Foster Care Agencies Provide Care Management for Children in Foster Care Network RequirementsDOHAI/COBRAWaivers (OMH SED, CAH & B2H)OMH TCM (SCM & ICM)Pediatric Health Care ProvidersOASAS/ MATSCare Managers Serving ChildrenAccess 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)OCFSFoster Care Agencies and Foster Care System **Care Managers Serving Adults(To support transitional care)15FundingMany 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.16Managed Care and Health HomesMCOs 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 negotiatedMCOs will continue to manage all in-plan services for Health Home members but will contract with Health Home care managers to coordinate services17Managed Care and Health HomesMCOs contracting for Health Home services must use NYSDOH designated Health HomesMCOs 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.The new info captures some of what slide 13 has. 18Managed Care and Health HomesMCOs and Health Homes share responsibility for outcomes for patients that are assigned to Health HomesMCOs 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.Are vulnerable people the ones meant by MCOs with members currently in OMH and AIDS/HIV COBRA, MATS and CIDP targeted case management?19Managed Care and Health HomesMCOs 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.20Lessons Learned from Adult Health HomesNew 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.Moved something from slide 16 here.21Lessons Learned from Adult Health HomesTransitions 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 termFunding does not cover startup costs. Cost of building infrastructure is prohibitive (NYCCP).Long term - more potential opportunities for collaborations and partnerships.Changed the order of 2 slides.22Lessons Learned from Adult Health HomesProductivity 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: ContractingCollaborationInformation sharingCoordinated care planningCross 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.)

23Why a children's Health Home?Childrens needs are different and require a different approachNationally, 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.

24Why 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