Download - OnCare Full Stakeholder Meeting

OnCare Full

Stakeholder Meeting4/7/14

COMMUNITY PROGRESS CHECK

Crisis Services Increase community awareness of available services

Residential Expand work being done on cross-systems discharge planning

Family-Driven Equip families for roles on governing/advisory boards Train providers on how to support family leaders

Youth-Guided Equip youth for roles on governing/advisory boards Train providers on how to support youth leaders What Helps/What Harms youth forums

Natural Supports

Targeted invitation /mini-event to engage missing community partners

Transition-AgeYouth

Develop paths/protocols that guide transitions from children and youth services to adult services

COMMUNITY PROGRESS CHECK

Access to Services

Focus on community awareness of services

Cross-Systems Issues

Training for providers and families to prepare for the implementation and impact of Health Homes

School Partnerships

Support Promise Zone / School-based Initiatives

Anti-stigma /Community Awareness

Maximize opportunities for community awareness (presentations, training, web site, etc.)

Cultural and Linguistic Competence

Data collection / dashboard that includes diversity issues

Community-wide CLC / Diversity training

New Workgroups• Transition 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 Charities– Cross-systems issues– Anti-stigma/ Community Awareness– CLC

• Social Marketing – Meeting 4/23/14 at Catholic Charities– Community Awareness and anti-stigma – Access to Services

Contact Bruce Brumfield at [email protected]

Got Art? 2014

– Theme: “Happiness is…”

– OnCare will provide funding support to agencies for workshops. Please contact Aishah Rudolph at [email protected]

– Submission forms available at www.oncaresoc.org/got-art-2014/

mailto:[email protected]

Liturgical Praise DanceJaimelita Hill

Jailin Gladney

Q U O VA D I M U S

HEALTH HOMES AND MANAGED CARE

AGENDA• Transition of All Medicaid Funded Services to Managed Care• What is a Health Home?• Lessons Learned from Adult Health Homes • How Will a Children’s Health Home be Different?• How Will the Transition to Health Homes Impact How

Services are Delivered?• Time Line for Development• Role of the Family and Youth• Potential Roles for Providers• Hillside/Northern Rivers/HHUNY proposal• Discussion: What should the Community do to get ready?

TRIPLE AIM•Improving Care•Improving Health•Reducing Costs

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Person-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 adults

Principles of BH Benefit Design

Proposed 2016 Children’s Medicaid Managed Care Model

For all children 0-20 years old

Required to have MOUs and/or working relationships

Mainstream Medicaid Managed Care Organization: Benefit Package*

All Health

& Pharma

cy Expande

d Benefits

Behavioral

Health State Plan

Services

Potential

Children’s 1915i

-like Services

Children’s 1915c

HCBS Waivers (OMH and

OCFS B2H)

Service Provider Network

*MCOs may opt to contract with other entities (e.g., BHOs) to manage behavioral health benefits

Care Management for AllCare Management will be provided by a range

of models that are consistent with a child’s 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 contract Pediatric

Health Care Providers

Community Based Providers (e.g., family support/peer services)

Pediatric Specialty Health Care Providers

Children’s Behavioral Health Providers

Foster Care Providers

School Districts &CSEs

Community Services & Support s (non-Medicaid)

Regional Planning Consortiums

Local Government (LDSS, LGU, SPOA, Probation)

Juvenile Justice/Criminal Justice System

12

2015

NYS Medicaid Behavioral Health Transformation Implementation Timeline

13

STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME FOR

INDIVIDUALS WITH CHRONIC CONDITIONS

Designated in the Affordable Care Act Section 2703

14

NEW YORK STATE HEALTH HOME MODEL FOR CHILDREN

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Health HomeAdministrative Services, Network Management, HIT Support/Data Exchange

HH Care Coordination Comprehensive Care

Management Care Coordination and

Health Promotion Comprehensive

Transitional Care Individual and Family

Support Referral to Community

and Social Support Services

Use of HIT to Link Services

Lead

He

alth

Hom

eD

owns

trea

m &

Care

Man

ager

Pa

rtne

rs

Prim

ary,

Co

mm

unity

and

Sp

ecia

lty S

ervi

ces

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

Netw

ork

Requ

irem

ents

DOHAI/

COBRA

Waivers (OMH SED,

CAH & B2H)

OMH TCM

(SCM & ICM)

Pediatric Health Care

Providers

OASAS/ MATS

Care Managers Serving Children

Access 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)

FUNDING

• Many 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.

