Provider-Sponsored Networks

“Building Partnerships”

Presented by…

Linda McKinnon, Chief Executive Officer, Central Florida Behavioral Health NetworkBob Holm, Regional Substance Abuse Director, Suncoast Region DCFRichard Brown, Chief Operating Officer, The Agency for Community Treatment ServicesNancy Hamilton, Chief Executive Officer, Operation PAR

Central Florida Behavioral Health Network is a not-for-profit organization of community providers incorporated to ensure and enhance an array of behavioral health and other human services needs for the citizens of our communities.

CFBHN Mission

CFBHN History

Linda McKinnon

Chief Executive Officer

Central Florida Behavioral Health Network

CFBHN History“Not an overnight sensation!”1995 No collaboration among providers or between disciplines

1996 Collaboration among mental health providers in Hillsborough and

Manatee counties related to pre-paid Medicaid pilot

1997 Collaboration between ADM and substance abuse providers in

Hillsborough and Manatee counties to create CFBHN No collaboration between mental health and substance abuse

providers DCF contracts with CFBHN to manage funds targeted at SSD and

SSI dis-enrolled and intervention services

CFBHN History1998 Hillsborough County mental health providers join collaboration as

vendors DCF contracts with CFBHN for TANF-funded services and children’s

substance abuse services CFBHN assumes additional administrative responsibilities for

outcomes and quality oversight for contracted services

1999 CFBHN joins Florida Behavioral Health Hillsborough County Workforce Board contracts with CFBHN to

implement a three-year grant for supportive employment services targeted to the most difficult to employ TANF recipients

CFBHN History2000 DCF regionalization pilot DCF expands contracts with CFBHN to include substance abuse

services for heroin and cocaine abusers and family intervention services

DCF contracts with CFBHN to provide services in collaboration with Hillsborough County children’s system of care development grant

Sarasota County substance abuse provider and Hillsborough/ Manatee Public schools join collaborative as vendors

2001 G. Pierce Wood Hospital closes Substance abuse and mental health providers in Hillsborough

County collaborate to address needs of substance abusing persons with serious mental illness

CFBHN History

2002 CFBHN Board membership expanded to include 19 substance

abuse and mental health non-profit providers in 9 counties comprised of Suncoast Region and District 14

Family intervention services expanded to Pinellas, Pasco and Sarasota counties

CFBHN contracts to operationalize COSIG Grant in Hillsborough County

TANF-funded services expanded to Pasco County CFBHN contracts to provide substance abuse aftercare services in

Suncoast Region

CFBHN History2003 CFBHN contracts for TANF-funded services throughout Suncoast

Region and District 14 (Polk, Highlands and Hardee counties) DCF contracts with CFBHN to provide TANF oversight functions in

Suncoast Region and District 14 Family intervention services expanded to District 14 SAMH Program Office contracts with CFBHN to provide services

targeted to persons with co-occurring disorders and operationalize COSIG Grant in Hillsborough County

CBC contracts with CFBHN to provide children’s mental health services in Hillsborough, Manatee and Sarasota counties

CFBHN awarded ASO development pilot for District 8 (Charlotte, Lee, Collier, Hendry and Glades counties)

CFBHN History

2004 DCF Suncoast Region contracts with CFBHN to provide substance

abuse prevention for adults DCF District 14 contracts with CFBHN to develop service strategies

for persons with co-occurring disorders CFBHN identified to operationalize Robert Wood Johnson

Resources for Recovery Grant throughout Suncoast Region CFBHN operationalizes substance abuse elder care pilot CFBHN implements diversion services for CBC District 8 DCF initiates start up contract for SB1258 ASO pilot

CFBHN History

Current FY2004-2005 Contract DCF Suncoast contracts with CFBHN to manage all substance

abuse treatment services and funding

DCF initiates single contract with CFBHN for contract administration, management and oversight functions for substance abuse treatment throughout Suncoast Region

The Purchaser’s Role

Bob Holm

Regional Substance Abuse Director

Suncoast Region DCF

DCF’s StrategyWhat the Purchaser Wants

Evaluate, integrate and re-engineer system of care into a seamless and easily navigated system

Ability to achieve uniform clinical policies and best practice throughout Network

Uniform data collection used to drive quality improvement initiatives

Resource maximization and cost effectiveness Increased access to care Simplification and non-duplication of contracting and oversight

functions to allow for effective use of limited staff

The Purchaser’s RoleMoving the System Forward State and District SAMH plan development

