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