Care Transitions in Behavioral Health

Transcription

1 Janssen Pharmaceuticals, Inc. Presents: Care Transitions in Behavioral Health Chuck Ingoglia, MSW Senior Vice President, Policy and Practice Improvement, National Council for Behavioral Health Nina Marshall, MSW Director, Public Policy, National Council for Behavioral Health June, 2013

2 Audio and Submitting Questions Open and close your control panel with red arrow Join audio: Choose Mic & Speakers to use VoIP Choose Telephone and dial using the information provided Submit questions and comments via the Questions panel 1

3 Disclaimer This promotional educational activity is not accredited. The program content is developed by Janssen Pharmaceuticals, Inc. Speakers present on behalf of the company and are required to present information in compliance with FDA requirements for communications about its medicines. This document is presented for informational purposes only and is not intended to provide reimbursement or legal advice, nor does it promise or guarantee coverage, levels of reimbursement, payment, or charge. It is not intended to increase or maximize reimbursement by any payer. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current as of the issue date of this document, the information may not be as current or comprehensive when you view it. We strongly recommend you consult the payer organization for its reimbursement policies. 2

4 Janssen Pharmaceuticals, Inc. Member of the Johnson & Johnson family of companies Dedicated to addressing and solving some of the most important unmet medical needs of our time, including mental health Named after Dr. Paul Janssen, a leading Belgian researcher and general practitioner who changed the treatment paradigm for mental health patients Remains at the forefront of advancing CNS treatments and improving care for people with brain disorders 3

5 National Council for Behavioral Health Represents over 2,000 community organizations that provide safety net mental health and substance abuse treatment services to over six million adults, children and families National voice for legislation, regulations, policies, and practices that protect and expand access to effective mental health and addictions services 4

6 Today s Agenda Care Transitions: What Do We Know Focus on Quality: Change in the Policy Landscape Care Transition Examples Responding to the Changing Environment 5

7 Care Transitions: What Do We Know Consequences of inadequate transitions to Patients and Families Poor health outcomes Unnecessary disruptions and stress to families and patients Coleman, E.A., Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 51: ,

8 Care Transitions: What Do We Know Consequences of inadequate transitions to the Medical System Medicare: Almost 20% of total Medicare beneficiaries are rehospitalized within 30 days, and 34% within 90 days Unplanned rehospitalizations in 2004 was $17.4 billion Medicare and Medicaid: 50% of total rehospitalizations within 30 days of discharge showed no bills for physician visits between discharge and rehospitalization Jencks, S.F.; Williams, M.V.; Coleman, E.A. Rehospitalizations among Patients in the Medicare Fee-for-Service Program, N Engl J Med 2009;360: Gilmer, T. and Hamblin, A. Hospital Readmissions among Medicaid Beneficiaries with Disabilities: Identifying Targets of Opportunity, Center for Health Care Strategies. Available from: 7

9 Care Transitions: What Do We Know Consequences of inadequate transitions to the Behavioral Health System Medicaid: Readmission rates increase with number of chronic conditions, including schizophrenia Jencks, S.F.; Williams, M.V.; Coleman, E.A. Rehospitalizations among Patients in the Medicare Fee-for-Service Program, N Engl J Med 2009;360: Gilmer, T. and Hamblin, A. Hospital Readmissions among Medicaid Beneficiaries with Disabilities: Identifying Targets of Opportunity, Center for Health Care Strategies. Available from: Accessed June 5,

10 Change in the Policy Landscape Built-in Focus Hospital on Quality Readmission Expectations for Improved Care Change in Penalties the Policy Transitions Landscape... 9

11 Focus on Quality: Hospital Readmission Hospital Readmission Penalties Reporting on quality measurements developed and approved by National Quality Forum required by: Deficit Reduction Act Hospital Inpatient Quality Reporting Program Affordable Care Act established Hospital Readmission Reduction Program Allows Medicare to reduce payments to certain applicable hospitals for excess readmissions related to specific health conditions Centers for Medicare & Medicaid Services, Proposed Rule 77 FR

12 Focus on Quality: Hospital Readmission Hospital Readmission Penalties As of October 1, 2012, the applicable conditions for which hospitals are penalized for readmission are: Heart Failure Acute Myocardial Infarction Pneumonia Additional measures will be considered for future years Centers for Medicare & Medicaid Services, Proposed Rule 77 FR

