1 nyaprs 7th annual executive seminar on systems transformation integration strategies for...

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1 NYAPRS 7th Annual Executive Seminar on Systems Transformation Integration Strategies for Behavioral Health: Managing Care, Outcomes, and Costs While Preserving our Recovery Vision Turning Health Homes Into Recovery Homes James Schuster, MD, MBA Chief Medical Officer Community Care Behavioral Health Organization Albany, NY April 27, 2011

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NYAPRS 7th Annual Executive Seminar on Systems Transformation

Integration Strategies for Behavioral Health:Managing Care, Outcomes, and CostsWhile Preserving our Recovery Vision

Turning Health Homes Into Recovery Homes

James Schuster, MD, MBAChief Medical Officer

Community Care Behavioral Health OrganizationAlbany, NY

April 27, 2011

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About Community Care

• Behavioral health managed care company founded in 1996; part of the University of Pittsburgh Medical Center

• Federally tax exempt non-profit 501(c)(3).

• Major focus is publicly-funded behavioral health care services; currently doing business in PA and NY.

• Licensed as a Risk-Assuming PPO in PA; NCQA Accredited Quality and Disease Management Programs.

• Serving over 1.3 million individuals in 36 Pennsylvania counties through a statewide network of over 1,800 providers.

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Erie

Crawford

Mercer

Lawrence

Beaver

Washington

GreeneFayette

Allegheny

Westmoreland

Butler

Armstrong

Venango

Indiana

Cambria

SomersetBedford

Blair

Clinton

Fulton Franklin

Cumberland

Perry

Lycoming

Dauphin

Lancaster Chester

Lebanon

Pike

Monroe

Carbon

Lehigh

Northampton

Bucks

Montgomery

DelawarePhiladelphia

Community Care Counties

Clarion

Forest

Warren McKean Potter

CameronElk

Jefferson

ClearfieldCentre

Huntingdon

MifflinSnyder

Union

Tioga Bradford

Columbia

Montour

Northum- berland

Schuylkill

Wayne

Juniata

Sullivan

Clarion

Forest

Warren McKean Potter

CameronElk

Jefferson

Clearfield Centre

Huntingdon

MifflinSnyder

Union

Tioga Bradford

Columbia

Montour

Northum- berland

Schuylkill

Wayne

Juniata

Sullivan

Allegheny

Luzerne

Wyoming

Susquehanna

Lackawanna

Adams York

Berks

Adams York

Berks

Chester

Luzerne

Wyoming

Susquehanna

Lackawanna

Pike

Monroe

Carbon

Adams York

Berks

Chester

Community Care OfficeCommunity Care Contract

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Recovery Initiatives

• Multi-year plan to change the clinical approach and culture of clinical systems

• Annual Recovery Institute for consumers and providers.

• Shared decision-making focus.• Learning Collaborative model. • Steps of Hope: Focus on wellness.• Statewide Member Advisory Board.

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Models for IntegratingPhysical and Behavioral Health

• Co-location of physical health and behavioral health providers.

• Integrated system.• Coordination among disparate providers.

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Connected Care™

• Initiative to improve the connection and coordination of care for those with Serious Mental Illness among health plans, PCPs, and behavioral health providers in outpatient, inpatient, and ED care settings.

• Based on Patient Centered Medical Home model with integrated care team and care plan to address all medical, behavioral, and social needs.

• Partnership between:– Center for Health Care Strategies (CHCS)– Department of Public Welfare (DPW) – UPMC for You– Community Care Behavioral Health – Allegheny County Department

of Human Services

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Connected Care™

• Data sharing: care plan viewable by staff from both health plans.

• Team meetings for integrated care.

• Resulted in reduced medical and BH admissions and reduced use of ER.

• Improvement opportunities include more structured provider health home and more consistent function of health navigators.

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Toward Integrated/Well-Coordinated Care: Next Steps

• Expand Steps of Hope to include smoking cessation and weight management.

• Train peers and case managers to support members as “system navigators.”

• Build health homes for consumers with serious mental illness or substance dependency that can functionally integrate care.

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Recovery Homes Basedin Behavioral Health Agencies

• Provide a person-centered system of care.• Develop a “virtual team” for each individual.• Enhance physical health competencies in the

behavioral health team.• Develop person-centered plans with individuals.• Coordinate physical, behavioral, and supportive

services.• Manage integrated reporting.• Integrate health focused activities into existing

recovery initiatives to create true health homes.

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Like Politics, “All Health Care is Local”

The challenge:

Create local and regional models of Physical Health/Behavioral Health recovery homes.

Participants include:• Counties/local governments.• Behavioral health and physical

health provider systems.• Consumers.• Advocacy organizations.• Behavioral health managed

care/payers.• Physical health managed

care/providers.• Content experts.

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Contact Information

James Schuster, MD, MBAChief Medical Officer

Community Care Behavioral Health OrganizationOne Chatham Center, Suite 700

112 Washington PlacePittsburgh, PA 15219

412-454-2120; [email protected]