Andrew Cleek, PsyD - CTACNYctacny.org/sites/default/files/trainings-pdf/readiness-tool... · The...
Transcript of Andrew Cleek, PsyD - CTACNYctacny.org/sites/default/files/trainings-pdf/readiness-tool... · The...
The Managed Care Technical Assistance Center of New York
Andrew Cleek, PsyD
The Managed Care Technical Assistance Center of New York
2
I. Introduction II. Readiness Assessment Results III. Addendum Results IV. Agency Readiness Benchmark Report V. Next Steps
The Managed Care Technical Assistance Center of New York
3
The Community Technical Assistance Center of New York (CTAC) is a training, consultation, and educational resource center available to all child and adult-serving agencies in New York State. Our goal is simple: to provide programs with a set of technical assistance, training activities and tools that promote effective care through efficient practices.
The Managed Care Technical Assistance Center of New York
What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State.
MCTAC’s Goal
Provide training and intensive support on quality improvement strategies including business, organizational and clinical practices, to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.
4
The Managed Care Technical Assistance Center of New York
Managed Care Readiness Assessment
5
Data Collection and Analytics • Data collection: online survey • Focus of Analysis: Examine readiness and
preparedness for the transition to Managed Care and identify areas where additional support is needed
• Report: MCTAC presenting aggregated data to relevant stakeholders
The Managed Care Technical Assistance Center of New York
• This MMC Readiness Tool is designed to provide organizations with 11 domains of processes, practices and change management activities needed to effectively prepare for and function during the early stages of a business relationship with a Managed Care organization.
• When completed, the self-assessment tool offers a snapshot of the organization’s current level of readiness as well as an assessment of the need for technical assistance. This tool may be helpful as a planning resource to guide organizations in their preparation and decision making activities.
6
MMC Readiness Assessment
The Managed Care Technical Assistance Center of New York
Readiness Assessment Results for Child-Serving Organizations
The Managed Care Technical Assistance Center of New York
276 Child – Serving Agencies submitted Readiness Assessments
On average, 60% of reimbursement was from Medicaid Only.
30% of agencies reported that less than 10% of reimbursement was
from managed care.
There are statistically significant differences by Region.
There are statistically significant differences by Reimbursement.
8
The Managed Care Technical Assistance Center of New York
9
The Managed Care Technical Assistance Center of New York
10
116 (42%)
36 (13%)
87 (32%)
43 (16%)
0
20
40
60
80
100
120
140
OMH OASAS OCFS Other
Num
ber o
f Age
ncie
s
Agency Type
Agency Type
The Managed Care Technical Assistance Center of New York
11
The Managed Care Technical Assistance Center of New York
12
Domain Name Label in Graphs
1 Understanding MCO Priorities & Present Managed Care Involvement MCO Priorities
2 MCO Contracting Contracting
3 Communication /Reporting (Services authorization, etc.) Communication
4 IT System Requirements IT
5 Level of Care (LOC) Criteria / Utilization Management Practices Level of Care
6 Member Services/Grievance Procedures Member Services
7 Interface with Physical Health, Social Support and Health Homes Interface
8 Quality Management/Quality Studies/Incentive Opportunities Quality
9 Finance and Billing Finance 10 Access Requirements Access
11 Demonstrating Impact/Value (Data Management & Evaluation Capacity) Evaluation
Aggregate Total Score Total Score
MCTAC Readiness Assessment - Domains
The Managed Care Technical Assistance Center of New York
13
Domain Average Score 1. MCO Priorities 3.34 2. Contracting 3.20 3. Communication 2.67 4. IT 3.17 5. Level of Care 2.87 6. Member Services 2.85 7. Interface 3.83 8. Quality 2.82 9. Finance 3.21 10. Access 3.32 11. Evaluation 2.63 Total Score 3.08
*Domain score is below total average score
The Managed Care Technical Assistance Center of New York
14
The Managed Care Technical Assistance Center of New York
15
3.29 3.09
2.56
3.11 3.44 3.47
3.07 3.40 3.49
3.00
2.38
2.98
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
1. MCOPriorities
2. Contracting 3.Communication
4. IT
Domain Scores by Agency's Region
NON NYC NYC Combined
The Managed Care Technical Assistance Center of New York
16
2.76 2.62
3.88
2.65
3.21 3.39
3.87
3.21
2.50* 2.40*
3.50
2.52*
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5. Level of Care 6. MemberServices
7. Interface 8. Quality
Domain Scores by Agency's Region
NYC NON NYC Combined
The Managed Care Technical Assistance Center of New York
17
3.06 3.19
2.45
2.97
3.57 3.83
3.09 3.41
2.96* 2.87*
2.40* 2.82*
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
9. Finance 10. Access 11. Evaluation Total Score
Domain Scores by Agency's Region
NYC NON NYC Combined
The Managed Care Technical Assistance Center of New York
18
3.02* 2.68*
1.90*
2.79*
3.64 3.65 3.38
3.64
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
1. MCOPriorities
2. Contracting 3.Communication
4. IT
Domain Scores by Agency's Managed Care Reimbursement
Less than 10% More than 10%
The Managed Care Technical Assistance Center of New York
19
2.38* 2.36*
3.77
2.44*
3.25 3.13
3.96
3.13
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5. Level ofCare
6. MemberServices
7. Interface 8. Quality
Domain Scores by Agency's Managed Care Reimbursement
Less than 10% More than 10%
The Managed Care Technical Assistance Center of New York
20
2.80* 2.81*
2.31* 2.66*
3.68 3.96
2.96
3.49
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
9. Finance 10. Access 11. Evaluation Total Score
Domain Scores by Agency's Managed Care Reimbursement
Less than 10% More than 10%
The Managed Care Technical Assistance Center of New York
21
The Managed Care Technical Assistance Center of New York
Number of Children – Serving Agencies Providing Specific Services 131 (66.8%) crisis intervention services
55 (28.6%) youth peer advocacy and training services.
