1 nh division of community based care services bureau of behavioral health payment and system reform...
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NH Division of Community Based Care ServicesBureau of Behavioral Health
Payment and System Reform ProjectJune 10, 2011
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Current System
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NH’s Community Mental Health System
• 10 Community Mental Health Centers• 8 Peer Support Agencies• 1 Family Mutual Support Agency – NAMI NH
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CMHC’s• Responsible for providing a comprehensive array of
services to individuals residing in a region who meet the criteria for a “severe mental disability” as defined in state law and administrative rule.
• The primary safety net system in NH that provides services to Adults with Severe Mental Illness and Children with Serious Emotional Disturbance.
95% of BBH Medicaid Funding is targeted to this population.
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CMHC’s
• Services are comprehensive and provide the most effective treatment for individuals with a Severe Mental Disability
• Emergency Services• Therapy Services• Medication Services• Residential Supports and Supported Housing• Case Management• Individualized Resiliency and Recovery Oriented Services• Illness Management and Recovery• Supported Employment
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What are we trying to address through this project?
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Challenges = Need for Change
• Rate of growth and demand for services is unpredictable, and with the past few years experience is unsustainable.
• Challenges with a fee-for-service model of reimbursement– Does not promote or create incentives for an
efficient service delivery system– Reimbursement based on volume and number of
people served, not outcomes
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Challenges, continued– Unsustainable growth in expenses, inevitably lead
to the need for cost containment measures, which can further erode the community mental health system
– The system and the state are continually in a position of trying to do more, with less funding
– Need for new strategies to support NH’s 10-year Plan
– BBH’s federal mandate to ensure an efficient and effective service delivery system
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Beginnings of the project…
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Project Partners• NH Endowment for Health• NH Community Behavioral Health Association• NH Department of Health and Human Services• NH Bureau of Behavioral Health• Optumas Health Strategy• University of New Hampshire- Institute on Disability• National Association of State Mental Health Program
Directors (NASMHPD)• Substance Abuse and Mental Health Services Administration
(SAMHSA)• Centers for Medicare and Medicaid Services (CMS)• Consumers, Families, and community organizations that
partner with NH’s Community Mental Health services system to support individuals and families
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Approach to System Reform• Review of NH’s Community Mental Health System in
July 2009• Request for Technical Assistance from NASHMPD-
Fall 2009• Development of Underlying Goals and Principles to
guide the work of the project• Developed a comprehensive project plan• Stakeholder Meeting with CMHCs, Peer Support
Agencies, CMHC and PSA Boards- December 2009• Reviewed multiple national models for managed care
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Approach to System Reform, continued
• Through the support of the Endowment for Health, retained a Project Manager through UNH
• Retain an Actuarial Firm- Optumas, to assist with the program design, and rate setting work- Fall 2009
• Solicited the input of stakeholders• Finalized recommendations for a managed care
approach that best meets the needs of our population
• Established a Rate Advisory Committee• Developed a comprehensive concept paper
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Approach to System Reform, continued
• Awarded SAMHSA grant to implement outcomes measures and tools on a statewide basis- the CANS and the ANSA, as well as implement a web based reporting and tracking database
• Development of quality and outcomes measures• Ongoing consultation with the CMS in the
development of a 1915(b) managed care waiver application
• Budget presentations incorporated the model and the goals and principles of the project
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Goals and principles…
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Underlying Goals and Principles
Establish the road map and the benchmarks to guide the project, and ultimately measure its success
Revised on an ongoing basis using stakeholder feedback and our work with the project team
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Goals and Principles
• Inclusive of Active Participation• Restructure the funding of community mental
health services• Develop a plan to more effectively address the
needs of the uninsured• Focus on collecting outcomes data, and
supporting improved outcomes through performance based contracting
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Goals and Principles, continued
• Establish a Timely, Flexible and Responsive System of Care
• Ensure Transparency to Consumers, the Public, and Stakeholders
• Locally Driven Care• Risk is initially shared with the State, and as
the system matures, is transferred more to the provider in specific areas
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New Proposed Service SystemCURRENT NEWServices paid for on a fee for service. Services paid for on a
capitated paymentmodel.
No performance based contracts or accountability Outcomes driven systemfor improved outcomes. with Performance contracts
for providers.
10 CMHCs responsible exclusively for community Establishing 10mental health services. Prepaid Health Plans,
move to a network based model which integrates care
on a local level with other
service systems(ex. Substance abuse, other mental health providers, inpatient,
primary care)
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New Proposed Service SystemCURRENT NEW
No Risk to providers- paid for every service Begin with a shared risk provided model utilizing risk
corridors through contract, as the
system matures, and appropriate tools areput into place, move to full risk model.
Services are not integrated on a local level Integrated service model of leveraging Health
Homes provision within the
Affordable Care Act.
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Next steps….
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Next Steps
• Finalize rates to budget• Submit waiver application to CMS for review• Develop new contracts for prepaid health
plans• Implementation- January/February 2012
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To learn more…and keep informed
