VT Care Partners Monthly Board Meeting April 12, 2017 VT ... · VT Care Partners Monthly Board...
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VT Care Partners Monthly Board Meeting April 12, 2017 VT Realtors Association 148 State Street Montpelier, VT 05602 Phone: 802-229-0513
Transcript of VT Care Partners Monthly Board Meeting April 12, 2017 VT ... · VT Care Partners Monthly Board...
VT Care Partners
Monthly Board Meeting
April 12, 2017
VT Realtors Association
148 State Street
Montpelier, VT 05602
Phone: 802-229-0513
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Directions to
VT Realtors Association
148 State Street
Montpelier, VT 05602
(802) 229-0513
Directions from Interstate 89 North or South:
At exit 8 take Ramp to second set of lights.
This is Bailey Avenue. Turn left and at the next light (State
Street) take a left.
It is the first building on the left at the corner. It is a white
building with a parking lot.
Come in on the right hand side of the building, this is the
entrance directly into the conference room.
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AGENDA
VERMONT CARE PARTNERS
Board Meeting AGENDA
April 12, 2017
9:30 – 2:00
AGENDA
8:00-9:30 State House Advocacy – Cafeteria
9:45 Approval of Council Minutes
VCP Board Meeting of March 8, 2017
9:50 Policy and Politics Discussion
10:30 ARIS Payments – Next Steps
10:45 Children’s Bundled Payment/IFS
11:00 Commissioners Melissa Bailey, DMH and Monica Hutt, DAIL
12:00 Council meeting adjourns
12:00 Lunch
12:30 VCN Meeting Called to Order
12:31 Approval of VCN Minutes
VCP Board Meeting of March 8, 2017
12:35 Additional discussion about bundled payments if needed, including adult
12:45 Grant potentials (SAMHSA and NMH)
DOC MHFA
1:00 Patient Ping Demonstration
1:30 Unified EMR
1:45 Conference Debrief
2:00 Adjourn
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Table of Contents
A) Calendar of Meetings for April and May 2017
Pages 5 – 6
B) Approve Minutes:
VCP Board Meeting March 8, 2016
Pages 7 – 11
C) Staff Report
Pages 12 – 16
D) Minutes:
DS Directors Meeting December 7, 2016
DS Directors Retreat February 2017
ES Directors Meeting February 27, 2017
CRT Directors Meeting March 3, 2017
PR/Communications Group March 13, 2017
VCP Outcomes Group March 15, 2017
AOP / SA Directors March 16, 2017
Crisis Bed Managers Meeting March 17, 2017
Pages 17 – 42
E) Attachments:
1. AHS MH Funding Workgroup
2. VCP Strategy for OneCare and Care Navigator
Pages 43 – 51
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Section A
April 2017 Calendar
Wednesday – April 5 9:30 – DS Directors Meeting
Friday – April 7
10:00 – CRT Directors Meeting
Wednesday – April 12 9:00 – 3:00 – VCP Board Meeting (VT Realtors)
Thursday – April 13
10:00 – DAIL Advisory Group
9:30 – Children’s Directors
Monday – April 17 10:00 – 12:00 – Emergency Services
Wednesday – April 19
1:00 – 3:00 – Outcomes Group
Thursday – April 20 9:30 – DS State Standing Committee
10:00 – 2:00 – CFO/Finance Directors
12:30 – 3:30 – AOP/SA Directors
Friday – April 21
10:00 – 1:00 – DS Executive Committee
10:30 – 2:30 – HR Directors Meeting
Friday – April 28
9:00 – Corporate Compliance
10:00 – 1:00 – VCP Executive Committee Meeting
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May 2017 Calendar
Wednesday – May 3 9:30 – DS Directors Meeting
Friday – May 5
10:00 – CRT Directors Meeting
Wednesday – May 10
9:00 – 2:00 – VCP Board Meeting (VT Realtors)
Thursday – May 11
9:30 – Children’s Directors
10:00 – DAIL Advisory
Monday – May 15 10:00 – 12:00 – Emergency Services
Wednesday – May 17
1:00 – 3:00 – Outcomes Group
Thursday – May 18
9:30 – DS State Standing Committee
10:00 – 2:00 – CFO/Finance Directors
12:30 – 3:30 – AOP/SA Directors
Friday – May 19
10:00 – 1:00 – DS Executive Committee
10:30 – 2:30 – HR Directors Meeting
Friday – May 26
9:00 – Corporate Compliance
10:00 – 2:00 – VCP Executive Committee Meeting
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Section B
VCP Board Meeting
VT Realtors, Montpelier
March 8, 2017
Present: Beth Sightler, Savi Van Sluytman, Bob Bick, Heidi Hall, George Karabakakis,
Linda Chambers, Sherry Thrall, Bob Thorn, Mary Moulton, Chuck Myers, Catherine Simonson,
Julie Cunningham, Dick Courcelle
VCP Staff: Simone Rueschemeyer, Erin Campos, Marlys Waller, Ken Gingras, Cath Burns,
Dillon Burns
Board Member Sharing
Chuck shared that NFI VT and Easter Seals are cosponsoring a parent training (0-6 age home
based model) in April. Alicia Lieberman will be coming back to VT in May. DMH and DCF
contributed to the training.
Linda discussed knowledge of our system at town meeting yesterday. She was impressed that a
citizen discussed the workforce issues, and health care reform based on a budget allocation for
CMC from the town.
Mary shared that they got the pilot COE scorecard and measures back and WCMHS did very well.
Lorna said UCS is having their review tomorrow.
Beth shared details from her trip to Vienna to present and receive the award. She added that VT is
looked at as a successful model. She will put out a press release.
VCN Portion of Meeting
Simone shared that they had a call with the Office of the National Coordinator in which they talked
about the data repository and data quality work. After the call, the ONC contacted VCN to conduct
a webinar related to the data quality work.
Minutes
February 8, 2017 board meeting. (Myers/Smith)
February 24, 2017 Executive Committee meeting. (Moulton/Karabakakis)
VCP Conference
March 27-28
Cath updated about the VCP conference. The registration numbers are low so she encouraged
agencies to send more people and get info shared outside of our agencies as well. Erin sent out an
email to all agencies with links and attachments urging them to send people and share the
conference info widely to help increase attendee numbers and also to find additional sponsorships.
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Health Reform Update
Secretary Gobeille has convened meetings to focus on the “mental health crisis”. Linda asked if we
could share what these groups are, who is in them and who the chairs are. Simone and Mary
updated on the various AHS meetings that have occurred focusing on mental health funding and
emergency room back-ups.
ER flow in and out
Mary is co-chairing this group with Jeff (from the hospital association) and shared the four page
document that they worked on. Dillon is working with NAMI, DMH, and others as a part of
another workgroup. They’ve identified problems, communication on the front end and then related
to what is happening to the people who have been stuck in the hospitals. Do we need a geri-psych
unit, work with nursing homes, etc? They have some data and are collecting more. Who are in the
crisis beds, what are the blocks keeping them there, etc.
DA funding – variations Sandy McGuire and Louis Josephson are sharing the workgroup. There has been discussion about
disproportionate share of hospital (DSH) funding – funding that is left through Medicaid goes back
to the hospitals – being used to support the DAs.
Bob Bick said it’s clear that the Secretary is not that supportive of our system, more focused on
hospitals. Chuck said that families are more stressed than ever. Heidi gave an update from the DA
funding group regarding AHS Mental Health Funding. DAIL and DCF funding is not currently
included in the discussion. There is a lot of work the group is being asked to do in a short period of
time. Sandy has met with Al to clarify the questions he is trying to answer. The workgroup is
developing a report for the next larger AHS meeting. He is interested in how the system is
currently organized, what is mandated by the state, what is not, what the variation is around the
state and why. This in addition to the difference in the systems organizational models – difference
in services, access, mandated vs community requests that aren’t mandated, documentations
requirements – pros and cons
Simone said AHS is willing to pay for Burns & Associates to assist with getting our data into a
platform similar to how the GMCB displays hospital data. We need to translate what we are
discussing in terms of funding issues. do some of the analysis.
Bob noted that we need to be mindful of how workforce issues affect our system differently than
every other system experiencing workforce issues. Less services are available when staff is
training or filling in and then staff leaves, so those people are not able to provide services to clients
and families.
Dick mentioned that the state expects us to be more like a business, if so we have to actually stop
providing services. Heidi cautioned that cutting staff leaves money on the table. We need a higher
cap and less staff to continue providing the services.
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Bob Thorn We need to determine how we do the best we can to meet the needs? When do you
communicate that? He said that CSAC did the exercise and it’s significant. This is real.
IFS Lessons Learned
VCP has spent time developing a document detailing the pros and cons of the pilots. VCP and
Melissa Bailey both had documents of this type so we brought them together. Further information
is in the March booklet, Section E, Attachment #2.
VCO
Board Update
Mary and George gave an update. The VCO carries on even though the funding did not
materialize.