Needs assessment Defining population eligibility Utilization standards Service allocation projection

Financing strategies ASO and service system design Contract development ASO contract performance and oversight Regulation and licensing Review and approval of quality and systems improvement initiatives and

plans Technical assistance to managing entity Review and approval of contracts with network providers

Reengineering Substance Abuse TreatmentRWJ Resources for Recovery Grant

Suncoast Region and CFBHN named as a pilot in Grant

Medicaid Maximization: Contract requires 10% increase in Medicaid revenues earned for substance abuse treatment throughout CFBHN providers

Testing of Flexible Payment Methodologies: Grant funds moved to CFBHN to allow greater flexibility for services to more adequately meet consumer needs and to test strategies for case rates and other prospective payment methodologies

Increased Access to Care: Contract requires reduction of wait lists for residential services and increased access to detoxification services

Contracting with Networks

Currently using a hybrid performance

contracting mechanism designed to increase and move towards flexibility and accountability.

Contract used to define ASO functions and Network requirements and is defined differently by local districts/region

Administrative Services Organization: “An independent operating entity organized for the purpose of managing and assessing a network of human service providers and provider agencies, to include but not limited to, quality improvement, clinical management, network management, data management, revenue maximization and integration of systems.” (As described in District 8 ASO contract)

Suncoast-Specific Terms

Managing Entity - An entity that manages the delivery of behavioral health services

Network Provider - An entity that contracts with the Managing Entity to provide services to clients that are funded through the contract with the department (subcontractor)

System of Care - Behavioral health services developed into an integrated network to provide services to substance abuse and mental health clients

Contract Requirements

The ASO… Is responsible for the administration and provision of

services

Must ensure that network providers will provide services as specified in the system of care plans identified for each county in the Network Operational Plan

Must ensure services described are provided throughout the contract period

Contract Requirements

The ASO… Must ensure that the number of persons served, as

required by contract, are served with outcomes

Must establish a client grievance procedure that assures that all grievances not resolved at the provider level are referred to the managing entity

Contract Requirements

The ASO is responsible for…

All mandated outcomes,electronic data submissions and performance improvement initiatives

Incident reporting

Assuring emergency preparedness ofits providers

Provider financial and audit requirements

Billing and invoice validation

ASO Contract ResponsibilitiesUnique to Suncoast Region

The ASO is responsible for… Management of wait lists for all substance abuse services Reduction of wait list for residential treatment services Evaluation of Region’s detoxification system Increase of Medicaid billing and reimbursement for

substance abuse treatment services by 10% Implementation of substance abuse services to the elder

care pilot Implementation of co-occurring service capability

throughout provider network

Lessons Learned from Purchaser Communication is Key!!

Need to clearly define what is being purchased Need to understand and articulate the role of the purchaser Requires partnership of all stakeholders Requires commitment of local SAMH Program Office and

state SAMH Program Office Requires transfer of administrative responsibilities, dollars

and staff Need to identify barriers and work toward resolving issues Requires ability to assess readiness of Network to assume

responsibilities

Building the NetworkGovernance Structure

Richard Brown

Chief Operating Officer

The Agency for Community Treatment Services

actsThe Agency for Community Treatment Services

CFBHNCFBHN

Suncoast & District XIV 9 counties 19 members (providers) 4 Regional Councils

District VIII 5 counties 8 members

5 providers 1 CBC 2 consumer representatives

Governance StructureGovernance Structure

All corporate generated documents need to reflect succinctly….

”who you are and what you are to do”

CFBHN DescriptorsCFBHN Descriptors

Not-for-profitProvider sponsored networkAdministrative Service OrganizationAspiring to become:

Single Managing Entity

Corporate DocumentsCorporate Documents

Articles of Incorporation Bylaws Business Plan Board Policies Member Agreements Vendor Agreements Etc.

