THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P...
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Transcript of THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P...
THE CHANGING HEALTHCARE ENVIRONMENT:POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS
PRESENTED ATThe Rehabilitation Summit, NYSRA Saratoga Springs, NYMonday September 16th, 2013
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Jonas Waizer, PhD, Chief for Healthcare PolicyFEGS Health and Human Services
Change Is Constant: Who Moved My Cheese
• Personal Journey
• State Medicaid Redesign
Provider Actions
• Challenges
• Models
• Actions
Next Steps
TODAY’S THEMES
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1968 –Autism: Parental Upbringing vs. Neurobiology
1980’s – Deinstitutionalization vs. Trans-
institutionalization
1990’s – Programs vs. Consumer Centered
Today – F-F-S vs. Managed Care, Service Integration,
Risk Sharing
CHANGE IS CONSTANT: A PERSONAL JOURNEY
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$25.9 Billion
Total ComplexN=976,356
$2,338 PMPM32% Dual
51% MMC
NYSDOH: SPECIAL PLANS FOR HIGH-NEED MEDICAID POPULATIONS
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Strategic Factor Old World New World (Federal ACA, MRT)
Change NYS Fiscal Environment
Fee-for-Service (FFS) – Session, DayRates Set by Each State Agency
Managed Care (MCOs)PMPM, Case Rates; Capitation
Consolidate and Shift Public Funding Mechanisms
Medicaid, Medicare, State/City ContractsLegislative Member Items
Medicaid/Medicare, FIDA
Consolidate Government Authority - Medicaid/Medicare
NYS OMH, OPWDD, OASAS DOH NYC DOHMH NCDMH SCDMH
Medicaid Redesign NYSDOH as Lead Agency
Redesign Public Health Service Structures
General Healthcare Clinic (A-28)Behavioral Health Clinic (A-31)Substance Abuse Clinic (A-22)Developmental Disabilities Clinic (A-16)Specialized Residences – Similarly Specialized
Under MCOsIntegrated Health Care: Co-locationCare Coordination: Health Homes
Affordable & Mixed Use Housing
Service Sector Success Measures
Hospitals – Fewer DaysOutpatient - Day Hab & Clinics - SessionsResidences – Stability and TenureWork Centers – Subsidized Employment
Hospital – Reduced ReadmissionsAftercare - 100% of DischargesResidences – Upward MobilityEmployment – Mainstream FT or PT Report Cards (Across Agencies)
Technology Billing, Client RegistrySpecialized EHRs (DD, MI, Psychiatry)Paper Medical/Clinical Charts
Full EHR – Clinical Record and BillingStatewide Connectivity (Local RHIOs)Customer Access to Personal Health Record
Provider Strategy Diversification, GrowthMedicaid Revenue Maximization
Partnerships, Networks, IPAsRisk-sharing w/MCOs Technology for Client Tracking w/in and w/RHIOs
STRATEGIC CHANGES IN NYS HEALTH CARE
Maintain Services to Disability Groups - Shifting from FFS
to MC
Partnerships and Networks - Forming New Business
Models
Risk-Sharing Arrangements – Contracting with MCOs
New Models of Care Coordination - DISCO, HARP, FIDA
Integrating Services - Health, Behavioral Health, SA,
Habilitation, etc.
Focus on Outcomes – e.g. Recidivism, Employment, Housing
Stability
Focus on Measures - Performance, Health and Quality
Metrics
Upgrade EHR - Tracking, Reporting, RHIOs , Customer
Centered Services
SOME PROVIDER CHALLENGES
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The Best Way To Predict the
Future Is to Invent It
Abraham Lincoln Peter DruckerSteve Jobs
One of the Nation’s Largest and Most Diversified Nonprofit Health and Human Services Organizations.
FEGS by the numbers: 100,000+ New Yorkers Served Annually$300 Million Annual Budget5,000 Staff3,000 Interns, Volunteers and Consultants 350 program locations across New York City, Long Island and Westchester County14 Subsidiaries1.6 Million Square Feet
FEGS HEALTH & HUMAN SERVICES
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Mission:
To help each person served achieve greater success, independence and dignity at work, at school, at home and in the community.
FEGS HEALTH & HUMAN SERVICES PRESENTATION TO: HEALTHPLUS AMERIGROUP
Operating Areas:
Health Disabilities Homecare Housing Employment Education Youth and Families
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NYS Medicaid MRT Program
(NYS DOH)
IPAs
Service Provider
Payment for Care Management Services
Service Provider
Service Provider
Service Provider
Service Provider
Medical Payment Risk Arrangements
Continue as Service Providers
MANAGED SPECIAL NEEDS (SIMPLIFIED VIEW)
HEALTH HOMES
(LIBA and CBCPartnership)
DD- DISCO (ACA
Partnership)
MLTC(SinglePoint
Care Network w/SelfHelp)
Managed Care Organizations
FEGS - NEW HEALTHCARE PARTNERSHIPS
Behavioral Health
Developmental Disabilities
Homecare
9FEGS HEALTH & HUMAN
SERVICES
Risk Sharing PartnershipsUnder MRT
Advance Care Alliance, LLC
EmblemHealth (MCO)
StateAlliance
Care Network,
LLC
Advance of Greater NY,
LLC
LI Alliance, LLC
ACA Structure
Providers
ACA IPA
owners
Care management contract
$
Contract for risk sharing, claims payment, IT, back office services
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PROVIDER ACTIONS FOR THE 21st CENTURY
Focus on Engagement, Outreach, Adherence (esp. Rx)
Care Coordination for Complex Cases – Keep People at
Home
Prepare for Variable Payment Systems: FFS, Case
Rates, PMPM
Pilot Innovative Services - e.g. Health Coordination,
Employment Support, Residential and Crisis Beds,
Self-Directed, etc.)
Partnerships*
IT Upgrades*
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PARTNERSHIPS AND NETWORK DEVELOPMENT
Acute Care Partners: Local Hospitals , Urgi-centers
Primary Care Community Partners: FQHCs, Medical
IPAs
Specialized IPA: With Other Licensed Providers
Families and Consumers: Promote Governance and
Choice
Managed Care Companies for Shared Savings, Shared
Risk
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IT REQUIREMENTS
Track/Monitor Consumers Inside and Outside the
Agency
Import & Export Data (Network Providers, Hospitals,
RHIOs)
Link to MCOs for Referral Stream
Collect and Process Standardized Measures, Metrics
Process Data Analytics, Report Cards 13
NEXT STEPS: FOR PROVIDERS (& GOVERNMENT)
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