They are continuing to have meetings. PCP PMPM increases were also expected from
transformation dollars. They are looking at impact on infrastructure. In spite of that, there has been
discussions around the importance of the DA system. We are community based and should be
supported. There is concern but they are moving along. Savi added that the transformation dollars
are not there anymore.
Next meeting was supposed to be this afternoon. Todd has cancelled. Nothing new, no additional
info, no adding to the budget. $212,000,000 + not there anymore. (was available if we could
match it)
We had hoped for some of the transformation dollars also for the unified EMR. 90/10 match
dollars will support bridges of data to/from the State, FQHCs, VITL. But not purchase of the
equipment for agencies already attesting to meaningful use.
Simone handed out a list of bullets detailing the goals of the VCO Population Health Committee.
High risk patient care coordination
Episode of care variation
Mental health and substance abuse
Chronic disease management optimization
Prevention and wellness
Bob Thorn will be in the next meeting on Monday March 13.
Patient Ping
Simone asked if the Board would be interested in a presentation by Patient Ping at the next
meeting and the response was yes.
Care Navigator
Four of our agencies are being asked to use Care Coordination tool. We’ve met with DMH, VCO,
Catherine, Cheryl Huntley and Dillon were there. We discussed pros, cons, payment, lead
coordinators, how many DA clients are actually in the initial pool and more. They are going to
track about 30,000 lives with about half being kids.
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Population Health Model
Simone handed out the OneCare flow chart of the Population Health Care Model. VCP has created
one similar in the hopes of it being morphed into the One Care model but so far that has not
happened.
Catherine shared additional details of what has been figured out and still working on.
Bob T added that there are confidentiality rules and expectations that we don’t know how it would
even work.
SASH
Simone and Dillon met with Molly Dugan and Kim Fitzgerald. It was a good conversation. They
will be joining the VCP Adult MH group to talk about eldercare clinicians or someone else to work
with SASH. Dillon added they were looking for case consultation.
VHCIP/SIM
We asked DVHA if we can use the leftover available funds for support and sustainability of the
repository. They agreed and it is being moved through CMMI.
Adjourn VCN portion of the meeting (Bick/Smith)
VT Council meeting called to order
VCP Website
Erin gave an update on the added features of the VCP website. We now have the capabilities to
highlight a video with text on the home page. Currently the video that we recently had produced is
on there. Only one at a time can be highlighted on the website.
DS Respite Update
Mary handed out the VCP letter to Monica and Roy. Marlys gave a background and asked for
approval today to send the letter signed by Anne Cramer. Payments that come through DAIL to the
agencies. The members approved the letter and Marlys will direct Anne to go ahead and send it to
the state.
Motion: bob/josh. Approved.
Minutes
February 8, 2017 board meeting. (Myers/Courcelle)
February 24, 2017 Executive Committee meeting. (Smith/Karabakakis)
Advocacy Trainings
VCP and Ken Libertoff and Peter Mallory held two advocacy workshops in the last couple of
weeks at WCMHS and RMHS. Mary and Dick both said that it was a very good experience and
worth doing.
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Legislative Update
House Health Care Memo on FY18 Budget
Mary discussed the House Committee on Health Care update memo regarding the FY2018 State
Budget. This includes $2.45 million to increase salaries of crisis service clinicians; increase service
clinician positions; increase bed staffing salaries.
This memo also included
$500,000 Psychiatric geriatric care and homeless individuals.
Housing First = $400,000 – pathway to housing funded slots.
George asked why this housing funding isn’t being spent through the agencies through their local
housing partnerships.
Community MH system – plan to increase the salaries of DA employees.
Increase DSH payment reduction from 10% to 20% and other funds to restore $50,000 from the Office of the Health Care Advocate.
Committee on Health and Welfare
Care Coordination Draft 7.1 17-1096
Mary discussed the draft on the ‘act relating to examining mental health care and care
coordination.
The document lists Findings; Operation of MH System; Care Coordination; Involuntary Treatment
and Medication; Psychiatric Access Parity; Geriatric and forensic psychiatric unit or facility;
Availability of units or facilities for use as nursing and residential homes; licensure of 23-Hour
beds; Omnibus Report; MH and SA disorder workforce study committee; Office of professional
regulations/Interstate compacts; Employment models for recovery; Rates of payments to
DA/SSAs; Payments to the DA/SSAs; Integration of payments and rate review; Health Insurance
DA/SSAs employees; Pay scale DA/SSAs employees.
Mary again urged everyone to reach out to their legislators.
Crossover is happening now in the committees so everyone needs to push.
Duty to Warn
Still have some work to do on this.
Psychologist Prescribing
Simone sent information out ahead of time and the draft legislation was discussed. After a robust
discussion, it was decided that we should not take a position on this.
The Board went into Executive Session for the remainder of the meeting to work on the budget
exercise.
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Section C
STAFF REPORT
March 2017
Systems Issues
Political Update
With just about a month until the close of the Legislative session Vermont Care Partners is in the
final phase of fighting for increased funding to address workforce challenges. Additionally there is
potential to receive improved funding for crisis services. On April 12th we are requesting all
agencies to set up morning meetings with key legislators at the state house and to have
community partners join us in our advocacy efforts to support Senate Bill 133 and inclusion
of funding in the appropriations bill. While the ultimate goal is a $15/hour minimum wage, it
looks like this will need to be phased in. Our interim ask is for a $14/hour minimum wage and for
all employees to receive 85% of state employee salaries. A recent meeting on the issue with
Governor Scott and Secretary Gobeille was positive. The big question is where will the revenue
come from in a level funded fiscal year 2018 budget. Hospital disproportionate share funds for
uncompensated care and savings related to reduced emergency department use are being explored.
Vermont Care Partners is also conducting advocacy related to independent contractors, telehealth,
review of critical incidents related to law enforcement and mental health; mental health and
corrections; and trauma. At this point we have not succeeded in having global commitment funds
appropriated to backfill lost federal funding for vocational rehabilitation.
Developmental Services
Funding
The FY2017 DAIL funding summary reflects that spending for March was $68,282 below DAIL’s
allocation for the month. Fiscal year spending through March was $624,888 above DAIL’s
projection. Overall spending for the year has been $10,837,692 with $10,050,879 spent from the
New Caseload/Equity appropriation of $11,517,483 and $786,813 from the Public Safety
appropriation of $2,504,652. Caseload expenditures for FY2017 include $1,386,380 spent from the
New Caseload/Equity appropriation in May and June of FY2016. Funds returned to Equity and
Public Safety so far this year are running $231,142 above projections. Based on current spending
and funds returned, DAIL forecasts that there could be a shortfall of $393,746 at the end of the
fiscal year.
ANCOR Names Direct Support Professional (DSP) of the Year Honorees
Since 2007, ANCOR has given Direct Support Professional Recognition Awards to recognize the
incredible work of DSPs in supporting quality lives for people with developmental disabilities.
ANCOR receives and reviews numerous nominations from around the country, and chooses one
person to honor from each state (and this year also from Moldova) and a national honoree.
National honors go this year to Forest Austin, a DSP in Kansas.
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Gina Brown who works at Green Mountain Support Services (GMSS) has been named Vermont
DSP of the year. Gina is exceptionally dedicated and genuinely thoughtful in supporting
individuals at GMSS. She utilizes person centered approaches to assist people to find opportunities
to participate in their community; helping those she supports to reach their highest potential in all
areas of their lives. When not providing one on one support, she helps the local self-advocacy
group with fundraising and activities. Congratulations Gina!
Mental Health Services
Wait Times in Emergency Departments Workgroups
Vermont Care Partners is working closely with DMH and other stakeholders to address the
problem of wait times in Emergency Departments. The larger workgroup has broken out into
smaller subcommittees focusing on the following areas: data needs; 23-hour crisis bed study;
improving flow; geropsych care; and inpatient resources for children with complex medical needs.
These groups are working hard and using the larger monthly meeting to report workplans, get
feedback, and inform each other’s progress. In addition, these groups are informing the two
mental health groups developed by Secretary Gobeille, focusing on issues of “flow” and “DA
funding,” to develop system-wide recommendations. See the memo on data needs attached in the
booklet for information on the focus of the Data Needs subcommittee. Since the memo was
written, the hospital association has initiated a pilot in which two hospital emergency departments
will be collecting point-in-time data on wait times for specific clients.
AHS MH Funding Workgroup
AHS established a funding group which was chaired by Sandy McGuire and Louis Josephson.
Others in the group include: Heidi Hall, Cheryl Huntley, Simone Rueschemeyer, Dillon Burns,
Melissa Bailey, Sarah Clark and Mourning Fox. Sandy presented to the larger AHS group that is
focusing on mental health and emergency rooms on March 24th
. The report is in Section E,
Attachment 1.