MANAGED CARE AND HEALTH HOMES

• MCOs 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 negotiated

• MCOs will continue to manage all in-plan services for Health Home members but will contract with Health Home care managers to coordinate services


• MCOs contracting for Health Home services must use NYSDOH designated Health Homes

• MCOs 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.


• MCOs and Health Homes share responsibility for outcomes for patients that are assigned to Health Homes

• MCOs 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.

MANAGED CARE AND HEALTH HOMES• MCOs 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.

LESSONS LEARNED FROM ADULT HEALTH HOMES

• New 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.


• Transitions 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.


• Productivity 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: Contracting Collaboration Information sharing Coordinated care planning

• Cross 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.)

WHY A CHILDREN'S HEALTH HOME?

• Children’s 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.

WHY 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 a cost predictor as it is in adults. Functional and behavioral challenges are more critical. (CANS-NY may have a role here.)

• ACES (Adverse Childhood Experiences Study) demonstrates that increased trauma events have a life-long effect on needs, outcomes, and, therefore, costs.

• Permanency matters – children need robust family networks to thrive; building those networks requires a deliberate process.

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DOH PRINCIPLES FOR SERVING CHILDREN IN HEALTH HOMES AND MANAGED CARE

• Ensure managed care and care coordination networks provide comprehensive, integrated physical and behavioral health care that recognizes the unique needs of children and their families• Provide care coordination and planning that is family-and-youth driven, supports a system of care that builds upon the strengths of the child and family • Ensure managed care staff and systems care coordinators are trained in working with families and children with unique, complex health needs• Ensure continuity of care and comprehensive transitional care from service to service (education, foster care, juvenile justice, child to adult)• Incorporate a child/family specific assent/consent process that recognizes the legal right of a child to seek specific care without parental/guardian consent• Track clinical and functional outcomes using standardized pediatric tools that are validated for the screening and assessing of children• Adopt child-specific and nationally recognized measures to monitor quality and outcomes• Ensure smooth transition from current care management models to Health Home, including transition plan for care management payments

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CONSISTENT WITH DOH PRINCIPLES WE RECOMMEND A DIFFERENT CARE MANAGEMENT APPROACH

• “Families as care managers”: Parents/caregivers should be coached and supported to manage their children’s health and wellness.

• “Family-Finding”: When children have no permanent adult in their lives, we recommend Family Finding to develop a lifetime network of support. When caregivers are not able to manage their children’s care on their own, Family Finding could be used to develop a network of natural supports to provide the necessary support to those caregivers.

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CARE COORDINATION APPROACH

• “Hi-Fidelity Wraparound”. For those children and youth with the highest need, the caseload must be low enough to allow fidelity to the Wrap-around model. For all children, practice should be informed by Wrap principles: Family Voice and Choice; Team based; Natural Supports; Collaboration; Community-based; culturally Competent; Individualized Strengths based; Persistence; and Outcome based

• Multi-disciplinary team. The team will be multi-disciplinary to allow the right expertise at the right time. Family and youth peer supports should be available for every family’s team.

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• Assessment of Acuity must take family structure and functioning into account. The strength and resources of the family system will impact how much time and energy will go into care management to meet the child’s needs.

• Model must build on the strengths of the child and family. Staff must be trained and have the time to write a “Strengths, Needs and Culture Discovery” (or other similar document) with the family. The assessment tool must ensure engagement by supporting the family to tell their story in a way that honors their culture, history and vision.

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• Family driven, youth guided planning and care coordination. Model must allow the time and provide staff with the skills and tools (e.g. Family Development Plan) necessary to let youth and families to guide their plan and develop goals that meet their needs, consistent with system priorities

• Funds for stabilization. Current case management models include funds to address immediate concrete needs that must be addressed before a child and family can concentrate on (physical and behavioral) health issues. The new system must include access to flexible dollars and a ensure robust service network.

