maricopa county integrated rbha overview · health and wellness for all arizonans azdhs.gov...

Health and Wellness for all Arizonans azdhs.gov

Maricopa County Integrated RBHA Overview

March 2013

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Successful Offeror Facts • Offeror will utilize the majority of the existing provider network • By October 1st bidder would have eight (8) SMI clinics that offer integrated

care – (4 are currently used as co-location sites in the existing contract) • SMI clinics offering integrated services will be increased to 20 sites over

the course of the contract • Management Team (CEO, CMO, CFO, COO) all come from behavioral health • Mercy Care Experience Serving Populations with Complex Care Needs

– 2400 SMI in the ALTCS program – (Fully integrated BH services) – 6200 SMI in the Acute program – 9300 in the DDD program

• Have held community outreach and development planning with 51 different stakeholders including providers, peer runs and community organizations

• Have shaped a Community Proposal versus a single organization approach

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What Would the Offeror Bring?

Recognition of what needs to improve the system – • Utilizes the existing network and enhances access to care • Member and family focused • Recovery and resiliency throughout the system • Already serving nearly half of the SMI population in acute plans • Extensive experience serving individuals with very complicated

care needs (Operate integrated BH models in Illinois, Florida, Delaware, Missouri, Texas)

• Two years of outreach to the community stakeholders with identified opportunities

• Builds on the existing crisis system and enhances through specialty crisis and ACT teams Crisis ACT

Children & Youth Homeless ACT School Based Forensic ACT DDD Peer Support ACT

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Offeror Response to Stakeholder Meetings

Feedback Summary “The meetings described above have produced a wealth of information about what works in the current system and what could use improvement. We left our sessions with two major realizations: (1) There are many people and providers working in the RBHA system who

care and seek to serve people in need and use resources well; and (2) Many of the issues they have encountered in trying to fulfill their

missions will be greatly helped by integrating the acute, behavioral and Medicare programs, if the integration is done well”.

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To address the concern that physical health practice will overwhelm and/or dominate BH practice.

“Maintaining access to a robust array of services and providers of behavioral health specialty care, while assuming responsibility for integrating these services within physical health care, is just one of many strategies in maintaining a focus on the behavioral health needs of Maricopa County residents. While this will be a major focus of RBHA integration efforts, assisting adults with SMI in accessing needed preventative and specialty physical health care should not disrupt the active and often successful treatment of the co-occurring behavioral health disorders. While the location and focus of care may be expanding for some individuals, access to needed behavioral health services will remain. For some this can occur within a single setting, for others it will require an expanded treatment team. As treatment teams expand, Care Coordinators and Case Managers will be responsible for making sure Individualized Care Plans are addressing the whole health needs of members”.

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How the System Operates Today - Most

• Member visits provider for immediate issue • Immediate issue treated • Limited delivery of other services • Member leaves • Member may or may not access care for secondary

issues • The RBHA may not know about any of the service • May be up to three different payor sources • Potential for bad outcomes even if the member

does everything right • Medication interactions; family is left trying to navigate multiple

issues; patient accesses higher levels of care for preventable issues; unnecessary funds are expended

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How the System Operates Today - Some

• Same as most experience except— • Four clinics with co-location partnership • Co-location is better but still does not meet the needs of the

whole person • Still limited sharing of information on diagnosis and

treatment • Members are limited on accessing these providers due to

proximity and transportation • Still have multiple streams of funding not communicating on

outcomes • Families may be left coordinating care and communication

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How the System Would Operate With Successful Offeror

• Member accesses the system for care • Seen by provider for presenting issue • Provider considers full treatment history

-Behavioral, Physical, Medication, Case Management • Member/family discuss whole health issue, receive treatment and

develop treatment plan adjustments in one step • Improve BH outcomes by welcoming person for whatever reason • Reduce morbidity by treating preventable illnesses and supporting

recovery with a whole person approach • Wherever you go Care Coordination will be there • RBHA involved in care coordination throughout entire experience

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Successful Offeror Integrated Care Approach • Member Centered • Family Support • Coordination of Care • Accountability • Whole health service delivery

1. East Valley 4330 E. University Dr. Mesa 2. Hampton 1440 S. Country Club Dr., Mesa 3. Centro Esperanza 310 S. Extension Mesa 4. San Tan 1465 W. Chandler Blvd., Chandler 5. Enclave 1642 S. Priest Dr., Tempe 6. Arcadia 3311 N. 44th St., Phoenix 7. Communidad 1035 E. Jefferson St., Phoenix 8. South Central 1616 E. Roeser Rd., Phoenix 9. Highland 4707 N. 12th St. Phoenix 10. Midtown 3333 N. 7th Ave. Phoenix 11. Capitol Center 1540 W. Van Buren St. Phoenix 12. Saguaro 3227 E. Bell Rd., Phoenix 13. Townley 8836 N. 23rd Ave., Phoenix 14. Osborn 3640 W. Osborn Rd., Phoenix 15. West McDowell 5030 W. McDowell Rd., Phoenix 16. Metro Center 10240 N. 31st Ave., Phoenix 17. Bethany Village 4210 W. Bethany Home Rd. Glendale 18. Garden Lakes 4170 N. 108th Ave. Phoenix 19. West Valley 11361 N. 99th Ave., Peoria 20. Hassayampa Campus 811 N. Tegner, Wickenburg