Suicide Prevention Coalition
The Center for Health and Learning is coordinating a grant proposal to expand Zero Suicide
Initiatives in Vermont. Zero Suicide is a set of practices that have been effective in other states to
reduce suicide rates through organizational self-assessment, trainings for clinicians, and
collaborative integrated care. Zero Suicide has been piloted at NCSS, Howard Center, and
LCMHS, and the grant could potentially fund opportunities for executive director training and
collaboration with leaders of other community organizations; support for a unified EHR that would
have the ability to flag clients for suicide risk and have assessments embedded; and support
training and implementation across the designated agencies. The group writing the grant is seeking
a letter of commitment from designated agencies.
Developing a VCP Strategy for OneCare and Care Navigator
VCP convened a meeting with representatives from WCMHS, NCSS, Howard Center, and CSAC
– the four “NextGen” Communities –to share information about their contacts with OneCare on
Care Navigator in order to develop a unified strategy. The group expressed commitment to the
goals of collaborative care, but detailed concerns about confusing communication with OneCare;
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concern about whether OneCare was adequately addressing compliance issues in its rollout of Care
Navigator; and concern about the expectations of entering information into Care Navigator and the
impact on direct service time. Notes from this meeting are in Section E, Attachment 2. As a next
step, VCP will coordinate a meeting between OneCare and compliance officers from the four DAs
to discuss compliance concerns. In addition, VCP will ask OneCare to streamline communication
to DAs by having one DA contact.
Network Initiatives
Centers of Excellence
Since our last meeting, we had a site visit at United Counseling Service. The peer review
committee and an additional reviewer will be meeting on 4/20 to complete their scoring, provide
more feedback about the elements, and write feedback to UCS. We have one more pilot site left
and will be waiting to schedule this site visit in May. It is likely that several elements will be
added to address assessing for trauma and trauma informed practices, domestic violence, client and
staff safety. We continue to hold to the July 1st deadline for opening up the process to the rest of
the network and are beginning discussions about how this process can occur in a way that won’t
overwhelm our existing resources. Cath Burns and Lorna Mattern presented a poster at the
National Council Meeting about the COE pilot process. A link to the poster can be found here:
https://natcon17.ipostersessions.com/default.aspx?s=02-0D-40-79-28-01-70-66-90-FB-79-6E-64-
42-83-C4
Outcomes Group
The outcomes group has been meeting to resume work on several issues including completing
phase 1 of the Wait Time project, continuing work to align measures across stakeholders and
payors, refining the methodology for collecting and analyzing the CANS (including a statistical
analysis of the measure itself), and articulating our value and cost benefit. Each of these
subgroups will be meeting regularly to work on these projects, with regular feedback provided to
the outcomes group.
Outcomes Report
We have extra copies of the outcomes report if you need them. Just let us know and we’d be
happy to send some copies along. Some agencies have been handing them out to board members
and other stakeholders to help articulate their agencies’ connection to VCP and the other agencies
in the network. All legislators and many of our stakeholders have received a copy.
VCP Conference: Stepping Forward Together: Advancing Equity and Cultural
Competency to Improve Population Health
On March 27th
and 28th
VCP hosted over 250 people for a 2 day conference exploring diversity.
While the official evaluations are still being tallied, we were overwhelmed by the support and
excitement about the content. In fact, we are still hearing people comment about how the
conference challenged their thinking and has led to further discussions about how to promote
equity in healthcare across populations in Vermont. VCP partnered with UVM LEND to organize
the conference and more than half of the attendees were from outside of our network including
from academia (both UVM and Dartmouth), health care providers, community organizations,
SASH, State government and more. The conference committee is scheduling to review the
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evaluations and to consider next steps. Thank you all for your participation, attendance and
assistance in hosting another successful conference. In addition to an amazing start to an important
conversation, a phenomenal educational experience, and a platform for working with new partners,
the conference was a tremendous marketing opportunity for VCP and its member agencies.
Unified EMR
This month saw a flurry of meetings to continue developing selection criteria, demonstrations, and
the scoring system.
10 different cross agency function workgroups met for 3 hours each in two weeks, to focus on
various aspects of a new EMR. Groups included: AOP Directors, Emergency Services Directors,
Billing and IT Directors and more. These meetings were tremendously productive and positive in
helping to define what we are looking for as well as to identify areas in which agencies can
collaborate and work together. Additionally, there was a great atmosphere of collaboration and
information sharing that will help us immediately. Discussions about how agencies currently
perform some tasks generated a lot of cross agency support and exchange of ideas.
As of the deadline for proposals, we received 16 complete proposals in response to our request.
They are being organized and disseminated to the core committee. Per our plan they will be
organized into three tiers and compared to each other. Scoring and discussion in subsequent
meetings will result in selection of a small number of candidates for in person demonstrations,
referral inquiries and customer site visits. A smaller subgroup is being formed to work on funding.
Thank you to all our participating members for the significant number of resources they have
contributed to this effort. We’re very pleased with the results and findings so far, and look forward
to continuing this very productive effort.
Office of the National Coordinator
The ONC has asked VCP to give a webinar on our data quality project. The Data Quality Project
Webinar is tentatively scheduled for April 26th
at 2:30. We will be sure to send an invitation to
anyone that is interested as the details are available.
Data Repository
Phase 2 (onboarding of clinical data) is moving forward. Lamoille is in production, NCSS is
nearly complete, CSAC is now moving into production. Ken is working remotely to bring Rutland
up to speed in April. Northeast Kingdom is in process and should be completed in the coming
weeks. We hope to begin work on HCRS very soon, followed by the remainder of the LWSI
users. Renaissance Information Systems, our consultant, is making great progress with the UCS
data set, and VCP is laying the ground work for the remaining agencies to engage with
Renaissance to keep the project on target.
NORC is working on converting existing dashboards from MSR based data to the more
comprehensive “phase 2 data”. Once the phase 2 interfaces are completed, and all of the agencies
are in production we anticipate putting significant energy into the development of additional
dashboards, as well as training the data analysts for our member agencies.
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Unified Coding Group
VCP has established a short term unified coding group to focus on common definitions for non-
billable and non-client contact codes. Six were agreed to at the first meeting with about 9 more to
go.
Youth Mental Health First Aid
There has been a lot of activity around AWARE Vermont. Aware VT set up a table and trained at
both the VCP conference and at the National Educators Association. In addition, Aware VT
presented about the initiative at the recent foster care conference and is working closely the VT
Child Welfare Training Partnership to set up additional trainings. Aware VT has also been working
with VT LEND on the YMHFA curriculum to assess its cultural competency and to engage the
cultural brokers. As part of that, Aware VT trained the cultural broker and health disparities group
this past month. In addition, VCP is about to send five cultural brokers to attend a week long
training to become YMHFA trainers. These trainers will be working primarily with the refugee
community in Vermont. After the training we will be meeting with them to learn if/how the
training needs to be revised to meet the needs of the refugee community. We anticipate that we
will then be asking the National Council for some flexibility while still being compliant and may
propose some changes to SAMHSA and the National Council for their upcoming revision.
Team Two
The Team Two trainings are continuing and we are meeting with DMH and DPS to work on next
year’s contract. The next training will take place on April 12th
.
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Section D
DS DIRECTOR MINUTES
DATE: December 7, 2016
TIME/PLACE: WCMH, Waterbury
FACILITATOR: Marie Zura
PRESENT: Marie Zura, Julie Martin, Beth Sightler, Bill Ashe, Dixie McFarland,
Greg Mairs, Kathy Brown, Dawn Danner, Josh Smith (phone), Jennifer Stratton (phone),
Julie Cunningham,
ABSENT: Ellen Malone, Theresa Earle, Sherry Thrall
TOPIC
DISCUSSION
RECOMMENDATION
/ACTION
Minutes Beth made a motion to accept both October
and November minutes. Dixie seconded the
motion.
October and November
minutes were approved.
Equity and Public
Safety
A situation that was not funded was
discussed.
Directors will talk with
Roy about equity.
Psychiatric
Services
Bill is seeking psychiatric services for his
agency.
Some Directors said they
may be able to offer
some psychiatric time
and Bill will follow-up
with them.
DCF/MOU Marie shared information from a MOU
meeting with DCF, and there was discussion
about crisis needs.
Dixie and Bill will work
on a proposal.
Bill will join the
meetings with DCF.
VR Outcomes There is a meeting on December 8th
. Directors would like
information in writing
from VR regarding their
contractual obligations as
a result of the changes.
Over $200,000
Cost
Marlys verbally shared information on costs
for people over $200,000 that was requested
by the Commissioner. Two agencies have not
reported and she hopes to have full data to
share with VCP and the Commissioner.
SAMS Josh said that agencies are being asked to bear
the user costs to access the SAMS system.
Josh will draft a letter for
Directors to send Megan
Teirney-Ward.
Topics for Monica
at the VCP
Meeting
Directors identified the
$200,000 cap and VR for
next fiscal year.
With Roy
ISA Letter Roy said a letter would
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come out from DAIL the
middle of next week.