127 (65.1%) community psychiatric treatment and support services.
53 (27.5%) crisis respite.
120 (63.5%) psychosocial rehabilitation services
68 (35.2%) planned respite.
116 (60.1%) family peer support services
75 (39.1%) prevocational services.
136 (70.5%) care coordination.
49 (25.7%) supported employment.
107 (56%) habilitative skill building. 54 (28.3%) non-medical transportation.
135 (71.1%) family caregiver supports and services.
20 (10.3%) day habilitation services.
113 (59.8%) community advocacy and support.
22 (11.5%) adaptive and assistive equipment. 23 (12%) accessibility modifications. 19 (9.9%) palliative care.
The Managed Care Technical Assistance Center of New York
Screening and Evaluation Tools: 73% of agencies reported that they conduct at least some type of specific screening and evaluation tool including the CANS, SDQ, CBCL, BDI, UCLA PTSD
Specific Treatment Models: 83% of agencies reported that they use specific treatment models including CBT variations, MI, 12 Step, Family Therapy models
Measures Used to Track Outcomes: 86% of agencies reported specific outcome measures including treatment plans, number of ER/Hospital Visits, CANs, OASAS Client Data System, Pre/post or satisfaction surveys
The Managed Care Technical Assistance Center of New York
Services offered by Agencies through Collaboration
N %
Crisis Intervention Services 78 80
Community Psychiatric Treatment and Support Services
75 86
Psychosocial Rehabilitation Services 58 65
Family Peer Support Services 68 70
Youth Peer Advocacy and Training Services 82 60
Care Coordination 71 88
Habilitative Skill Building 58 64
Family Caregiver Supports and Services 59 80
Crisis Respite 108 75
The Managed Care Technical Assistance Center of New York
Services offered by Agencies through Collaboration
N %
Planned Respite 96 71
Prevocational Services 79 62
Supported Employment 90 62
Community Advocacy and Support 65 67
Non - Medical Transportation 75 55
Day Habilitation Services 85 53
Adaptive and Assistive Equipment 91 54
Accessibility Modifications 86 52
Palliative Care 79 48
The Managed Care Technical Assistance Center of New York
Agencies… N % Have a system in place to orient families to the rules and expectations of the
program. 84 89
Train and supervise staff on trauma informed principles and practices. 71 75 Have a system in place to ensure that our physical environment is safe and
welcoming for consumers. 88 94
Develop rules and regulations that are sensitive to the needs of caregivers and children who have experienced trauma.
79 84 Have a system in place to ensure that the suggestions, needs, and perspective of
families, informs the decisions we make. 84 89
Have a clearly defined plan or protocol for management of crises with families that have been clearly communicated to all staff.
79 84
Services focus on ‘what happened to you’ rather than ‘what's wrong with you’. 82 87 (or collaborating agencies) are implementing at least one evidence-based trauma
treatment approach to help families heal from past traumatic experiences. 72 77
Routinely screen and assess for trauma in caregivers and children 69 73 Have a supervisory process to address the impact of our work on the staff’s
emotional and physical wellbeing. 74 80
The Managed Care Technical Assistance Center of New York
27
The Managed Care Technical Assistance Center of New York
28
The Managed Care Technical Assistance Center of New York
29
The Managed Care Technical Assistance Center of New York
30
The Managed Care Technical Assistance Center of New York
Assessment / Work Plan
Development Tool –
Available Online
31
The Managed Care Technical Assistance Center of New York
• Each agency submitted a survey based on self- report.
• The benchmarking tool is based on scores relative to agencies that completed the assessment. Agencies that have not submitted the assessment may differ in significant ways.
32
Important Limitations of the Data
The Managed Care Technical Assistance Center of New York
60
• Using a work plan template, individualized results of the readiness assessment, and a menu of suggested activities in areas of greatest need, agencies can develop individual strategies to support the transition to managed care.
The Managed Care Technical Assistance Center of New York
Domain Readiness Score
Improvement Tasks
Performance Measure
Resources Needed
Funding Source
Estimated Dated of Completion
MCO Priorities
Contracting
Communication
IT
Level of Care
Member Services
Interface
Quality
Finance
Access
Evaluation
The Managed Care Technical Assistance Center of New York
Business Best Practices
Services Best Practices Professional Development Value Based Practices System Redesign
35
The Managed Care Technical Assistance Center of New York
The Managed Care Technical Assistance Center of New York
37
Tools Timeline
Matrix
Completed Launched July 15, 2015
Billing/Claims Completed August 2015
Glossary of Terms Completed
The Managed Care Technical Assistance Center of New York
38
Tools Timeline
Credentialing September 2015
Chargemaster September 2015
Utilization Management September/October 2015
Outputs to Outcomes Fall 2015
Plan of Care Tool (Proposed) Proposed
The Managed Care Technical Assistance Center of New York
A comprehensive and interactive online tool that provides agency staff with the information needed to successfully engage with MCOs. Launched July 15, 2015 – 3,772 Page views the first week 6,373 page total views, as of 8/11/15
39
The Managed Care Technical Assistance Center of New York
40
The Managed Care Technical Assistance Center of New York
41
The Managed Care Technical Assistance Center of New York
42
The Managed Care Technical Assistance Center of New York
43
The Managed Care Technical Assistance Center of New York [email protected] @CTACNY