Note: Sites 5, 7, 8 & 16 are existing SMI co-located clinics Sites 2, 10, 11 & 14 are anticipated opening by 10-01-13 Choices (5,6,8,10,13,15); People of Color (3,7,11) Partners in Recovery (1,16,19,20); Southwest Network (2,4,9,12,14,17,18)

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System Entry Points – Successful Offeror

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So what is Care Coordination?

Community based system wrapped around members and families Single accountable entity

Care management function ensures accountability, transparency, seamless service delivery, minimizes possible gaps in care

Care manager (administrative level) Big picture trends; systemic issues; real time Exp. - Notices member went to ED over 5 times…identifies possible issues… communicates issue and opportunity to treatment team through Care Coordinator

Care coordinator (team focus) Treatment team management; views the whole person; bridges communication gaps; develops team approach to problem resolution

Case manager (member and family single point contact) High touch with member and family Carries out the plan at the service level

Peer navigator (member educator/advocate) Helps members and families understand and communicate throughout the process

Member Engaged with the team to utilize strengths in plan development

Health Record Wrapped around the member at all points of contact to facilitate coordinated care

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Members and Families First

“Our Care Management approach will weave together physical, behavioral health, and psychosocial support needs in a holistic manner. • Taking a holistic person-centered focus: We will focus on members’ life

goals, not their diagnoses, while incorporating their strengths, preferences and needs in a culturally and linguistically appropriate manner.

• Maintaining and supporting the current behavioral health system and adding supports that strengthen it:” – Mercy Maricopa Integrated Care

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Member Transition

Members

•Over 40% SMI currently receive services with successful bidder •Have up to ninety days after contract start day to select a PCP •Option to use single case agreement if member chooses to keep current PCP • Successful bidder already has letter of agreements with behavioral health providers

ADHS Transition Plan & Coordination

•ADHS, Successful Bidder & Magellan work together to ensure seamless transition •ADHS coordinates activities with AHCCCS & Health Plans to ensure continuity of care during

transition •Community Engagement Team is ready as of March 6, 2013 •Member Transition activities required to start 10 days post contract award

ADHS Monitoring

•ADHS Comprehensive Member Transition Plan is in place •Member Transition Team has been identified •Real-time data monitoring tools and strategies have been developed •Community Engagement Team members have been trained •ADHS will use enterprise system to work interactively with Magellan, AHCCCS, Health Plans and

Successful bidder during member transition period

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Successful Offeror Summary

• Supports the whole person vision for behavioral health services – Reduces stigma – Delivers services where the person wants – Supports families – Closes gaps in care – Improves quality of life

• Have experience in delivering high quality service in behavioral health

• Utilizes the existing provider network and grows • Provides full coordination of care • Member and family focused

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Recovery through Whole Health: the Administrative Level

ADHS/DBHS

Maricopa County RBHA

Medicaid Funds Federal Grant Funds State General Funds Other Funds (e.g. County, City funds)

Behavioral health network Physical health network

From AHCCCS From Maricopa County , City of Phoenix, Dept of Housing

From HHS From OSPB, Legislature

One contract = one accountable entity for TXIX SMI members; Responsible for whole health outcomes and for the whole person’s healthcare needs

Medicare Funds

From CMS since RBHA will be Medicare Special Needs Plan

Serves TXIX and non-TXIX adults with SMI, adults without SMI, and children/adolescents; Also provides crisis services to anyone in need

Serves TXIX adults with SMI only

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Primary Care

Peer Support Employment Support

Housing Support

Behavioral Health

Recovery through Whole Health: the service provider level

Specialty Care

Multidisciplinary team

•Use of evidenced based practices • Routine screening, prevention, whole health, wellness AND RECOVERY focus

• Care management, chronic disease management AND RECOVERY programs • Shared medical records

Community & Social Support

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Anticipated Benefits

• Lengthen the lifespan and improve healthcare outcomes – Overcome disparities through integrated care

• Strengthen the focus on screening, prevention, early intervention, care management, patient education, wellness, AND RECOVERY FROM MENTAL ILLNESS AND SUBSTANCE ABUSE

• Control costs – 60% of Medicaid’s highest cost beneficiaries with

disabilities have co-occurring physical and behavioral health conditions

– Current healthcare system is unsustainable

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