DD Act
Regulations and
Proposed Changes
There was discussion about the Division
communicating changes with DS Directors
versus just with staff and having input into
things such as guidelines before they are
finalized. Roy said they would address those
things. He also said DAIL needs to fully
update the ISA guidelines, Medicaid Manual,
etc.
Equity Roy would like to change the Equity process
with some proposals being presented and
others done in writing. They are researching
reconsiderations. He would like to get
feedback early next year from DS Directors
regarding their experience.
Planning on things
to work on
together
Noon to 3pm will be set
aside at the January
meeting to plan on things
Roy and Directors want
to work on together.
Health Care
Reform
Julie Tessler and Simone shared information
regarding health care reform.
February 1st and 2
nd will
be a retreat to address
what DS Directors want
from health care reform
and how DS can meet the
goals identified for
reform. Simone will
work on a template.
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DS Directors’ Retreat February 2017
Present: Josh Smith, Simone Rueschemeyer, Julie Cunningham, Julie Martin, Ellen Malone,
Sherry Thrall Greg Mairs, Dawn Danner, Theresa Earle, Kathy Brown, Alysia Chapman, Beth
Sightler, Bill Ashe, Jennifer Stratton (Feb. 2nd
)
February 1, 2017
Retreat Goals:
1) DS Directors understand the goals of health care reform, including value based
payments.
2) DS Directors agree on how DS should be included in health care reforms and why
Health Care 101 – Simone gave a presentation and answered questions about health care reform.
DS in Health Care Reform:
Vision:
Be the best in the nation
*Person at center of and directing everything related to their life
*Community values the individual’s lives and DS values
*Community based
DS values
Outcomes of integrated living
People served have interesting valued lives
Make this a career for workers in the system, not just a job
Flexible system to support individual needs i.e. residential – support people where they are
Access to services is quick and simple
Value of individual budgets based on need
Build partnerships within the system and within the community
Function in a health home model
People truly belonging (community acceptance/understanding, investment and recognition
of returns)
Extension of adequate funding
Increase market – other populations could benefit from model
Provision of employment services across populations
Current and future growth (caseload #)
Vermont as epicenter of thinking/ practice for the country
Be proactive to share out model
Supported employment model
Work collectively to train shared living, individual budgets, best practices
Preserve and expand hospital diversion/programs for children and adults
Co-existing MH diagnoses and other
20
Systems should work cohesively
CRISIS
Means agreement on best practice
Adequate resources to support most complex needs
Access beyond willingness – training
Appropriate expertise
*Residential options for transitional youth
Affordable/accessible housing
Transportation
Be more of a resource to other entities within the State i.e. DCF
*Zero reject
Family centered services for aging parents – additional services for parents
Proactive approach for 40% who don’t meet funding priorities but are eligible
Self-directed self-advocacy
Population more involved in community (on boards, etc.); Diversity is importantf
Technology tools to enhance services
Restraint/use of ABA – expand self-regulation training (impact on school budgets)
Agreed upon set of performance measures based upon agreed upon values
*Life long
One overarching message that is catered to the audience:
Collaborate with partners to support people with disabilities through customized, cost
effective approaches that are person centered and directed
Vision Statement:
We support Vermonters with I/DD and our network values individuals, cost-efficient person
centered services that result in one’s ability to be an integral and engaged (contributing) member of
one’s community. Supports may be life long, flexible and customized to meet an individual’s need.
How do we Impact:
Care Coordination
Have jobs
Supports vulnerable populations
Affordable housing
Transportation
Employment
Care Coordination
Saves money
Collaborate with partners
We are Cost Efficient:
Prevent higher level of care (inpatient, ER, ICF/DD)
Provide housing (decrease risks, MH, criminal involvement, etc.)
Community based/no institutions
Less expensive compared to nursing homes and group homes
21
Data plus cost comparison. Flip side to the 5 points
Funding priorities force us to focus on one side of the bell curve
Savings from VCIN utilization (Bill has a chart)
Daily cost of VCIN compared to institutions
By promotion of civil rights (analysis of lawsuits)
Employment data
Data from NCSS/maybe system wide on high utilizers (Simone to ask Cath)
Short Term VS Long Term:
Sell expertise as a product
*Case management (bill as spec. rehab)
Lonely
Short term case management
Redefining ref. from intake
Again population
People on fringes with no one to go to
Going to ER
Lower barrier
Needs are not medical in nature
Social determinants stabilization program
Relationship is at core – It is about face to face more so than care management
Police, LIT, ERs, intake, stabilization, police social workers could meet the need if role
was expanded, PCPs.
Would be maxed out with caseload
Who
70 – 85 IQ
DOC should make an investment
SFI
Loss of VR funding coming out of schools
Population isolate with no support (no show rate with MH); SFI; fall off DCF at 19
Population:
70 – 85 IQ not eligible for CRT or other already defined services
Isolated without supports (increased no show rates)
Disconnected from natural supports i.e. work related accident
SFI type but don’t use term SFI
People who fall off DCF at 19
Alcohol dependence
People who fall between eligibility cracks
Non-clinical Treatment Goal
Where community based service is their need (social determinants: lonely, can’t find work,
housing, etc.
Medical condition is bad enough but living alone
22
What service are you providing?
Community based social supports
Assistance in accessing appropriate supports (first responders)
(clinical, doctor, help with budgeting, facilitate referral to community based services, fill
out applications, help with meds, supportive counseling, shopping)
Decrease social isolation
Help with employment
Help with housing (provision, application, referrals, help get water on so can shower, etc.)
Point to data in absence of care coordination/SNC coordination
Case management-It’s the everything in DS
Outcomes:
Impact on social determinants
Decreased ER utilization
Decreased hospital stay
Decreased involvement of law enforcement
Increased paying taxes
Increased employment
Increased stable housing
Decreased homelessness
Decreased From intake to first service
Increased access
Increased community relationships
Increased resources for community
Enables us to be leaders
Decreased incarceration
Decreased court appearances
Increased satisfaction for transition aged youth
Increased workforce
Trump would say this would be HUGE
Help a very vulnerable population to stay in communities
Increased PD satisfaction
Decreased suicide and SUD
Expanded statewide street team
Expand sense of professionalization for service coordinator
Increased visibility of SC
Decreased strain on families
Increased staff satisfaction
Low cost high impact
SC Rates: DS rates were noted to be too low to provide the service and there was a discussion
about what might be an adequate rate.
Items to address were identified: Measurement; pilot vs statewide; individual agency
interest/willingness; barriers; billing; SSAs do not bill spec. rehab.; VBP model; Non-Medicaid
23
people; Timeliness; Vetting; Preparation for implementing: governance; consumer voice; digital
story telling; PR/marketing
February 2, 2017
Measures/Outcomes:
Decrease PCP visits (get ref. rejection data for past fiscal year)
ER – unnecessary visits
Crisis services
VCURES
Decrease overtime
Current case management metrics
Total health care costs pre and post
Overall health score
Employment and housing
Establish baseline in 1st year and track cohort – many people may be unknown through
current intake
Learn more about the population/needs
People who don’t meet clinical eligibility – seeing an increase in SUD
Barriers
Defining and getting access to a cons. Database to track and measure/ availability of
evaluators
Is DS responsive enough?
Defining an identifiable population
Should it be narrow?
Large enough sample but not everyone
Different service plan
Additional costs for assessment (re-testing)
Impact on other agency programs
Would insurance pay for case management
Impact on intake
Increase ref. from crisis
Eligibility
Once in door may use crisis more
Other additional hidden costs
Building capacity may take awhile
Market it differently/individual may not want to be associated with DS and then “all” that
eligible people “get”
Clinician in collaboration (AOP)
Evaluation costs
Needs assessment (new one for this population? Altered)
Define what 70 – 85 means – improperly using health care resources – change terminology
Act 79
Income verification ; meets criteria; write off
24
How many are uninsured? On and off Medicaid due to paperwork
Previous SFI funding? Baseline data?
Referral “rejections”
Surveys of unmet needs
A place where we are forced to drop the ball
Functional definition of population not diagnostic – do not have supports; cannot manage
What type of assessment tool – a functional assessment; problems; adaptive
A limited service
Theresa will write a couple examples of people being considered for these services
Consumer Voice
DD Council
Self-advocate group
Each agency identify a few people for planning
Job club
A pilot would sell better
Statewide 3 year pilot
Stronger internal network referral process
Timeline
Draft – 2-3 weeks (will use cases)
Internal vetting – 2-3 months with a y/n response
Re-convene in 3 months
25
DS Directors Minutes
February 2, 2017
Present: Josh Smith, Simone Rueschemeyer, Julie Cunningham, Julie Martin, Ellen Malone,
Sherry Thrall Greg Mairs, Dawn Danner, Theresa Earle, Kathy Brown, Alysia Chapman, Beth
Sightler, Bill Ashe, Jennifer Stratton
VR Cuts:
Beth, Bill Ellen, Kathy and Greg will meet regarding the proposed budget VR reductions.
Beth will convene the group.
