Impact of Health Care Reform & Other Changes on our Behavioral Health System. Tracy J. Plouck September 23, 2011

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1 Impact of Health Care Reform & Other Changes on our Behavioral Health System Tracy J. Plouck September 23, 2011

2 Overview Snapshot: Ohio s mental health system Governor s Office of Health Transformation Medicaid health homes & Ohio s plan Other department priorities (highlights only) Other MH work underway for FY 13 Affordable Care Act & 2014 Questions/discussion 2

3 Ohio s Mental Health System More than 200,000 adults & 100,000 youth served annually 50 local ADAMH boards 400 community providers 6 regional psychiatric hospitals (1,000+ beds) $1.1 billion ODMH budget, approximately ½ GRF $330 million local levy Carve out approach to Medicaid community services But, taking a step back

4 Mental & physical health are affecting the same body!

5 Gov's Office of Health Transformation What is it? What happens there? We have a significant opportunity here, since behavioral health is in spotlight Focus areas include: hot spots, behavioral/physical health integration, housing 5

6 Medicaid Hot Spot: Enrollment and Spending for Severe Mental Illness Adults with Severe Mental Illness (SMI) All Other Source: Ohio Colleges of Medicine Government Resource Center and Health Management Associates, Ohio Medicaid Claims Analysis (February 2011) 6

7 Medicaid Hot Spot: Hospital Admissions for People with Severe Mental Illness Avoidable hospitalizations per 1000 persons for ambulatory care sensitive conditions (avoidable with proper treatment) Source: Ohio Colleges of Medicine Government Resource Center and Health Management Associates, Ohio Medicaid Claims Analysis (February 2011) 7

8 Our Opportunity! How to most effectively leverage OHT s work to move our system forward? Health homes for individuals with chronic conditions Improvements to community Medicaid mental health benefit package Housing, particularly for specific populations 8

9 Medicaid Health Homes Federal Legislation ACA Section State Medicaid Director's Letter Optional for states to participate OHIO WILL States have significant flexibility in design 9

10 In a Nutshell Feds will provide time limited, enhanced reimbursement for specific Medicaid services that help medical providers transform their existing practices into a more person-centered, coordinated care environment Example: physician practice or FQHC Transforms scheduling Adds resources for care coordination Effectively uses EHR for analytics, outreach, referral 10

11 In a Nutshell, 2 With physical/behavioral health integration in mind, practice must have meaningful BH partners We are making the case that some BH providers can be a health home lead agency Requires true integration, not just lip service Would need to meet standards for other health homes (with some possible small modifications) Reflections from an agency currently in transition 11

12 Clarifying Terms Patient Centered Medical Home - Generally primary care practice with support from any payer source - Medical model, emphasis on wellness - Any person Health Homes for Chronic Conditions - Providers serving Medicaid enrollees with specific diagnoses (Section 2703 of Affordable Care Act) - Effective BH & PH partnership; may be bi-directional; social supports - Focus on hot spotters May overlap, but not necessarily 12

13 Eligible Participants Must Have Two chronic conditions; One chronic condition and are at risk for a second chronic condition; or One serious persistent mental health condition to qualify for health home services Conditions identified by the state 13

14 Chronic Conditions Mental illness Substance abuse Asthma Diabetes Heart Disease BMI > 25 Other conditions may be identified by the state & considered by the HHS Secretary 14

15 Ohio Medicaid Health Home Eligibles - DRAFT - SPMI 250,000 Two chronic conditions on list 75,000 One condition & at risk for second 360,000 TOTAL 685,000 Funding in FY 13 to enroll approximately 67,000 15

16 Medicaid Health Home Services Comprehensive care management Health promotion Transitional care including appropriate followup from inpatient to other settings Patient and family support Referral to community and social support services Use of health information technology to link services 16

17 Financing 90% federal match for the first 8 quarters Clock starts anew with each geographic area Regular FFP matching rate thereafter States have flexibility in payment methods May deploy via managed care or fee for service 17

18 FY 12 Work to Prep for FY 13 Ohio Department of Health will establish Patient Centered Medical Home rules May be used anywhere in Ohio by any payer or practice seeking to participate ODJFS and ODMH leading other state agencies to develop Medicaid Health Home model(s) May be used in designated geographic areas for designated Medicaid enrollees & providers 18

19 Medicaid Health Homes Timeline Fall/early winter concept development Winter CMS review, negotiations Winter/Spring IT development, rules, training, outreach, etc. Summer 2012 Deploy health home in specific communities; bring others on line as readiness dictates 19

20 Other Department Priorities, FY 12 Housing Re-entry services & supports Hospital system of care Children & intersystem collaboration Regulatory reduction Ongoing work related to Medicaid cost containment, Medicaid elevation, etc. 20

21 Housing Increase meaningful partnerships Adult Care Facilities rules, training, financial assistance for structural/safety improvements Planning, service & min-capacity grants HOME Choice/Money Follows the Person Seeking special federal approval to use Medicaid resources for housing supports in limited circumstances 21

22 Re-Entry Services & Supports Mental Health Block Grant mini grant approach Support of local re-entry coalitions Forensic monitoring Budget & relationship to sentencing reform 22

23 Hospital System of Care Six hospitals, ~ 1,000 beds Opportunity to share consistent & improved practices Topics: Access/bed management Quality/standards of care Safety/risk reduction: suicide risk, medication management, crisis intervention 23

24 Other Work Underway for FY 13 Community Medicaid improvements New services Monitor cost containment results Prepare for next stage of Medicaid elevation Non-Medicaid community funding formula Hospital bed day planning with boards 24

25 Affordable Care Act & 2014 Medicaid expansion for childless adults to ~138% FPL This will pull many folks who we serve into the Medicaid fold Ohio's 209(b) status is outstanding question Will impact our system s focus areas & expenditure path to varying degrees Important to contemplate strategy now Increased focus on comprehensive recovery services 25

26 Conclusion What are the best plans & investments that we can make for our communities? How can we make the work actionable ASAP? How can partnerships improve the product? 26