recovery services in the era of health care reform: federal and state perspectives

Recovery Services in the Era of Health Care Reform:

Federal and State Perspectives

Susan Brandau, Director, Bureau of Recovery

SusanBrandau@oasas.ny.gov

“Behavioral Health”: SAMHSA• State of mental/emotional being and/or choices and actions

that affect wellness;• Includes substance use, misuse, abuse, addiction; SPD;

suicide, mental and substance use disorders;• Range of problems- unhealthy stress to diagnosable, chronic

diseases (treatable and recovery-oriented)• Systems: emotional health promotion; prevention, treatment

and recovery support

The Patient Protection & Affordable Care Act: Four Interlocking Strategies

• Insurance Reform (parity)• Coverage Expansion (30 million; 1

million in NY)• Delivery System Redesign• Payment Reform (P4P; Value-based

purchasing; episodes of care)

PCMHs; HHs; ACOsWhat Are They?

• The Triple Aim: Better Health; Better Quality; Reduced Costs

• Movement from a specialty-driven, FFS, volume-driven system to a primary care, managed system

• Reconnect the mind and the body• Improve the overall health of the nation; the

effectiveness of the care delivered; at reduced cost (right service at the right time at the right price)

Patient-Centered Medical Home The center of the health care delivery system reform:• Integrates pts. as active participants• Personal physician team leader (not the MD’s team– the patient’s

team)– Coordinates all aspects of preventive, acute and chronic care

• Whole person-oriented care– Pt. satisfaction & experience of care– Quality of care/metrics

• Payment reform (incentivizing PCPs)• Integrated Clinical Information Systems (HIT)• https://inetshop01.pub.ncqa.org/publications/product.asp?dept_id=

2&pf_id=30004-301-11.

Health Homes• Target: one chronic health condition and at least at risk for

another (SMI exception)• A longitudinal home; inter-disciplinary array of medical,

behavioral health care and community-based social services• 90% FMAP for HH services for two years • 12 states approved SPAs by CMS

– 5 states include SMI eligibility– 3 states include SUD eligibility (plus one other chronic condition;

NY; OR;MO)• http://www.health.ny.gov/health_care/medicaid/program/

medicaid_health_homes/meetings_webinars.htm

HH ServicesNetworks provide:• Comprehensive care management• Coordination and Health Promotion• Transitional Care• Referral to social services and

community supports• Use of HIT

Health and Recovery Plans (HARPs)

• Premiums include all MA State Plan services.• Specialized, integrated MC product for individuals

with significant BH needs– Enhanced benefit package of medical, behavioral and

social benefits– Enhanced access and care coordination standards

• RFI—October/November; Final RFQ– Feb. 2014; NYC HARP—Jan. 2015; ROS HARP– July 2015

• Statewide 140,000 HARP eligible; ~37,000 SUD• Eligibility initially based on UR

Behavioral Health Organizations (BHOs) in New York

• 2011: Introduced managed care operations to MA FFS IP settings (but eventually all BH care settings)

• Originally: no UR; no pre-admission review– Discharge planning; concurrent review;

provider profiling• 2014: risk-bearing for all BH services

1915(i) Like Services• Part of the 1115 SPA– final submission to CMS in December• Rehabilitation & Habilitation• Crisis Intervention• Educational Support• Support Services

– CM; Fam Support.; Training for Unpaid Caregivers; Non-Medical Transportation

• Employment Services• Peer Support • Self-Directed Services• Eligibility based on Functional Needs Assessment

1915(i) Like Peer Services (perhaps)

MH SUD• Administered by

trained individual• Personal experience of

a MH dx.• Assist in the recovery

process• Psychosocial clubs• For individuals

engaged or not engaged in treatment?

• Administered by a trained (certified?) individual

• personal experience of SUD dx.

• Recovery coaches?• Recovery center

settings?• For individuals not

engaged in treatment

Peer Services (APGs)• Face- to- face service provided by a peer

advocate to an active patient of an outpatient clinic. Peer support services are clinic-based services for the purpose of connecting patients to community based recovery supports consistent with the treatment / recovery plan.

• Under rehab option, peer services can be delivered off-site for those in treatment.