Advocacy:
DS Directors will try to get people to Disability Awareness Day on March 2nd
.
Equity/Public Safety:
Dawn will be the new alternate for the Equity Committee.
Executive Committee:
The new committee will be Greg, Julie M., Ellen, Beth and Jennifer.
Medicaid Payments for Physicals:
Josh shared that they have had payment denied for physical exams and they are trying to
determine the issue.
February DS Exec. Committee:
The meeting will be at CSAC and will involve discussion of VR funding with DAIL.
March 3:
Josh is holding an in-service for home providers on taxes, ARIS, etc. and others are
welcome to attend it is from 11am to 4pm.
Chair of the DS Directors:
Jennifer agreed to chair the group for one year.
26
Vermont Care Partners Emergency Services Directors Meeting
Date: February 27, 2017 Location: DMH Waterbury Minutes: Karen Kurrle (WCMHS) Participating: Christie Everett (CMC), Dillon Burns (VCP), Marian Greenberg (CSAC), Neil
Metzner (HCHS), Jack Heddon (HCRS), Mike O’Brien (RMHS), Anna Mattison
(UCS), Bernard Norman (NEKHS), Brandi Littlefield (HCHS), Monique Reil (LCMHS) Guests: Emily Hawes (DMH)
Topic
Discussion Recommendation /
Action Team Two
Update
Proposed bill in legislature (H. 145) to create a
Mental Health Review Commission. Discussion
in the Legislature about making Team Two a
mandatory training for law enforcement. Next
Team Two training in Manchester on April 12.
DMH Update No current Medical Director for DMH, with no
responses received for the Medical Director
position RFP. Emily also reported that
Mourning Fox is the new Deputy Commissioner
and Frank Reed is the Interim CEO at VPCH.
VCP Updates Dillon updated the group about the wait time in
ED workgroup progress. Dillon said there have
been several proposals for potential solutions for
the ED boarding situation such as a ‘23 hour bed’
for people to wait for potential admission rather
than in the ED (for people who are EE’d there
would need to be a change in current state law.)
There is also discussion about the Geri-psych
need and nursing homes needing to accept elders
with psychiatric needs. Discussion around data
needs to support illustrating the problems
presenting in the system. Dillon shared that Al
Gobeille, AHS Secretary, has also asked for the
mental health system to be evaluated and has set
an aggressive timeline for workgroups. Dillon
also talked about VCP’s white paper about the
emergency department wait times as well as the
hospital association white paper on the subject.
There was a discussion about the Master Grant
and data outcome requests/requirements/needs.
VAHHS White paper
to be shared with
group.
Scheduled meeting in
May tentatively
extended to discuss
reporting
requirements/Master
Grant, etc.
27
The group talked about having a longer meeting
in May to discuss the outcome data needs and the
Master Grant for FY18.
People
Waiting/Boarding
in Emergency
Departments
Emily reported there has been an increase in need
since August. ES Directors talked about different
protocols for triage and communication/treatment
coordination in different EDs. Some hospitals are
willing to admit client to med/surge floors to
decrease the pressure in the EDs. ES Directors
noted that it seems wait times for decisions about
potential admissions have increased from the
Designated Hospitals. ES Directors also noted
that it seems there is sometimes poor
communication at the DHs across shifts in
admissions where the next shift doesn’t know the
information already communicated previously by
the referring screener. There was a discussion
about the problematic nature within the system
that the DHs get to choose/refuse admissions
even while beds are open and available. Emily
reminded the group the VA is accepting EE
admissions. Brandi expressed concern that the
Retreat is now requesting medical clearance for
all potential children/adolescent admissions. The
group talked about this leads to less emergency
department diversion. Discussion around how it
can currently be confusing to get DMH accurate
information about the number of people boarding
as people who are boarding voluntarily are not
reported to DMH and therefore are not a part of
the statistics gathered by DMH. The group also
discussed the role of DMH Care Management and
CAFU when children/adolescents are boarding as
this can also be confusing when CAFU does not
view themselves in role of care managers to
support/facilitate admission.
BC/BS Payments
for Crisis Services
Brandi asked the group about BC/BS payment for
crisis services. The group talked about the most
recent BC/BS communications and gave Brandi
some ideas about who to contact at other DAs to
follow up with any further questions/need for
clarification.
Transport
Payments
Discussion on how DMH is no longer paying for
transport specialists for Howard Center and
WCMH. DMH will pay for involuntary
transports but not voluntary. Both Bernard and
Emily to clarify
options DMH will
pay for and share
with group.
28
Monique discussed sometimes using cadre
members to drive people to the hospital. The
group also talked about ambulance transport and
using families as well as sheriff transports.
NEKHS is using non-categorical case managers
through Act 79 funding to assist with transports.
Wait time
“Talking Points”
There was discussion about how to define
‘boarding’ as well as other data points potentially
to be collected (why a person is not being
admitted; is the person boarding
voluntarily/involuntarily; are they a CRT etc.; are
they a child or adult etc.) Also does not capture
children that may be waiting at home for a bed to
become available. The group again talked about
the need for a longer meeting time in May to talk
through some of the data collection needs.
Further discussion at
May ES Director’s
meeting.
Dillon will work with
DMH to get a list of
the individual
performance
measures selected by
each agency for
distribution.
One Care
Emergency
Services Measure
Dillon discussed the proposed outcomes measure
from One Care related to Emergency Services.
The proposal is to report on the agency follow up
with people seen in an emergency room within 30
days. Discussion in group around difficulties in
this measure, as it can be affected by a number of
variables outside of our control.
Columbia Suicide
Severity Rating
Scale (CSSR-S)
Mike shared that RMHS is looking at training
community partners in use of the Columbia
screening tool to help establish s common
language in the community, and assessment of
need for someone to be referred to an emergency
room. Hopeful that it might reduce the number of
inappropriate referrals to EDs and capture those
that might otherwise fly below the radar. Also
reported that they are looking to open a
downtown walk-in crisis center, in collaboration
with other organizations
Next Meeting Scheduled for March 20, 2017 at DMH
Waterbury.
29
Vermont Care Partners CRT/CSP Director’s Meeting
Date: March 3, 2017 Location: Waterbury State Complex – DMH office Minutes: Elaine Soto Participating: Ginny Havemeyer (LCMHS), Gretchen Pembroke (CMC), Leslee Tocci (WCMHS), Sandy Smith (CSAC), Elaine Soto (HC), Kate Lamphere (HCRS), and Dillon Burns (VCP) Guests: Trish Singer (DMH), Jane Winterling, and Katie Wilson
TOPIC
DISCUSSION RECOMMENDATION/
ACTION Master Grant
performance
measures
Reviewed the list of measures from the 10
DA’s. Also discussed SAMHSA’s 4 measures
of recovery: employment/meaningful role;
community inclusion/social networks; housing;
and health.
Further discussion when
more members of our
group are present.
Variance reports Trish reviewed the process of DMH’s use of
these and noted that they are now looking at
these monthly as opposed to every other month
in the past.
N/A
Peer Wrap
facilitators
Jane Winterling and Katie Wilson of the
Copeland Center informed us that peer
facilitators are not getting enough work to get
really good at what they’ve been trained for.
They explained that Wrap groups are only
offered via the Blueprint. The Blueprint pays
for facilitators and supplies for 2 groups per
year for a total of 32 hours (8 weeks per
group). Research shows that participation in
such a group by itself (even without creating a
Wrap) leads to the strongest positive result
(often via connecting with other peers).
There is also a Wellness Engagement training
for staff to help clients draft a Wrap.
Contact Jane if interested
in learning more. Dillon
sent out contact info.
Jane to talk to the Co-op
or to DMH about
possibility of sponsoring
a training.
HCBS rules Elaine raised concern about whether there will
be additional data reporting requirements
without additional resources.
We need more clarity on
this from DMH.
Also, DMH is planning
meeting with res
30
coordinators in April.
Residential
costing
Gretchen asked about a request we received
recently to describe services provided in our
bundled per diem rate. It is not clear why this
is being asked for since we assumed that all
services were already known and included.
No further clarification
received from DMH.
Dillon will invite
Shannon Thompson to
next CRT directors’
meeting for further
discussion.
Consumer
satisfaction
surveys
Leslee asked about what other’s return rates
are for these. Generally speaking, the
percentage is in the 20’s.
N/A
Next meeting: April 7 at DMH (Linden)
31
Public Relations Work Group
March 13, 2017
Present: Joe Halko NCSS, Alice Bradeen HCRS, Heidi Goodrich CMC, Kirk Postlewaite
WCMHS, Casey Dewey GMSS, Luciana Swenson LCMHS, Simone Rueschemeyer VCP, Julie
Tessler VCP
Structure
Joe Halko will co-chair the group with Julie.
