OnCare Full Stakeholder Meeting
description
Transcript of 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/
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
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2015
NYS Medicaid Behavioral Health Transformation Implementation Timeline
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STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A HEALTH HOME FOR
INDIVIDUALS WITH CHRONIC CONDITIONS
Designated in the Affordable Care Act Section 2703
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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
MANAGED CARE AND HEALTH HOMES
• 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.
MANAGED CARE AND HEALTH HOMES
• 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.
LESSONS LEARNED FROM ADULT HEALTH HOMES
• 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.
LESSONS LEARNED FROM ADULT HEALTH HOMES
• 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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CARE COORDINATION APPROACH
• 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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CARE COORDINATION APPROACH
• 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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CARE COORDINATION APPROACH
• 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
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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)
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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
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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!