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Health Homes: What Are They and What Might They Look Like NYAPRS 29 th Annual Conference September 14, 2011 Adele Gregory Gorges Executive Director, New York Care Coordination Program, Inc. Slide 2 New York Care Coordination Program 2 Multi-county, multi- stakeholder collaborative to improve outcomes for those with serious behavioral health issues formed in 2000 six western and central counties with support from NYS OMH Operational in mid-2002 project management through Coordinated Care Services, Inc. (CCSI). Partnership with Beacon Health Strategies, LLC in 2009 for managed care. Expanded in 2010 to include Westchester County 2011 Conditional Award for Managed Behavioral Health Organization procurement for Western Region NYCCP partnering with Beacon Health Strategies and CCSI Slide 3 NYCCP Strategic Plan for System Transformation 3 Structures Participatory process for governance Data access, analysis and reporting capacity Platform for disseminating best practices Initiatives Culture change to a person-centered, recovery-focused system of care Care coordination Peers services Physical health integration Finance reform Pay for performance Managed behavioral health Conserve dollars for behavioral health, use dollars flexibly, access and use information Slide 4 Timelines for System Transformation 4 Phase 1: 2002 - Laying the foundation for transformation Collaborative processes, care coordination, person-centered practices, recovery focus, peer services, physical health awareness, data driven Phase 2: 2009 - Partnership with Beacon Health Strategies, LLC Managed care readiness Complex Care Management Phase 3: 2011 - RBHOs and Health Homes Western Region Behavioral Health Organization Health Home Application to be submitted Slide 5 What have we learned that should inform what Health Homes look like? 5 Listen to the customer Slide 6 6 Guiding Principles for Person-Centered, Recovery- Focused Services, developed by the Peer and Family Advisory Group of the WNYCCP in 2007 The goal is recovery, not just stabilization and maintenance. Hope is necessary and recovery is possible for everyone. Every individual is unique; every recovery different. People have prompt access to compassionate care and services. The system is flexible, wherever possible, to support the persons recovery. Every plan for recovery is centered on the persons goals, strengths, and preferences -- not the availability of a particular program or service. Slide 7 7 Guiding Principles for Person-Centered, Recovery-Focused Services (continued) Natural supports, outside the mental health system, are explored and encouraged. Family support is valued and included when appropriate. There is a partnership between individuals and their treatment team, care coordinators, service providers, and their peers and family members, when appropriate. Individuals are educated to make informed choices about their health care and recovery. Peers (people in recovery) are included and involved at all levels in the organization. Everyone is treated with dignity and respect; differences in culture, belief, or language are valued. Slide 8 What have we learned that should inform what Health Homes look like? 8 Listen to the customer Person centered, recovery focused care coordination produces better outcomes for individuals, and lower costs for payers Slide 9 Person-Centered, Recovery-Focused Care Coordination adds value 9 Better quality 46% decrease in emergency room visits per enrollee* 53% reduction in days spent in a hospital* 78% of enrollees report dealing more effectively with problems (2009 Enrollee Survey) Better outcomes 31% increase in gainful activity* 54% decrease in self harm among enrollees* 53% reduction in harm to others* Lower costs 2008 Medicaid mental health costs for Care Coordination populations in NYCCP vs. comparison counties: (OMH August 2010) 92% lower for inpatient services 42% lower for outpatient services 13% lower for community support, physical health savings would be additional $5,541 lower average cost per person * 2009 Periodic Reporting Form Analysis Slide 10 Outcomes Westchester County Care Coordination Program 10 Slide 11 What have we learned that should inform what Health Homes look like? 11 Listen to the customer Person centered, recovery focused care coordination produces better outcomes for individuals, and lower costs for payers Getting those outcomes requires new knowledge, new skills, a new culture and that is hard work Slide 12 12 It took a massive effort to develop the new knowledge, new skills and the new culture needed for person-centered, recovery-focused care coordination Changing the system to meet the needs of individuals rather than expecting individuals to fit into existing systems It will take an equally massive effort to move to from Targeted Case Management to Health Home Care Coordination Slide 13 Starting in 2003 and continuing.. 13 Education and training Onsite mentoring Online practice recoveryskillbuilder. com Webinars Focused modules MonitoringFeedback Incentives P4P Slide 14 What have we learned that should inform what Health Homes look like? 14 Listen to the customer Person centered, recovery focused care coordination produces better outcomes for individuals, and lower costs for payers Getting those outcomes requires new knowledge, new skills, a new culture and that is hard work The Targeted Case Management work force is well positioned to make a successful transition to Health Home Care Coordination Slide 15 Pilot with Monroe Plan for Medical Care 15 Teamed Community Based Intensive Case Managers with Office Based Managed Care Plan Case Managers What we learned The collaboration was effective in finding and serving individuals with serious mental health concerns and serious medical conditions The cultures of behavioral health providers and physical health providers are VERY DIFFERENT - we need to learn to speak each others language Slide 16 