Information Sharing
Kirk shared information on a social media and marketing conference put on by SkillPath. This is
the same group as Josh shared information from. The conference cost is $199 per person. There is
a slightly discounted rate if there are four or more people. Website: www.skillpath.com
Heidi shared information on a 5K color splash run on May 7th which is the final event in the Clara
Martin Center 50th
year celebration series.
Joe shared that NCSS will have their 4th annual Autism Awareness Walk on the same day, May
7th
Casey said May is Older Americans Month. Lamoille County will do a wellness event on May
11th
in collaboration with other local agencies.
May is Mental Health Awareness Month. WCMHS might be doing some events in May.
Lucianna shared that LCMHS will hold weekly events in May, including having the ME-2
orchestra on May 4th
. A blood drive will be held on May 5th
.
Alice said on April 29th
in Brattleboro HCRS is doing an event on developmental disabilities at the
River Garden. On June 9th
is they have their annual golf tournament.
Simone suggested doing education for May is Mental Health Awareness Month on a statewide
basis. We could create a statewide press release and each agency can customize it. It will be on
Stigma. The conference will include this topic.
VCP Conference
The registration is slowly trickling in. 160 people have registered so far. We will share
information on VCP and all member agencies. Plus, there will be a separate table for Youth
Mental Health First Aide. Please send your agency brochures to Simone in advance of the
conference. Please publicize the event as widely as possible. VCP has an ad in Seven Days and it
was suggested that a press release go out to the digger. That was done immediately after the
meeting.
32
Advocacy Workshops
Heidi and Kirk agreed that the Advocacy Training by Ken Libertoff and Peter Mallary was very
helpful. Kirk thought having more advocacy workshops would be a good idea. There is some
interest in doing workshops next November in preparation for the next legislative session. The role
playing was considered the best part of the training.
How to count the number of people we serve
Kirk said they estimated that they serve over 40% more than the number of enrolled clients.
Simone said that the outcomes group has been working on how to collect non-client contact.
Simone said that DMH used to collect that information. Alice gave the example of police social
worker program and how they do not enroll people into the EMR system. Other examples of
people served who do not enroll as clients include: work with other students in a class room,
family work and trainings such as mental health first aide training. Alice feels like we are hugely
under reporting. Developing a standard to count people across the system of care would be
helpful. The estimate must be verifiable.
We now do more population health work than we used to. We also serve people who are
experiencing greater acuity of symptoms. Kirk suggested that we toot our horn more about
promoting wellness.
Next Agenda and work for the interim period before the next meeting Branding proposal for VCP
Social media conference – confirm whose going
May is Mental Health – focus on Stigma- start draft of op-eds, etc. and share with the group
Critical incident media policies – homework – please share
Joe will start a calendar of events – for the year
Joe will bring materials back from Natcon Conference
Next meeting: April 10, 12:30 to 2:00 PM at the VCP Office
33
Council Outcomes Meeting March 15, 2017
WCMHS Administrative Offices, S. Barre
Agenda Items
Discussion Points
Action Needed Next
Steps/by whom
Welcome and Introductions
Laura from Rutland , Matt McNeil, Bonnie, Mary Birkman NFI
Jeremy Martin – Crisis Beds and Satisfaction Surveys
Jeremy and Michael are MIA Crisis Bed group: Satisfaction surveys; Jeremy, had 4 then 2 more got added. Cath attended the crisis group. Folks were surprised by the extra questions. This prompted a broader discussion. Recommendations have been developed but have not been circulated yet. Group had questions about the questions. Email going out to the group. Friday the group will be discussing. Quality of life question does this make sense? Refer a friend? Can this be tweaked? Last year these questions were put out there. Outcome / WCC Keith, lots of people are asked to complete a survey Michael: Can we tweak them or not? Matt; could have come from the execs. net Promoter score. The format is significant. How flexible is the language? Not flexible at all.
Discussion Keith to work with Cath, and others to collect existing surveys, and review what is going on. Make a decision as to whether or how much they can edit. Add some guidance documents that can go along. Jeremy will bring back the information to the group.
Came along later
34
Jeremy, They don’t like it. Some people have changed the language already. That may have been the case. How important is it to stay the same. Michael: we should review the surveys and make sure the language is close enough. Marlys: define the process that is being used. Mary: Agreed: Crisis Stabilization beds. Using it as is. Quality of life. Elizabeth: how about third party? Bonnie: we use smiley face scale to facilitate Jeremy will bring back the info to Crisis Bed Group
Communication with VCP leadership groups
What to cover and who can do it? In Reference to the retreat: E.G. CRT, Crisis, DS Directors, IT, Compliance, YF Directors; Autism Group. AOP, SA groups. Not necessarily VCP sponsored. What? Who? Laura; are they looking for information from us? Michael; We need to resuscitate the process Dillon; Groups want to have presentations from outcomes; Not all groups know who their Outcomes rep should be. Not all groups have a VCP rep on them. Master grant questions can cross groups.
Discussion / Decision
35
Keith; Working on aligning the groups further. Let’s talk about how we communicate within our respective agency. Mary; is there a listing of these groups? Ken: on the VCP Web site Keith: are there some outliers? Medical Directors Early Childhood Directors may be creating their own. They are interested in aligning their outcomes. Marlys: At what point do we need so many groups, and when can we have sub committees? Keith: Ongoing history in large part based on funding. There are conversations. Michael: What level do we want to function on? There may be too many groups for us to track/ manage
Consumer participation in Outcomes Group
Who and How? (Green Mountain Self Advocates, VAMHAR, others?)
Discussion
Annual Priorities– revisit tasks
Measuring Value Wait Time Coordinating Measures CANS Elizabeth: We do lots of work that is
Report Out/Discussion Value Group top 10 non direct service codes that we want to do. Internal and
36
not funded. Laura: Transportation? Case managers Keith, we may not be able to get covered for this, but we would be better off if we could advocate for these things. Bonnie; we do this because we see the value Michael: Most of the stuff that is not billable. Not required, but necessary to us to tie things together. I.E. putting case workers with police.
External Consultations are not being tracked. Wait time update: group being scheduled Coordinating measures group. CANS narrowing a time to meet. Report is due. We are working on pulling the data together. There are a number of models to choose from
Role of outcomes group in electronic health record discussion
Ken gave update: Flexibility Strong user interface Ability to add, update the system Outcomes: management tools IT and Analytics on the 30th. Productivity and work flows
Report Out / Discussion Ken to try to keep an eye on analytics and interface.
Being Change Agents
Challenges and How To’s Keith: What are some things we can do to help with organizational change? Bonnie: Do agencies have an outcomes oriented group internally? Michael; annual or low frequency are hard. Bonnie; once a month get to an internal group. She meets them as soon as possible after the Outcomes group
Discussion
37
Keith this work is important. Leadership “gets it”. Clinical folks also get it. The challenge is getting people aligned. Fidelity to the process is important. How do we balance autonomy with unity?
VCP Updates
Cath: 27th 28th VCP Conference. 4:40 – 6:30 reception COE: last week. Working on the process. July will be the start Master Grant Negotiations. Cath will move ahead with incomplete groups Put questions on the base camp.
Other / Future Business
Questions about what we can and cannot do: Bonnie: outreach and information. Community collaboration service code. Bonnie could Keith Reviewed committee assignments Dillon self-selected performance measures out on the outcomes basecamp. DMH doesn’t expect them to be different. Cath: April invite State partners. Keith: Do we want to talk to DAIL about those questions? June got some people together in the fall. Marlys: Updating DDS Regulations
Keith will send out the CSAC survey. Collate surveys and processes.
38
may impact outcomes. Cath: will invite other State partners .
Adjourn
Polycom/Tandberg Information for Outcomes Meetings The schedule is set to recur Monthly, 24 times. expiring 7/2018 Conference: VCP Outcomes Group (C. Burns)
39
Minutes from AOP Directors Meeting
3/16/2017 Attendees: Clay Gilbert (RMHS), Paul DiIonno (UCS), Julie Parker (NCSS), Dillon
Burns (VCP), Gretchen Pembroke (CMC), Margaret Joyal (WCMHS); Michael
Hartman (LCMHS).
On Phone: Marcia Stricker (NKHS)
Guests: SASH Kim Fitzgerald, Stefani Hartsfield
VCP Ken Gingras
Updates from the morning Substance Abuse Providers Group:
Discussions on: Inconsistency with decisions from the Office of Professional
Regulation (OPR) since they have assumed jurisdiction of the Licensed Alcohol and
Drug Counselor certification/license process. A letter from the Vermont Association
of Addiction Treatment Providers (VAATP) citing concerns will be sent to OPR.
There is a workforce development meeting on 4/17 that is by invitation only to
discuss workforce issues. It is in Randolph.
The AOP group has invited the VAATP to get together at some point at the 12-12:30
“between meeting break” to discuss overlapping issues. The VAATP has accepted
and Clay Gilbert will invite members of the VAATP to come next month.
The Vermont Department of Corrections (DOC) is cutting funding back on
transitional housing and Phoenix House may have to close the one in South Barre.
