Chapter title

Explanation of chapter here

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Presented by:Richard Sheola, ValueOptions’ Senior Vice

President, Public Sector Division

April 28, 2011

New York Association of Psychiatric Rehabilitation Services

A ValueOptions Presentation to:

• ValueOptions Corporate Overview

• Public Sector Experience and Related Systems Integration Successes

• Partnering with Peers to Transform Systems

• The Emerging Landscape: ACO Partnerships

• Provider Positioning for the Road Ahead

• Housing First

• Preserving the Integrity of our Public Behavioral Health System

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Agenda

ValueOptions Corporate Overview

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• Singular focus on behavioral health and wellness

• More than 24 million members nationwide

• Medicaid represents 80% of our annual revenue

• Medicaid programs in 14 states, covering 5.3 million Members

• 15 years of Public Sector Experience

Public Sector Landscape

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States with a ValueOptions Medicaid Contract

Service Center locations

Support office locations

Medicaid Program Successes

• Reducing costs while improving outcomes

• Facilitating long-term systems change through re-alignment of financial incentives

• Reducing children’s institutionalization (Hospital and PRTF level of care)

• Reducing adult psychiatric inpatient, state hospital admissions, and nursing facility usage

• Expanding holistic treatment for high-cost/high-risk members through Complex Chronic Care Management

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Provided seed-funding and developmental support for peer-operated organizations and service models.

(800) 495-0086100 High St, 3rd Floor

Boston, MA 02110

A ValueOptions Organization

2002 - Peer Support in Aftercare clubhouse peers bridging to inpatient units and providing aftercare support and integration into peer and recovery activities

Consumer Advisory Council proposed peer specialists in emergency services, contributing to MBHP policy, procedures and member materials since 1996.

Family Advisory Council proposed family training infrastructure, contributing to MBHP policy, procedures and member materials since 1996.

Trained providers in rehabilitation, recovery and the integration of peer services.

1999 - Launched self-help peer support groups, including Recovery Workbook meetings, DoubleTrouble addictions meeting and W.E.L.L. meetings for women experiencing trauma, addictions, and psychiatric conditions

2003 - MBHP coordinated peer planning process and developed the first proposal for Recovery Learning Communities In Massachusetts, a peer-operated wellness and recovery infrastructure, a national model

1999 - Launched the first Massachusetts Leadership Academy to develop peer-trained peer leadership, now a national model in outreach and training of diverse language and cultural groups, including Deaf and Hard of Hearing

1999- Supported development of peer infrastructures for training and support, including peer mentoring, peer-to-peer education, cross-training, and the development of peer facilitator and peer educator training, which led to the development of the peer-operated Massachusetts Certified Peer Specialist training program, a national model

1999 - Consumer Quality Initiatives Launched consumer satisfaction evaluation of provider services, a national model, now an independent peer-run, nationally-recognized organization

1999 - The Transformation Center Peer-operated hub of statewide Recovery Learning Communities, Certified Peer Specialist training, and MBHP-funded peer and provider training

1999 - Launched statewide support of Dual Recovery Anonymous peer facilitated meetings in clubhouses, now a national and international ICCD model program

2008 - Pat Deegan PhD & Associates and MBHP launched CommonGround in Massachusetts, a consumer/prescriber shared medication decision-making program with peer-support, a national model

2005 - Enhanced Day Treatment created peer specialist positions in day treatment programs

2009 - Certified Peer Specialists hired to work in redesigned community-based Emergency Service Programs statewide, a national model

1999-2008 - Partnering for Recovery, large statewide conference creating dialogue among peers, providers, families, and state agencies, a national model

2009-present - Three regional forums per year focused on recovery, wellness, and peer specialist integration, produced by The Transformation Center

2010 - MBHP and The Transformation Center began collaborating on training for Emergency Service Provider teams statewide, a national model

ValueOptions, through its Massachusetts Behavioral Health Partnership, has worked with peers since1998 to build individual and organizational KNOWLEDGE and LEADERSHIP for wellness and recovery.

Ahead of the Curve: Partnering with Peers to Transform Systems of Care

Created, expanded, and supported peer workforce capacity.

Rehabilitation & Recovery, a dedicated MBHP business unit since 1996

Expanded peer support services and peer leadership training.

Health Care Reform: Colorado’s Accountable Care Initiative

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• Program Objectives:– Expand access to comprehensive primary care– Build patient-centered Medical Home capacity– Ensure a positive member and provider experience– Effectively apply an unprecedented level of

statewide data and analytics functionality

• Performance Goals:– Achieve cost neutrality – Reduce unnecessary ER utilization– Reduce preventable hospitalizations– Reduce unnecessary imaging

Health Care Reform: Colorado’s Accountable Care Initiative

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• Colorado ACO/ASO Services

– Member enrollment and referral services

– Network development and integration

– Practice supports (patient-centered Medical Homes)

– Medical management and care coordination

– Performance improvement

– Reporting

– Financial management

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Health Care Reform: Colorado’s Accountable Care Initiative

• New LLC—Integrated Community Health Partners

– 3 Federally Qualified Health Centers

– Colorado Community Managed Care Network

– 4 Community Mental Health Centers

– ValueOptions – Management Services Partner

• Region 4: Southeastern Colorado

– 70+ k Members– >$6.5M total contract

revenue

Provider Positioning for the Road Ahead

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• Promote collaboration• Learn about new health care landscape and educate

about recovery• Form/join coalitions regarding parity/Health Care

Reform• Involve/promote/advance individuals in recovery and

promote consumer-directed care• Identify gaps in coverage and services• Promote high-quality and integrated care• Promote prevention and wellness• Understand economic environment and provide

guidance—tough choices for States• Stay focused on people we serve

-- Pamela S. Hyde, J.D., Administrator, Substance Abuse and Mental Health Services Administration (SAMHSA)

Housing First

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• Community Support Program for People Experiencing Chronic Homelessness (CSPECH)– CSPECH is a behavioral health model that supports

members who are chronically homeless – Pioneer Award-winning “housing first” program– Partnership between Massachusetts Behavioral Health

Partnership (MBHP), Massachusetts Housing and Shelter Alliance (MHSA) and the Department of Transitional Assistance.

– Estimated savings of $3M annually

Pre-CSPECH CSPECH-Year 2 Savings

BH Costs $12,388 $10,702 $1,686

ED Utilization $2,795 $1,144 $1,651

Medical Costs (MHSA)

$28,436 $6,056 $22,380

Total $43,619 $17,902 $25,717

Preserving the Integrity of our Public Behavioral Health System

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• Containing costs while strengthening our Systems of Care

• Expectations of our BHO partners/Raising the bar

• Performance contracting: “Doing Well by Doing Good”

• The Importance of Visionary Leadership

• The Road Ahead

Thank You

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If you have any questions, please feel free to contact:

Richard Sheola, Senior Vice President, Public Sector Division

(617) 790-4081(office)

Richard.sheola@valueoptions.com