Policy ContentPolicy Content

Reflect commitment to community driven, consumer centered care:Increased accessibilityContinuous care approachesIntegration with other systems

Scope of Fund AdministrationScope of Fund Administration

Select substance abuse funds All substance abuse funds Select substance abuse & select mental

health All substance abuse & select mental health All substance abuse & mental health Other (or) “Lines of Business”

Purchase RelationshipsPurchase Relationships

ADM Substance Abuse ADM Mental Health AHCA Community Care Provider(s) Local / Governmental Community Care Provider(s)

MembershipMembership

Most congruent structure for a Provider Sponsored Network

would reflect major providers of the anticipated

“Lines of Business”

Substance Abuse Mental Health Insurance

Single

Managing

Entity

Eligibility(Factors for Membership Decisions)Eligibility(Factors for Membership Decisions)

Accreditation Financial Buy-in to Membership Current Contractor for Anticipated

“Lines of Business” Medicaid Provider Demonstrated ethics & conformance with

requirements of Member / Vendor Agreements In good standing with current funders

Governance DecisionsGovernance Decisions

Financing ASO InfrastructureEarn & BuildStaffing Grants (OPS)FCO GrantsMembership Fee(s)Member / Vendor Dues

Governance DecisionsGovernance Decisions

Build & BuyClaims ManagementHuman Resources / PersonnelCall CenterInformation System & MIS ManagementAuditing / MonitoringEtc.

Governance DecisionsGovernance Decisions

Targeted Reserve Fund Development

A. Capital Equipment

B. Research & Development

C. Financial Security

D. Risk Management

E. Insurance Licensure

F. Innovations

Governance Sticking PointsGovernance Sticking Points Large vs. Small Agencies Mental Health vs. Substance Abuse Comprehensive Providers vs. Niche Providers Local vs. Remote Headquarters Inclusiveness: Members, Vendors, Purchasers,

Stakeholders & Consumers Right of First Refusal Market Share Protections

Sticking Points – cont.Sticking Points – cont.

Non-compete vs. Notification of Intentions

ASO vs. Provider Status

TOOLS Towards Focus of Effort & the Attainment of InclusivenessTOOLS Towards Focus of Effort & the Attainment of Inclusiveness

Business PlanningSystem of Care Planning

Ah Right…It’s time for extreme

makeover!!

“We will know that we have arrived when the ASO readily matches consumers benefit to provider payments & providers are free to focus on matching consumer needs to services consistent with their progress in recovery”

Building Administrative Capacity

Linda McKinnon

Chief Executive Officer

Central Florida Behavioral Health Network

Building Administrative CapacityThe Role of the ASO

Provider network development and management Planning Customer service Quality management Utilization management Information management Financial management Training and education; best practice development Systems integration Resource development

Current Organizational Structure Defined by Functional Roles

August 16, 2004Collaborating for Excellence in Behavioral Health Services

Linda McKinnonChief Executive Officer

Sue WebberDirectorFinance

TBHManager

Information Systems(On Hold)

Lisa MainFiscal Supervisor

Lisa ThomasFiscal Assistant

TBHIS Technician

(On Hold)

Ioan FernandezData Specialist

Yenny HernandezData Specialist

Mary HerkertDirector

Network Operations

Jan BurtonManagerContracts

TBHAccountant

Kathy WayManagerContracts

Laura GrossAdministrative

Assistant

Rebekah BicklingExecutive Assistant/Admin Supervisor/

HR Liaison

TBHAdmin Assistant

(On Hold)

Brandi MasonAdministrative

Assistant

Jimmie Adams Admin Assistant/

Receptionist

Paula Pressler-TashDirector

Quality Management/Utilization Management

Ibelice RiveraQuality Specialist

TBHQuality Specialist

TBHQuality Specialist

Laura CronkQuality Manager/

Data Operations Analyst

Marcia MonroeDirector

Provider Services

Kay DoughtyManager

Specialty Services

TBHManager

Adult Services

TBHManager

Children’s Services(On Hold)

Tampa Office

Current Organizational Structure Defined by Functional Roles

August 16, 2004

Collaborating for Excellence in Behavioral Health Services

Linda McKinnonChief Executive Officer

Nancy RossbackReceptionist/Admin Asst

Rick SanefskiQI Manager

Brian MogoskyDirector

Jennifer FormicaData Specialist

Susan LangConsumer Affairs

Manager

District 8 Office

Building Administrative CapacityQuality Management

Performance Improvement Program Evaluation – Specialized reports, outcomes

improvement, best practice identification, outlier review, customer satisfaction

Performance Compliance - Corporate service validation, regulatory compliance and oversight, clinical pathway compliance

Utilization Management - Clinical UM development and oversight

Outcome/Data Management - Data and outcome validation, tracking and reporting

Technical Assistance and Training Accreditation

Building Administrative CapacityProvider Services

Credentialing and profiling Clinical systems development Best practice implementation Technical assistance Product development Service development Provider information and orientation Management of training resources Consumer, stakeholder, purchaser and provider satisfaction Complaints and grievance