Discussion on the RFA for Block Grant funding. Several providers were concerned
regarding data of uninsured/underinsured. The proposals are due on 3/31.
Afternoon Agenda:
Two guests from SASH came and talked to the group. The main topic was, “How
can we work better together?” Some of the main issues were: funding, as many have
Medicare and can’t be billed for services unless there is a LISCW; many have co-
occurring disorders including personality disorders and a history of trauma;
identifying a target population for collaboration; how can grants/funding/staff be
secured to provide services. Stefani will summarize SASH’s interest in collaboration
and send it to Dillon for distribution to AOP directors.
Data Repository: Ken from the Vermont Care Network came and did a presentation
on the Data Repository that has been in development. It gathers data from the
Monthly Service Reports (MSR’s) and arranges it by Designated Agency. The plan
is to have accurate data more available in a timelier manner so decision makers can
make more informed decisions. Access is now available but will need to be set up
through IT or Ken.
Legislative proposed Bill on trauma:
There was a discussion on the wording of a bill that appears quite prescriptive of
how to proceed with screening for and treating trauma. There were ideas presented
40
to help improve the wording and suggest that there be a Trauma Service Director
(which used to exist) and a Trauma Services Advisory Board. Suggested wording
will be forwarded to Julie Tessler so she can best strategize on how to effect change.
Respectfully submitted,
Clay Gilbert – 3/17/2017
41
Vermont Care Partners Crisis Bed Managers Meeting Minutes
Date: 3/17/17 Location: Collaborative Solutions Corp, Barre, VT, 1pm-3pm
Attending: Troy Parah(NCSS), Dillon Burns (Vermont Care Partners), Crocker Stickney (Maple House/WCMHS), Denise Stubbs (Second Spring), Jeremy Martin (Oasis/LCMHS), Ilana Scharoun (Home Intervention/WCMHS), Kaysha Coccia (RMHS), Justin Wagner (notes, Chris’s Place/CMC) (on phone: Diane Leach-Howard Center and Linda Simoneaux-HCRS/Alternatives) Guests: Anne Rich (DMH), Cindy Olsen (DMH), Patricia Singer (DMH), Scott Acus (new ED for Collaborative Solutions) Regrets: Bob Doran (CSAC), Gloria Van Den Berg (Alyssum)
Agenda Items
Discussion Points
Action Needed
Next Steps/by whom
News From DMH-Trish Singer
Fox wants to know if there are problems staffing crisis beds. What challenges are crisis beds facing? This lead to a lengthy discussion about the challenges facing the various crisis bed programs. Some challenges included: proper/improper utilization of CB’s. Hard time retaining qualified staff (potentially offer higher salaries/better benefits to retain staff). Discussed how referrals are made to crisis beds. Each program is slightly different, but most referrals come through crisis teams and case managers and are then directed to crisis bed managers. The group discussed tracking referrals, however this is hard to do as many referrals do not make it all the way to CB programs.
Reporting has a September 30th
deadline
It was suggested that DMH talk or meet with each program to learn more about the uniqueness and challenges of each program as they are all so different.
Conversation with DMH Care Managers (Anne Rich and Cindy Olsen)
Anne Rich/Cindy Olsen-discussed some of the struggles the care managers face in finding placements for clients. Hard time finding placements for Geri-psych patients, adult males with aggressive behaviors, those experiencing homelessness. Care managers have weekly call with crisis bed managers to discuss placements. Would like more CBM’s to
Dillon will coordinate with care managers to get crisis bed managers connected to weekly call. 3 month trial to decide whether the calls are helpful or not. Possibly look more closely at what HCRS is doing to keep people flowing
42
join the call, so that all parties can share info more freely (confidentiality covered by HIPPA). Group discussion about those experiencing homelessness taking up crisis beds because they have nowhere else to go. All agreed it would be good for all programs/hospitals to have a better flow of people through the system. Discussed HCRS having a great system involving many programs to keep people moving forward.
through their system (what makes it work so well?)
Develop Shared Recommendations for Increasing Occupancy Rates
Group discussed the occupancy rate of 80% and whether this is a realistic goal. Jeremy questioned if the utilization rate accurately reflected the closed beds. There should be a way to account for the acuity that a CB program is facing; if only based on occupancy rate, this does not accurately reflect the hard work the programs are doing. Discussed increased staffing for some programs. Especially when dealing with high acuity clients. Some programs are single staffed 100% of the time.
Dillon will distribute a one-page survey for crisis bed managers to contribute thoughts on what it would take to increase occupancy in your programs.
Follow-Up on Conversation with Outcomes Group
Jeremy met with outcomes group and reports it was a good meeting. The group has not spent a lot of time addressing the issues raised by crisis bed managers, but they now have the info that Jeremy sent. Hopeful that this outcomes group will wrap up/resolve the issues with our satisfaction surveys.
Waiting for a response from outcomes group.
Electronic Medical Records (EMR’s)
Changing to a new EMR system has been a large undertaking. Hard to agree on one company as each program uses the EMR differently.
Looking at several different companies, then testing/trying out each one to find the best fit.
LOCUS Training LOCUS Training will occur on April 28th
at DMH
Time of training is TBD. Carolyn McBain will send an Outlook invite to crisis bed managers.
Adjourn
Future or deferred agenda items:
Next Meetings
April 21st at DMH (Beech Conference Room)
May 19th
Intake/Discharge Forms
43
Section E
Attachment 1
AHS MH Funding Workgroup
Report - March 24, 2017
Executive Summary
The MH Funding workgroup was asked to respond to the following questions:
(1) Should AHS pay providers more? If so, where?
(2) What is provider accountability?
(3) How is the system currently organized? Why? What are the differences in services provided by
agencies and why are there differences? What are the differences in access to services?
While the impetus for the conversation is the current backlog in the ERs, the
workgroup looked beyond the current MH ER crisis to the current financial status
and crisis of the system at large. At the core of many of the current day "crises"
in and around the MH system is the underfunding of the system primarily as it
relates to Medicaid rates that have remained fairly stagnate in comparison to
inflationary and market changes. To manage within the current rates and
reimbursements, agencies have increasingly paid staff below market, postponed
necessary capital and infrastructure improvements (specifically buildings and
information systems), and limited capacity for staff training and professional
development. Ultimately, the compounding of these strategies has resulted in
tenuous financial positions as well as high turnover and challenges in recruiting
which has a direct negative impact on service access, quality, and has
compromised the system's ability to move forward with system changes .
Addressing the issue is made difficult by the challenge of clearly and succinctly
quantifying financial and service need, utilization, current resource allocation, and
workforce availability which differs across regions and organizations. This is
compounded by the ongoing fiscal pressures on the state budget and the current
Federal climate.
At the most fundamental level, there is a critical financial need in the system to
aid addressing workforce challenges that will result in stabilizing the current
system so it can move from crisis response to proactive engagement in moving
44
the system forward in the health care reform environment. To address this, the
workgroup is recommending an immediate financial strategy (rate increases) in
tandem with imperative data, processes, and dialogues to occur within the next
year that provide sufficient information for strategic decisions to be made
regarding funding, reimbursement rates/levels, scope, and populations and
numbers to serve. Regardless of how we choose to move forward, adequate
reimbursement and service expectations that match level of funding are non-
negotiable tenet s. The DA/SSA system is a critical component of Vermont's health
care system and we cannot afford to let it fail.
45
Service delivery challenges are an outcome of rates not keeping up with inflation
• Workforce issues result in direct and negative impact on the quality of services, wait lists, and
outcomes.
• Research shows that higher organizational stress, such as turnover and staff burnout, is
associated with lower client participation and higher suicide rates [Landrum, 2012]\ [Healthy
Services and Safe Patients, 2015 ii].
• High turnover rates can also negatively impact substance abuse recovery. Relative to adolescents
who did not experience any clinician turnover, adolescents who experienced both direct and
indirect clinician turnover had significantly higher percent of days using alcohol or other drugs
[Garner, 2013 ]iii
Unintentional increased health care system costs are an outcome of rates not keeping up with inflation
• Workforce issues that result in direct and negative impact on the quality of services, access, wait
lists, and outcomes can result in cost-shifts to other more costly sectors of the health and human
services system, such as hospitals, education and corrections.
The health care system cannot endure any longer the high turnover in the DA
workforce year after year . DAs must be able to recruit and retain high quality staff
as an essential provider in the larger healthcare system.
Recommendations
Immediate: Given the current financial pressures, timing of fiscal planning
for the new year, current payment structures, and available information
there are limited options for addressing the immediate need right now. At
the core of each strategy recommendation is increasing reimbursement
rates to begin moving closer to necessary costs and pushing the question
of what/how much the State can afford to buy.
1. Broad scale increase to reimbursement/rates with proportionate increases to caps. This
investment would help providers begin to stabilize and maintain current planned service
delivery capacity. Any increased capacity to actual would be the product of filling vacant
positions and/or reducing turnover to meet planned capacity.
