Whole Person Care Pilot Update

Transcription

1 Whole Person Care Pilot Update Kathleen A. Clanon, MD Alameda County Board of Supervisors Health Committee March 14, 2016

2 Whole Person Care Pilot in Alameda County Lead County Must match 50% Funding Statewide, up to $300M/year Optional competitive grant program Estimated potential ask: $10M-$30M / year x 5 years Purpose Provides support for integration infrastructure, to enable coordination of health, behavioral health, and social services Timeline Guidance is expected 5/1; proposal due 6/15 (est.) 2

3 Vision Crisis / Higher cost than nec. Emergency Dept Psych Emergency Homeless Shelters Street Homeless Jail Sobering Centers For some: SNF Psych sub-acute Stabilization & Wellness Supportive housing Supported housing Primary Care Medical Home Specialty Mental Health Home Substance Use Treatment Home Health Services

4 Core Program Components supportive services primary care mental health care SUD treatment housing complex care coordination system to share data 4

5 Portfolio of interventions structure 1. Clinical/Program: Care Coordination Clinical services: SUD, MH, PC Supportive services, community resources, 2. Housing Solutions for Health 3. Plan for sharing data across systems to coordinate care 4. Collaboration / Quality infrastructure

6 Planning Challenges Funding cliff in 2021 Predicting procurements Detailed guidance not available until June Finding dollars for match (without knowing what the rules will be) 6

7 Sustainability strategies Financial Workflow infrastructure System for sharing data Housing

8 CHCN AHS Casting a wide net Social Services Agency Place Matters Better Health East Bay Everyone Home Anthem Blue Cross EMS Senior Services Coalition Alameda Alliance Hospital Council East Bay Housing Organizations This list is not complete! 211/Eden I&R Housing Authorities And others 8

9 Potential sources of matching funds HealthPAC MHSA Other unmatched General Fund dollars TBD 9

10 Collaboration on Healthcare Delivery Partnering with AHS on Prime & Global Payment Program Aligning Whole Person Care Pilot with Health Homes Program (Alameda Alliance) Developing plan to share data collaboratively with AAH, AHS, CHCN, and HCSA/BHCS 10

11 1115 Medi-Cal 2020 Waiver Funding Opportunity: Whole Person Care Pilot (WPCP) Due Date: targeted June 15, 2016 (or 45 days after DHCS issues the WPC Pilot Request for Application (RFA), whichever is later) Anticipated Notice of Award: approx. 3.5 months after submission (Fall 2016) Performance/Budget Period: date of approval December 31, 2020 RFA release: targeted May 1, 2016 Timing: Lead Entities shall submit WPC Pilot applications to DHCS by June 15, 2016 Available funding: up to $300M per year total for the state; with equal match of non-federal funds Purpose: Support to integrate care for a particularly vulnerable group of Medi-Cal beneficiaries who have been identified as high users of multiple systems and continue to have poor health outcomes. Through collaborative leadership and systematic coordination among public and private entities, WPC Pilot entities will identify target populations, share data between systems, coordinate care real time, and evaluate individual and population progress all with the goal of providing comprehensive coordinated care for the beneficiary resulting in better health outcomes. WPC Pilot payments shall support 1) infrastructure to integrate services among local entities that serve the target population; 2) services not otherwise covered or directly reimbursed by Medi-Cal to improve care for the target population such as housing components; and 3) other strategies to improve integration, reduce unnecessary utilization of health care services, and improve health outcomes. Who can apply: DHCS will accept applications for WPC Pilots from a county, a city and county, a health or hospital authority, or a consortium of any of the above entities serving a county or region consisting of more than one county. Lead Entity that will be either a county agency, designated public hospital as identified in Attachment D or district municipal public hospital Required partners A minimum of one Medi-Cal managed care health plan (MCP) Health Care Services Agency Specialty mental health department (Behavioral Health Care Services) At least one other public agency or department, which may include county alcohol and substance use disorder programs, human services agencies, public health departments, criminal justice/probation entities, and housing authorities At least two other key community partners that have significant experience serving the target population within the participating county or counties geographic area such as physician groups, clinics, hospitals, and community-based organizations. Whole Person Care Pilot Programs Target Population(s). WPC Pilots shall identify high-risk, highutilizing Medi-Cal beneficiaries in the geographic area that they serve and assess their unmet need. WPC Pilots must define their target populations and interventions to provide integrated services to high users of multiple systems. The target population shall be identified through a collaborative data approach to identify common patients who frequently access urgent and emergent services often times across multiple systems. Target populations may include but are not limited to individuals: a) with repeated incidents of avoidable emergency use, hospital admissions, or nursing facility WPCP Summary.docx 1

12 1115 Medi-Cal 2020 Waiver Funding Opportunity: Whole Person Care Pilot (WPCP) placement; b) with two or more chronic conditions; c) with mental health and/or substance use disorders; d) who are currently experiencing homelessness; and/or e) individuals who are at risk of homelessness, including individuals who will experience homelessness upon release from institutions (hospital, sub-acute care facility, skilled nursing facility, rehabilitation facility, IMD, county jail, state prisons, or other) WPC Strategies. WPC Pilots shall include specific strategies to: Increase integration among county agencies, health plans, and providers, and other entities within the participating county or counties that serve high-risk, high-utilizing beneficiaries and develop an infrastructure that will ensure local collaboration among the entities participating in the WPC Pilots over the long term; Increase coordination and appropriate access to care for the most vulnerable Medi-Cal beneficiaries; Reduce inappropriate emergency and inpatient utilization; Improve data collection and sharing amongst local entities to support ongoing case management, monitoring, and strategic program improvements in a sustainable fashion; Achieve targeted quality and administrative improvement benchmarks; Increase access to housing and supportive services (optional); and Improve health outcomes for the WPC population. Housing and Supportive Services. WPC Pilots may target the focus of their Pilot on individuals at risk of or are experiencing homelessness who have a demonstrated medical need for housing or supportive services. In these instances, WPC Pilots would include local housing authorities, local Continuum of Care (CoCs) programs, community based organizations, and others serving the homeless population as entities collaborating and participating in the WPC Pilot. WPCP Summary.docx 2