Building Administrative CapacityFinancial Management

Financial reporting and forecasting requires tracking, analysis and reporting of the following:

Rate Setting and development methodologies Provider allocations Cost accounting system Revenue maximization strategies/ internal resource management Funding utilization and cash flow analysis Agency reconciliation Accounts payable and receivable Budget development and management Insurance Board communication

Building Administrative CapacityAdministrative Services

Information systems and data management

Information system development and technical assistance

Management reporting support

Contract development, negotiation on and compliance

Revenue maximization

Provider resource management

Medicaid maximization

Grant development

Risk mangment

Facility management

Building Administrative Capacity IS Capabilities - Lessons Learned

Identify information system needs early on and be willing to invest in them!!

Requires identification of software functional needs for: - Network management functions - Claims processing functions - GL linkage and financial functions - Member services functions - Care access functions

- Care management and utilization management

Building Administrative Capacity Executive Services

Board development

Regional council development

Purchaser relations

Advocacy

Legal

Marketing

Human resources

Oversight of all Network and ASO operations

Building Administrative Capacity Lessons Learned Identify potential conflicts of interest (an ASO is not a

provider) Be prepared to perform once you have got what you asked

for – greater flexibility has its own set of requirements Don’t over-commit Be prepared to act on opportunism quickly Understand the implications on providers Develop a strong relationship with the Board This is a partnership with all stakeholders and requires open

communication and trust ASOs are not “one size fits all”

Nancy Hamilton

Chief Executive Officer

Operation PAR

Provider/Member’s ViewProvider/Member’s ViewTwo-Hatters in Provider Two-Hatters in Provider

Sponsored NetworksSponsored Networks

PAR

CFBHN

““We have met the enemy & he is us” We have met the enemy & he is us” PogoPogo

Keep this in Keep this in mindmind…..ALWAYS!!…..ALWAYS!!

Holy Cow…What will become of us…will we

survive???I’m so confused…what

to do…get on the bus…or find my self hitchhiking later??

Contracting thru The ASOContracting thru The ASOOpportunitiesOpportunities FlexibilityFlexibility Sharing expertiseSharing expertise SustainabilitySustainability Giving up control to gain Giving up control to gain

some control over the some control over the unpredictability of politicsunpredictability of politics

Respond to the needs of Respond to the needs of the communitythe community

Improve quality of servicesImprove quality of services

ChallengesChallenges Our invoices will now be Our invoices will now be

matched to the information in matched to the information in the data warehouse.  The the data warehouse.  The network is not going to hold network is not going to hold up invoices for the first up invoices for the first couple of months (good) but couple of months (good) but could be problematic in the could be problematic in the futurefuture

Investing in the network Investing in the network meant reduction in revenues meant reduction in revenues – invest today for potential – invest today for potential higher returns later – scary, higher returns later – scary, hard to explain to Board & hard to explain to Board & staffstaff

Testimony – the CFOTestimony – the CFO Renegotiating contract – reduced tedious Renegotiating contract – reduced tedious

financial reports required in the past. financial reports required in the past. At negotiation, all reimbursement rates were At negotiation, all reimbursement rates were

increased to the model rate, less the admin. increased to the model rate, less the admin. rate, which resulted in increased rates for rate, which resulted in increased rates for most of our services most of our services

Contract was restructured to allow us more Contract was restructured to allow us more flexibility to spend dollars among cost flexibility to spend dollars among cost centers.  Don’t have to go through contract centers.  Don’t have to go through contract amendments to move dollars around amendments to move dollars around

End of the year, the network was able to re-End of the year, the network was able to re-allocate funds due to lapse dollars.  Since allocate funds due to lapse dollars.  Since PAR was over-producing units in some of PAR was over-producing units in some of the cost centers, we were able to share in the cost centers, we were able to share in this reallocation – Next year who knowsthis reallocation – Next year who knows

ASO must have an excellent data system & provide ASO must have an excellent data system & provide “value “value added”added” or this is just an extra expense to providers/partners or this is just an extra expense to providers/partners within the ASO. I don’t think I can emphasize this enough. within the ASO. I don’t think I can emphasize this enough. The The data system MUST be easy to use & not place additional data system MUST be easy to use & not place additional demands on the providers; one thing providers do NOT need demands on the providers; one thing providers do NOT need is additional demands or requirements.is additional demands or requirements.