13 Focus on Quality: Concentrated Care Expectations for improved care transitions in other programs Medicaid Health Homes Core Measures Care Transition Transition Record Transmitted to Health Care Professional Follow Up After Hospitalization for Mental Illness All Cause Readmission Accountable Care Organizations Outpatient and inpatient providers work together CMS Bundled Payments for Care Initiative Incentivizes closely coordinated care for certain conditions CMS, Health Home Core Quality Measures, State Medicaid Director Letter # January 15, 2013; CMS, Bundled Payments for Care Improvement Initiative. January 31, 2013; CMS, Accountable Care Organizations. N.D. 12

14 Quality Measures: National Nationally Developed or Endorsed HEDIS Effectiveness of Care: Chronic Conditions, Follow-Up After Hospitalization for Mental Illness Percentage of patients hospitalized for certain mental health disorders AND Had a follow-up visit after discharge either outpatient, intensive outpatient, or partial hospitalization with a mental health practitioner within a certain time frame (7 days) Required reporting by all NCQA-accredited health plans Recommended Medicaid health home core measure Center for Health Care Strategies, Quality Measurements in Integrated Care for Medicare-Medicaid Enrollees. January CMS, Health Home Core Quality Measures, State Medicaid Director Letter # January 15, Policy-Guidance/downloads/SMD pdf. 13

15 Quality Measures: National Nationally Developed or Endorsed CMS/NCQA Structure and Process Measures, Care Transitions The organization manages the process of care transitions, identifies problems that could cause transitions and where possible prevents unplanned transitions. Element A: Managing Transitions Element B: Supporting Members Through Transitions Element C: Analyzing Performance Element D: Identifying Unplanned Transitions Element E: Analyzing Transitions Element F: Reducing Transitions National Committee for Quality Assurance, "Special Needs Plans Structure & Process Measures. April

16 CTI Few models specifically address the population of people with Serious Mental Illness, but there are several well-researched and widely known care transition models. TCM CTI: Care Transitions Intervention TCM: Transitional Care Model 15

17 Care Transitions Intervention (CTI) Developed by Eric Coleman, MD, MPH, Univ. of Colorado Key components: Patient-centered record, or Personal Health Record Structured checklist of critical activities to empower patients pre-discharge Patient self-activation and management session with a Transitions Coach in the hospital Transitions Coach follow-up visits and phone calls Outcomes: Randomized control trial showed 30% reduction in hospital readmissions CMS follow-up 14-state pilot showed 36% reduced readmission rate (Voss et al. 2011) 16

18 Transitional Care Model (TCM) Developed by Mary Naylor, University of Pennsylvania Studied on older adults, but has good lessons for other populations as well Key components: Transition support begins in the hospital Heavy emphasis on patient education/activation Home visiting component Accompany consumer to appointments Different than traditional case management Outcomes: Reduced readmission rates and, if readmitted, shorter stays and longer time between first and second admissions Improved physical health, functional status, and quality of life Increased patient and family caregiver satisfaction Reduction in total and average costs per patient (mean savings of $5000 after accounting for cost of the intervention) 17

19 Common model elements Time-limited supports Heavy investment in education and patientactivation Assigned person to support patient and family pre- and post-transition 18

20 Responding to a Changing Environment 19

21 Focus on Quality Expectations for improved care transitions in other programs Medicaid Health Homes Core Measures Care Transition Transition Record Transmitted to Health Care Professional Follow Up After Hospitalization for Mental Illness Accountable Care Organizations Outpatient and inpatient providers work together CMS Bundled Payments for Care Initiative Incentivizes closely coordinated care for certain conditions CMS, Health Home Core Quality Measures, State Medicaid Director Letter # January 15, 2013; CMS, Bundled Payments for Care Improvement Initiative. January 31, 2013; CMS, Accountable Care Organizations. N.D. 20

22 Use of Technology Information sharing between hospital and community providers Remote monitoring/engagement technologies 21

23 Changing Reimbursement Mechanisms Medicaid Health Homes New CPT codes for 2013 Transitional Care Management:

24 Staff considerations Case managers vs. care managers Culture shifting inherent in multi-specialty work 23

25 Emerging Collaborations in Health Care Partnerships with hospitals and medical homes Environmental scan: where are ACOs and Bundled Payment Initiatives unfolding in your area? 24

26 Additional Information September

27 Contact Information Charles Ingoglia, MSW Senior Vice President, Public Policy and Practice Improvement Nina Marshall, MSW Director, Public Policy 26