NYCCP/Beacon Model for Complex Care Management 16 Teams provider-based Targeted Case Manager with MBHO based Complex Care Managers Intensive, flexible/episodic, focusing on physical and behavioral health care for individuals with highest needs -- serious mental illness, complex medical needs, top 10% in total costs. Achieved average length of stay of 6 months at the intensive level. Slide 17 Characteristics of NYCCP/Beacon CCM 17 Grounded in supporting individuals to attain recovery goals related to life objectives living, working, socializing. Empowers individuals through development of skills for self- management of physical and behavioral health symptoms Supports individuals in building an integrated, coordinated team of providers of choice Enhances the use of Peer Support services and other natural supports in the community. As generally available in the community, but also purchased using wrap around dollars if necessary for program enrollees. (e.g. Compeer Peer Wellness Coaches for the Well Balanced Program) Slide 18 NYCCP/Beacon Complex Care Management can be an effective core for Health Homes 18 Focuses HR/HN populations and episodes of care Based on transition from Targeted Case Management to a practice equivalent to that of a Health Home Care Coordinator Maximizes resources through shorter lengths of stay in higher levels of care coordination and effective linkage with providers of choice Effective linkage to a provider of choice for a health home can lead to enhanced self management skills, timely health promotion and prevention services, early intervention, and mind-body health Melds Person-Centered Practice as an underpinning for the initiative AND a managed care focus on an episode of care and movement to recovery. Slide 19 What have we learned that should inform what Health Homes look like? 19 Listen to the customer Person centered, recovery focused care coordination produces better outcomes for individuals, and lower costs for payers Getting those outcomes requires new knowledge, new skills, a new culture and that is hard work The Targeted Case Management work force is well positioned to make a successful transition to Health Home Care Coordination Peer services will be a key to success for Health Homes Slide 20 20 Peer services will be a key to success for Health Homes Experience of the NYCCP/Beacon Complex Care Management Model Critical resource within this model Referral to peer services developed from 2002 to the present NYAPRS Peer Bridger Model NYAPRS collaboration with Optum for CIDP Slide 21 What have we learned that should inform what Health Homes look like? 21 Listen to the customer Person centered, recovery focused care coordination produces better outcomes for individuals, and lower costs for payers Getting those outcomes requires new knowledge, new skills, a new culture and that is hard work The Targeted Case Management work force is well positioned to make a successful transition to Health Home Care Coordination Peer services will be a key to success for Health Homes The Behavioral Health treatment providers are well positioned to be a part of an integrated behavioral/physical health service system Slide 22 Options for Behavioral Health Provider participation in Health Homes 22 Partner with Primary Care Based Health Home providers Contracted specialty provider for Individuals with chronic serious mental illness who choose a primary care based health home provider Individuals with serious chemical dependency and co- occurring chronic medical issues who choose a primary care based health home provider Contracted basic level services provider for behavioral health for individuals who qualify for Health Home by virtue of multiple chronic medical and/or chemical dependency issues and have chosen a primary care based health home provider Provide Specialty Behavioral Health Home service Slide 23 Target Populations for Specialty Behavioral Health Homes 23 Adults with Serious Mental Illness Adults with Serious Chemical Dependency + Co-Occurring Chronic Physical Illness Deferred Children with Serious Chemical Dependency + Co- Occurring Chronic Physical Illness Children with Serious Emotional Disturbance Slide 24 Model for Specialty Behavioral Health Home Team Composition 24 Core Team Individual and family as appropriate Mental Health or Chemical Dependency Primary Therapist (PT) Nurse Practitioner or Primary Care Physician onsite at Behavioral Health Home Provider Care Coordinator - with appropriate qualifications and training for integrated, person-centered work and a team reflecting the need for peer experience and cultural and linguistic competency Plus Psychiatrist Primary Care Physician or Nurse Practitioner Other specialty providers as appropriate Plus Consulting Members of Team Pharmacist Managed Care Plan Case Manager Slide 25 What have we learned that should inform what Health Homes look like? 25 Listen to the customer Person centered, recovery focused care coordination produces better outcomes for individuals, and lower costs for payers Getting those outcomes requires new knowledge, new skills, a new culture and that is hard work The Targeted Case Management work force is well positioned to make a successful transition to Health Home Care Coordination The Behavioral Health treatment providers are well positioned to be a part of an integrated behavioral/physical health service system Peer services will be a key to success for Health Homes BHOs can add value to Health Home development Slide 26 26 Interface of BHO and Health Homes BHO will facilitate transitions from Inpatient to Health Home BHO will provide data that can be used for practice improvement BHO will provide forum for stakeholder participation and operations Slide 27 For more information 27 Adele Gregory Gorges Executive Director, New York Care Coordination Program, Inc. C/O Coordinated Care Services, Inc. 1099 Jay Street, Building J, Rochester, NY 14611 585-613-7656 agorges@ccsi.org www.carecoordination.org