Offer an IS system for those smaller agencies & providers that Offer an IS system for those smaller agencies & providers that do not have any IS system at all. do not have any IS system at all. This could be just client This could be just client services & state reporting or it could be for other functions as services & state reporting or it could be for other functions as well like HR, etc.well like HR, etc.

IS should be involved strategically (like at CFBHN) & involved IS should be involved strategically (like at CFBHN) & involved in the process assuming there is the appropriate staff to do in the process assuming there is the appropriate staff to do so. so. This will produce better IS systems and processes & since This will produce better IS systems and processes & since ASOs move great amounts of data, it is so important that we ASOs move great amounts of data, it is so important that we have IS systems that minimize paper movement & increase have IS systems that minimize paper movement & increase automationautomation. .

Testimony – VP of ISTestimony – VP of IS

Re-engineering Re-engineering (infrastructure, conceptually, & philosophically)(infrastructure, conceptually, & philosophically)

BudgetingBudgeting Data ManagementData Management Q.I.Q.I. HR / CredentialingHR / Credentialing Billing / ReportingBilling / Reporting Business / Strategic PlanningBusiness / Strategic Planning System of Care PlanningSystem of Care Planning

ASO ExpectationASO Expectation

Reflect commitment to community Reflect commitment to community driven, consumer centered care:driven, consumer centered care: Increased accessibilityIncreased accessibility Continuous care approachesContinuous care approaches Integration with other systemsIntegration with other systems

ClinicalClinical Client Centered - Assessment & TreatmentClient Centered - Assessment & Treatment Consumer SatisfactionConsumer Satisfaction Matching & Prioritization Matching & Prioritization Waiting List Management Waiting List Management

Sticking PointsSticking PointsSticking PointsSticking Points

Large vs. Small AgenciesLarge vs. Small Agencies Mental Health vs. Substance AbuseMental Health vs. Substance Abuse Comprehensive Providers vs. Niche Comprehensive Providers vs. Niche

ProvidersProviders Local vs. Remote HeadquartersLocal vs. Remote Headquarters Inclusiveness: Members, Vendors, Inclusiveness: Members, Vendors,

Purchasers, Stakeholders & ConsumersPurchasers, Stakeholders & Consumers Right of First RefusalRight of First Refusal Market Share ProtectionsMarket Share Protections

EligibilityEligibility(Factors for Membership Decisions)(Factors for Membership Decisions)

AccreditationAccreditation Financial Buy-in to MembershipFinancial Buy-in to Membership Current Contractor for Anticipated Current Contractor for Anticipated

““Lines of Business”Lines of Business” Medicaid ProviderMedicaid Provider Demonstrated ethics & conformance with Demonstrated ethics & conformance with

requirements of Member / Vendor Agreementsrequirements of Member / Vendor Agreements In good standing with current fundersIn good standing with current funders

One Big Happy Family???One Big Happy Family???• Young & Old – Big & SmallYoung & Old – Big & Small

• Naive & JadedNaive & Jaded

• Quiet & NoisyQuiet & Noisy

• Unique PersonalitiesUnique Personalities

• Conflict / ResolutionsConflict / Resolutions

• In it for the long haul / RecommitmentIn it for the long haul / Recommitment

• Agree to DisagreeAgree to Disagree

• Safety in numbers / One for all – all for oneSafety in numbers / One for all – all for one

Sometimes the needs of the many outweigh the needs Sometimes the needs of the many outweigh the needs of the few or the one…other times? of the few or the one…other times? Mr. SpockMr. Spock

For more information…

Contact:

Richard BrownThe Agency for Community Treatment Services4612 North 56th StreetTampa, FL 33610813-246-4899 phone <> 813-621-6899 faxrbrown@actsfl.org

Nancy HamiltonOperation PAR6655 66th Street NorthPinellas Park, FL 33782727-545-7564 phone <> 727-545-7584 faxnhamilton@operpar.org

Bob HolmDepartment of Children and FamiliesSAMH Program Office11351 Ulmerton Road, Suite 329Largo, FL 33778727-518-3271 phone <> 727-588-3618 faxbob_holm@dcf.state.fl.us

Linda McKinnon719 US Highway 301 SouthTampa, FL 33619813-740-4811 phone <> 813-740-4824 fax <> 813-389-8179 celllmckinnon@cfbhn.org

Thank you for your attendance and participation!!