STAKEHOLDER GROUP

Center for Health Care Strategies and the NJ Department of Human ServicesFriday, January 20, 2012

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Agenda

Welcome, Introductions and Purpose of this Meeting S. Somers, CHCS; V. Harr, DMAHS; L. Kovich, DMHAS

State Models of Medicaid/Mental Health CollaborationA. Hamblin, CHCS

The Steering Group and Work Group Process S. Somers

Adjourn

1:301:30

Guided Discussion of NJ’s Core Values and Principles S. Somers, V. Harr, L. Kovich

1:451:45

2:152:15

3:153:15

3:30 3:30

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Purpose of the Steering Committee Meeting• Inform the Department of Human Service’s values and

vision regarding the design and implementation of the Administrative Services Organization/Managed Behavioral Health Organization (ASO/MBHO)

• Elicit broad stakeholder input regarding the design and development of the various components of the ASO/ MBHO assuring that the voices of consumers, providers, advocates and payers are heard. • Initiate a small group process to inform at a more detailed level components of the ASO/MBHO including clinical practice; access; financing; and, performance standards. • Identify and leveraging opportunities under Health Care Reform to support a transformed system.

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Estimated Timeline of the ASO/MBHO

• July 2012 – ASO/MBHO RFP Posted

• January 2013 – RFP Awarded

• January –April 2013- ASO/MBHO Readiness Review

• July 2013 – ASO/MBHO implementation

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Guiding Principles

• The Comprehensive Waiver is a collection of reform initiatives designed to:• sustain the program long-term as a safety-net for eligible

populations• rebalance resources to reflect the changing healthcare

landscape• prepare the state to implement provisions of the federal

Affordable Care Act in 2014

• The DMHAS merger: Integration of mental health and addictions

• Integration of behavioral health and primary care

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Mission

New Jersey is committed to promoting the wellness and recovery of consumers with behavioral health conditions by providing access to quality services at a reasonable cost that result in improved consumer outcomes and satisfaction.

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Goals of the ASO/MBHO• To improve access to appropriate physical and

behavioral health care services for individuals with mental illness or substance use disorders• To better manage total medical costs for individuals

with co-occurring BH-PH conditions• To improve health outcomes and consumer

satisfaction. • Reduction in frequency, severity and duration of acute episodes• Reduction in institutional care and increased use of community-based services and supports

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The Steering Group and Work Group Process

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The Steering Committee and Workgroup Process

• Key Stakeholders charged with providing workgroup leadership • co-chair workgroups with DMAHS/DMHAS staff• Facilitate development of recommendations in

response to specific questions regarding four core domains of the MBHO design and implementation• Access • Clinical• Fiscal • Outcomes

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A Consumer-Centered Approach to Wellness and Recovery

• Client choices are informed and input is valued• Multiple pathways to recovery are honored• Mental illness and substance use disorders are

treated as a primary chronic disease• Client-centered care refers to care that is

respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions (Crossing the Quality Chasm: IOM, 2001)

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Critical Considerations Across Workgroups• Consumer Level

• Consumer and family-centered• Primacy of psychosocial needs • Promotion of wellness and recovery• Consumer choice• Ease of use • Empowerment, self-management and self-advocacy• Eligibility maintenance• Peer supports• Incentives• Leveraging technology• The needs of special populations i.e. I/DD, Emerging Adults, Justice Involved

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• Systems Level• Integration (services, data, finances)• Alignment of incentives• Performance measurement and accountability• Stratification and triage• Team-based care and provider engagement• Real-time information exchange• Care transitions• Leveraging technology• Contracting FFS Network requirements by each service

Critical Considerations Across Workgroups

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Workgroup Summary Recommendations Format

Each Workgroup should use the following bulleted format to summarize each area in their recommendations to the Steering Group:

Key Issues for Consideration

Challenges and Opportunities

Recommendations for the Steering Group

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Access Workgroup• Describe ways the behavioral health system will

provide better access to services that are client centered within an ASO/MBHO• Provide recommendations about using technology to

improve access to behavioral health services• Provide recommendations about ways the behavioral

health system can ensure consumer choice and a “no wrong door” approach within an ASO/MBHO• Proved examples of a client walking through your recommended system design.

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Clinical Workgroup

• Describe how the behavioral health system will ensure a uniform and consistent approach to screening, assessment, placement and continuing care functions while focusing on patient centered care with an ASO/MBHO

• Prioritize strategies that the behavioral health system could use to increase system capacity to provide integrated care for consumers with

co-occurring MH/SUDs and BH/PH needs.

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Clinical Workgroup• Describe ways the behavioral health system can utilize

the ASO/MBHO to reduce use of acute, high-cost services and increase the use of community-based services, including supportive housing and peer supports

• Describe the specialized services that are need for special populations within the behavioral health system and an ASO/MBHO: • Criminal Justice• Aging in Youth• I/DD

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Fiscal Workgroup• Describe the critical components of a seamless, user-

friendly service authorization and claims processing system

• Prioritize the services in the behavioral health system to target for rate rebalancing

• Describe reasonable options for a transition from cost reimbursement to fee for service provider contracts

• Suggest payment strategies that will incentivize provision of good care for reasonable cost

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Outcomes Workgroup• Identify the most effective and meaningful approach to

monitoring/measuring outcomes that will also comply with national quality standards (national BH quality strategy)

• Provide recommendations for outcomes measures that will demonstrate quality, value, appropriate level of care and consumer satisfaction

• Prioritize performance outcomes and quality measures that should be used when looking to incentivize providers and the ASO/MBHO.

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Timeline for the Steering Group and Workgroup Process

•Workgroups Meet and provide feedback to this Steering Group by March 2, 2012• Steering Group provides their final recommendations to DHS in early April, 2012.

•Steering Group meetings continue as needed