2. If no additional appropriation can be made available, rates should still be increased with
current funding caps maintained. While this will result in a proportionate decrease in service
delivery, it will be a critical first step in stabilizing agencies so they can adequately hire and
retain staff thus easing system pressures.
46
2. PROVIDER ACCOUNTABILITY
Providers are currently held accountable to meet a plethora of State and
federal requirements related to the provision of service data, financial data,
and outcomes information. AHS Departments (ADAP, DAIL, DMH, DCF, DOC)
continue to have distinct reporting requirements and mechanisms with a blend
of 4 electronic systems for data submission (MSR, SATIS, MMIS, e-fins) in
addition to numerous manual templates/forms for program and financial
reporting.
Recommendation
Identify a workgroup to propose minimal, necessary, and streamlined measures
and data, as well as streamlined reporting methodologies, which provide
essential information to the Agency..
3. SYSTEM ORGANIZATION (Efficiency and Access)
Background
18 V.5.A. § 7201 Mental health
The department of mental health, as the successor to the division of mental health services of the
department of health, shall centralize and more efficiently establish the general policy and execute
the programs and services of the state concerning mental health, and integrate and coordinate those
programs and services with the programs and services of other departments of the state, its political
subdivisions, and private agencies, so as to provide a flexible comprehensive service to all citizens of
the state in mental health and related problems.
The Department of Mental Health works with 10 private nonprofit agencies in
Vermont to provide mental-health care. They are called Designated Agencies, or
community mental health centers. For each population served by the
Department of Mental Health, there is designated one agency in each
geographic area of the state to assure that people in local communities receive
services and supports, consistent with available funding, the state System of
Care Plans, the local System of Care Plans, outcome requirements, regulations
promulgated by DDMHS, the goals of Vermont for its citizens, the goals of the
citizens themselves, and other policies, plans, regulations, and laws.
46
Separate designation is required for each of the populations served by DMH:
Individuals with developmental disabilities; Adults with mental illness, or with
significant behavioral health needs; Children and adolescents with, or at risk
of, severe emotional disturbance, or with significant behavioral health needs,
and their families. In addition to Designated Agencies, DMH works with two
Specialized Service Agencies: Pathways Vermont, who serve adults, and the
Northeastern Family Institute, who serve children and families.
• Designated Agencies (DAs): There is one designated agency in each region of the state responsible for
ensuring availability of needed developmental disability and/or mental health services. Key
responsibilities are providing or arranging comprehensive services for all eligible
Page 48 of 51
Recommendations
Service Offerings and Access -
1. AHS to determine what System of Care structure looks like. From this, clarify the scope, depth, and
expectations of DAs and SSAs as well as proposed system organization changes.
2. DA/SSA system must play a leadership role in operationalizing health care reform.
DA/SSA System Organization -
3. Provider group continue to explore, identify and initiate opportunities for increased efficiencies
across organizations.
4. Workgroup to analyze and recommend consistent, core operational practices across the system (for
example standard response time to discharge planning).
Next Steps
Should the recommendations of the workgroup be supported, develop sequenced work plan as all cannot all be
concurrent, identify resources/leads, and develop timeline.
The Funding Workgroup consists of the following individuals:
• Sandy McGuire, Chief Financial & Operations Officer, Howard Center(Chair)
• Louis Josephson, Chief Executive Officer, Brattleboro Retreat (Co-Chair)
• Heidi Hall, Chief Financial Officer, Washington County Mental Health
• Cheryl Huntley, Operations Director, Youth and Family Services and Addition Recovery Services,
Counseling Services of Addison County
• Simone Rueschemeyer, Executive Director, Vermont Care Network
• Dillon Burns, Mental Health Services Director, Vermont Council
• Melissa Bailey, Commissioner, Department of Mental Health (consulting AHS staff)
• Sarah Clark, Chief Financial Officer, Agency of Human Services(consulting AHS staff)
• Mourning Fox, Deputy Commissioner, Department of Mental Health, Agency of Human
Services (consulting AHS staff)
Page 49 of 51
Page 50 of 51
Attachment 2
Care Navigator Strategy Meeting 3 21 17
Present: Todd Bauman, Kim McClellan (NCSS) Catherine Simonson, Betsy Cain, Matt McNeil,
Laura Pierce, (Howard Center) Keith Grier, Cheryl Huntley (CSAC), Simone Rueschemeyer,
Dillon Burns (VCP), Sally Benvenuti, Michael Curtis (WCMHS)
OneCare has said:
Expectation on implementation by DAs: “whenever” (may not match regional messaging)
50% of 30,000 in All-Payer Waiver pilot are kids. 10,000 kids in tier 1. 600 are tier 4.
Currently piloting in 4 NextGen communities. Next year it is supposed to roll out to all the DAs.
What is happening in 4 DAs currently?
NCSS Care Navigator: 8-9 NCSS Blueprint staff trained and using Care Navigator in primary care offices
(primarily practices serving adults, not pediatrics). Not putting in NCSS client info, but putting in
other client info. Those Blueprint staff don’t have LWSI access. Those staff received two
trainings. OneCare wants us to train other staff. Thought about having Alison Krompf, quality
director, trained. Nervous about bumping it out to other staff. Software is reportedly clunky.
Trevor Hanbridge came to present; wanted to come and talk and learn.
VITL: Three years ago hired full-time person in medical records office to send medical records to
VITL. Sending crisis, psych evals, and med changes.
CSAC Care Navigator: We are in the process of due diligence aka “stall mode.” OneCare trained
management team onsite. One CRT staff on Blueprint has been trained, but asked him not to use it.
No one is putting our info. Willingness to explore and look at it.
VITL: We are doing VITL direct (send information doc to doc). “Automatic” but not to set up,
administer. We are taking responsibility for consent management. Disclaimer on all the
documents that go over that say they can’t be disclosed. IT staff are shipping the information; not
taking away from direct service staff. Doctor wants info on case manager, psychiatric contact info.
Evals and meds.
Howard Center
Care Navigator: Communication with OneCare has been confusing. Mixed messaging. Would
love to have a clearer communication stream. Initially trained some employees. Haven’t had those
staff engage yet. Feedback from training has been: we support the idea, but in practice it is very
cumbersome. Cohesion of two systems has been a big challenge. Not clear which of our clients are
also Care Navigator clients. When doing training, we intentionally didn’t do kid providers because
we were not sure if it was a good investment. Concerned about CFR Part 2, and told OneCare we
won’t put any substance abuse information in. OneCare contact: Trevor Hanbridge and Chantelle
Birch.
WCMHS
Care Navigator: Heather Colangelo is data inputting. 5 hours of time to maintain a database. Been
cross-training a bunch of people. Mary Moulton is supportive. Started with Care Collaboratives.
Care management spread across different agencies, assigned based on who is having the most
interaction. We are getting informed consent on DA end. Heather has been training others in the
community on how to use Care Navigator. [This work paid for with Robert Wood Johnson funds
obtained by OneCare.]
Page 51 of 51
Benefits:
Documentation of integration of health care
Supporting people in crisis by giving EDs access to mental health information
Compliance Concerns:
Consent Management Process: need more clarity on consent/privacy. Does Care Navigator block
access to those who don’t have consent?
CFR Part 2 – Incomplete SUD information
Concern with FERPA and other non-covered entities: privacy issues; minimum need to know
Other concerns:
Risk of developing a parallel system
Spending direct care time on data entry
How is OneCare measuring effectiveness and outcomes?
What do we want for communication?
Need OneCare to have a DA liaison
Need to communicate to the right people at the DA.
Need one DA voice to talk to OneCare.
Want more collaboration.
Other ideas:
OneCare should give us money to build a new EMR – the ability to communicate with Care
Navigator.
“Consent2Share” model – thinking about that for the data repository. Could data repository share
with CareNavigator?
Hospitals are getting a PM/PM payment. We should be costing it out in parallel ways. Do we say:
pay for us to have a care manager in hospitals with attributed lives!
Next Steps:
WCMHS and/or VCP will get more information from Heather Colangelo on how it is working. Some questions: Is Heather doing double entry? How long does it take per client? Any technical difficulties? What do local agreements look like? Norms and protocols? Acuity of current caseload? Is anyone looking at outcomes? What about part 2 and compliance?
Dillon will set up a meeting between Trevor Hanbridge and Compliance officers for April.
Compliance officers will ask OneCare for information on quantity of people in tier 4 in each region
who are receiving services from the DAs.
Simone will stay involved with OneCare collaboration with Dartmouth Institute, which is trying to
do predictive analysis on comorbidities with people with SPMI/predictive analysis.
Simone will speak with OneCare to get clarity around:
o Their evaluation process? Are they measuring effectiveness and outcomes?
o A more streamlined communication process to DAs
o Could information for Care Navigator come directly from the EMR?
o What about DCF?
o Without SUD info its not a full record
o Hospitals are receiving a per member per month/ could they pay for one person to be in
the PCP offices – bridge work as an operational compromise.
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