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• Adopt child-specific and nationally recognized measures to monitor quality and outcomes. CANS-NY might be the best we can do but we recommend exploring other measures as well.

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NEW YORK STATE HEALTH HOME MODEL FOR CHILDREN

32

Health HomeAdministrative Services, Network Management, HIT Support/Data Exchange

HH Care Coordination Comprehensive Care

Management Care Coordination and

Health Promotion Comprehensive

Transitional Care Individual and Family

Support Referral to Community

and Social Support Services

Use of HIT to Link Services

Lead

He

alth

Hom

eD

owns

trea

m &

Care

Man

ager

Pa

rtne

rs

Prim

ary,

Co

mm

unity

and

Sp

ecia

lty S

ervi

ces

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

Netw

ork

Requ

irem

ents

DOHAI/

COBRA

Waivers (OMH SED,

CAH & B2H)

OMH TCM

(SCM & ICM)

Pediatric Health Care

Providers

OASAS/ MATS

Care Managers Serving Children

Access 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)

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Anticipated Schedule for Enrolling Children in Health HomesReview Health Home Children’s Model with Stakeholders - MRT Children’s Work Group, HH-MCO Work Group

October 2013

Collaborate with Stakeholders to Refine Health Home Model and Develop Health Home Application for Children

November 2103 - March 2014

Applications for Health Homes Serving Children Made Available

April 2014 May 2014

Due Date for Submission of Applications for Health Homes Serving Children

August 2014

Health Home State Agency Team Review and Approval of Applications

October 2014

Develop and Distribute Health Home Assignment /Eligibility Lists for Children

November – December 2014

Begin Enrolling Children in Health Homes January 2015Behavioral Health Services for Children in Managed Care

January 2016

10.16.13

Proposed 2016 Children’s Medicaid Managed Care Model

For all children 0-20 years old

Required to have MOUs and/or working relationships

Mainstream Medicaid Managed Care Organization: Benefit Package*

All Health

& Pharma

cy Expande

d Benefits

Behavioral

Health State Plan

Services

Potential

Children’s 1915i

-like Services

Children’s 1915c

HCBS Waivers (OMH and

OCFS B2H)

Service Provider Network

*MCOs may opt to contract with other entities (e.g., BHOs) to manage behavioral health benefits

Care Management for AllCare Management will be provided by a range

of models that are consistent with a child’s 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 contract Pediatric

Health Care Providers

Community Based Providers (e.g., family support/peer services)

Pediatric Specialty Health Care Providers

Children’s Behavioral Health Providers

Foster Care Providers

School Districts &CSEs

Community Services & Support s (non-Medicaid)

Regional Planning Consortiums

Local Government (LDSS, LGU, SPOA, Probation)

Juvenile Justice/Criminal Justice System

34

HHUNY/HILLSIDE/NORTHERN RIVER’S CHILDREN’S HEALTH HOME PROPOSAL

A FAMILY DRIVEN CARE MANAGEMENT MODEL

EMPOWERING AND EQUIPPING FAMILIES AND CHILDREN TO MANAGE THEIR OWN HEALTH AND WELLNESS

We will organize a strong network of down-stream care management organizations in counties across

the upstate region, as well as a large network of service providers who wish to work with the families

and The Health Home to improve health and wellness for this vulnerable population.

HHUNY/HILLSIDE/NORTHERN RIVER’S CHILDREN’S HEALTH HOME PROPOSAL

• The Hillside/Northern Rivers Children’s Health Home will adapt infrastructure created by HHUNY and its Adult Lead Health Homes

• We will hold regional information meetings throughout Upstate NY. The first meeting will be held on May 1, 2014 at 10:30 at Hillside’s Work Scholarship Connection Office in Syracuse.

DISCUSSION

What should our community do to get ready for Children’s Health Homes and Medicaid

Managed Care?

WRAP UP

OnCare Evaluation Team staff changes No May Stakeholder meeting Got Art?—May 6 from 4-6 pm at the MOST Hillside Regional Health Home session—May 1

at 10 am at Hillside Work Scholarship Connections

THANKS FOR COMING!