What Does It All Mean For BH Providers?• Threats and Opportunities

– PCMH Opportunity: Outstationing a BH specialist for SBI; the RT function– New business lines

• Care management/case management• Behavioral interventions: adherence• SBIRT • Integrated BH and PC services• Peer-based Services• MAT

• Clinical & Fiscal Accountability– Performance on Medical as well as Behavioral Metrics– Supervision– EBPs– Risk Sharing?

• Mergers and Consolidations• Digital World

– HIT Infrastructure

ATR as a Prototype for Recovery Support Services

• Four year, $13 million CSAT grant• Brooklyn, Rochester, Delaware/Otsego• Co-location with RCCs• Recent expansion: Bronx, Queens,

Manhattan• 7,000 participants served to date• Monthly recovery care mgt + access to

recovery supports

Bringing Recovery Supports to Scale (BRSS) Policy Academy

• OASAS, OMH, DOH, Peers, MH & SUD Providers, Managed Care , Housing Providers

• Focus: Peer Integration• Four Community Forums• Peer Leadership Training• Mini-grants: Community and

Provider

Peer Certification• Florida Certification Board• ASAP + FOR-NY• Role Delineation Study-Core

Competencies and Skills• January, 2014• Deeming of Recovery Coaches

Peer Integration• Building capacity now to integrate

peers• Fixsen’s Implementation Stages:

Exploration Activities• Engagement and Retention

Challenges• Culture Changes• Job Descriptions and Pay Scales• Supervision & Monitoring• Value of Alumni Associations

Client/Participant Surveys• Essential Component of Health

Reform • How do we know those we serve are

getting what they want and need?• Routine surveys-perception of care

linked to CQI• https://www.oasas.ny.gov/poc/index.c

fm

OASAS’ Adaptation of theSAHMSA-sponsored Modular Survey

5 Domains : Rating ScalesA. Access and Quality (7 items)B. Perceived Outcome (6 items)C. Social Connectedness (7 items)D. Readiness for Change (2 items)E. Program Recommendation (2 items)

Open-ended Items (write-ins)What is the program doing right?What can be done to improve the program?Is there anything that annoys you?

Content of Survey (Continued)

Best PracticesPatient / Client RightsNicotine Replacement TherapyMedication Supported RecoveryOther ItemsTime in Program (months)Age, Gender, Ethnicity / RacePresenting Problem (SA, MH, or both)Prior TreatmentCriminal Justice MandateEmployment / School Enrollment Status

A: Access and Quality1. When I needed services right away, I was able to see

someone as soon as I wanted.2. This program helped me develop a plan for when I feel

stressed, anxious or unsafe3. The people I went to for services spent enough time with me.4. I helped to develop my service/treatment goals.5. The people I went to for services were sensitive to my

cultural background (race, religion, language, sexual orientation).

6. I was given information about different services that were available to me.

7. I was given enough information to effectively handle my problems.

As a result of the services (treatment) I have received ...

8. I am less bothered by my symptoms9. I am better able to cope when things go wrong.10. I am better able to accomplish the things I want to

do.11. I am not likely to use alcohol and/or other drugs.12. I am doing better at work/school. (If this does not

apply to you, please leave it blank.)13. I get along with my teachers/boss. (If this does not

apply to you, please leave it blank.)

B: Perceived Outcome

C: Social Connectedness14. There is someone who cares about whether I am

doing better.15. I have someone who will help when I have a problem.16. I have people in my life who are a positive influence.17. The people I care about are supportive of my

recovery.18. People count on me to help them when they have a

problem.19. I have friends who are clean and sober.20. I have someone who will listen to me when I need to

talk.

21. Using alcohol and/or drugs is a problem for me.

22. I need to work on my problems with alcohol and/or drugs.

D: Readiness for Change

E: Program Recommendation (Satisfaction)

23. I would return to this program if I need help in the future

24. I would recommend this program to a friend or family member.

Survey Reports• The Survey System will compile a report based on the most

current data; and includes the date on which the report was generated

• Reports can be generated at any time during or after data collection– It is important to assure that interim reports do not get confused

with reports after data collection is complete.• The report provides tabulations and graphics for each survey

item• Refer to the PoC User Guide section “Interpreting Reports” for

examples of reports and tabulations•  

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Interpreting Reports

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Interpreting Reports

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Acknowledgement• Frank McCorry-graciously allowed

some of his slides to be shared-thank you Frank!