Behavioral Health Community Partners. May 2018

Transcription

1 Behaviral Health Cmmunity Partners May 2018

2 Assciatin fr Behaviral Healthcare (ABH) 2 Wh We Are ABH is a statewide assciatin representing 85+ cmmunity-based mental health and addictin treatment prvider rganizatins. Fr ABH, cmmunity-based services means BH services prvided utside f an acute inpatient hspital All f the BH CP primary entities are ABH members Abut ½ f ur member rganizatins are part f 1+ BH CP Our members serve apprximately 81,000 MA residents daily, 1.5M annually, and emplying >46,500 peple. ABH prvides leadership and statewide crdinatin n imprtant public plicy, financing, preferred clinical mdels, and quality assurance issues

3 3 Assciatin fr Behaviral Healthcare (ABH) ABH and Behaviral Health Cmmunity Partners (BH CP) Nne f ur members lk alike very different service arrays Wide variety in cntracted service breadth and array (Department f Mental Health, DPH/Bureau f Substance Abuse Services, Department f Children and Families, Department f Develpmental Services, etc.) Different mix f third-party payers. Thse that deliver third-party reimbursable services are heavily dependent n Medicaid many clinic services (e..g, methadne maintenance, Cmmunity Supprt Prgram, Emergency Services Prgrams, etc.) r clinicians (LMHCs, master s-level staff) that are reimbursed by Medicaid are nt reimbursable thrugh Medicare and/r private insurance. Range f prvider-based care crdinatin/care management experience e.g. Here Fr Yu, Cmmunity Service Agencies/Children s Behaviral Health Initiative, etc.

4 System Transfrmatin: BH CP Selectin Criteria 4 Cmmunity-based prvider r cnsrtium f cmmunity-based prviders with experience and expertise supprting ppulatins with serius mental illness (SMI), substance use disrder (SUD), and c-ccurring disrders. Awardees required t deliver at least ne service within each f the fllwing: Cmmunity based mental health services (e.g., CBFS, ESP, PACT, CSP, CSPECH, crisis stabilizatin, respite services, residential services) Substance Use Disrder treatment services (e.g., ATS, CSS, SOAP, MAT, utpatient SUD treatment) Outpatient mental health services (e.g., clinical, day treatment, medicatin, intensive utpatient); and Integrated care management services (e.g., One Care Health Hme, MBHP PBCM, Here Fr Yu, ICC, grant-based and care management prgrams) MassHealth and/r MassHealth-cntracted Managed Care Entity Prvider; and, At least ne clinical service cntract with a state agency such as DMH, DPH/BSAS, r DCF.

5 ABH Members in Brief 5 Cmpared t ACOs, ABH members have mre limited resurces fr staffing, technlgy, and ther infrastructure FY 16 average annual ABH member revenues were $39.2M and median annual revenues were $27.0M ABH members have adpted ehealth slutins decisins driven by available resurces and unique needs f BH prviders Sme ABH members ffer telepsychiatry but rates and ther challenges have prhibited widespread adptin Almst all ABH members have implemented EHRs - typically prducts tailred t BH E.g., ehana, Netsmart and Qualifacts prducts predminate BH CPs are in the prcess f implementing care crdinatin prducts r mdules Cnnectins t MassHiWay are few Sme early adpters wrking with PreManage Primary fr event ntificatin

6 6 BH CP Cnfiguratins BH CPs are rganized in three primary ways: Standalne, e.g., Behaviral Health Netwrk; Cmmunity Healthlink; Elit Cmmunity Human Services. Cnsrtium, e.g., Eastern Massachusetts Cmmunity Partners, LLC (cmprised f Vinfen Crpratin, Bay Cve Human Services & Bridgewell) r Innvative Care Partners, LLC (Center fr Human Develpment, Inc., Gandara Mental Health Center & ServiceNet) Lead Entity with Affiliated Partners (management agreement), e.g., High Pint Treatment Center, Inc. with Brcktn Area Multi Services (BAMSI), Bay State Cmmunity Services; Child & Family Services; Duffy Health Center & Steppingstne, Inc.); Lwell Cmmunity Health Center with Lwell Huse, Inc. and Mental Health Assciatin f Greater Lwell Each mdel has strengths and challenges

7 System Transfrmatin: Lnger-Term Opprtunities 7 Imprve health utcmes fr MassHealth members with SMI and/r chrnic SUD Imprve care experience fr MassHealth members with SMI and/r chrnic SUD Better integrated care

8 System Transfrmatin: BH CP Perfrmance Measures 8 Accuntability Scre At-Risk $ Tied t Scre w/ Weighted Dmains Care Integratin (40%): cmmunity partner engagement; annual treatment plan cmpletin; fllw-up with CP after any hspitalizatin (3 days); fllw up with any prvider after ED visit (7 days) Ppulatin Health (35%): annual primary care visit; cmmunity tenure; AOD treatment initiatin/engagement including MAT; fllw-up MH hspitalizatin (7 days); diabetes screening fr individuals w/schizphrenia r biplar disrder wh are using antipsychtic medicatin; TBD Member Experience (15%): TBD Avidable Utilizatin (10%): All-Cause hspital readmissin; ED visits fr adults with SMI, addictin r c-ccurring cnditins Nte: Fr illustrative purpses nly. Measures and weights may evlve

9 9 System Transfrmatin: Early Challenges Wrkfrce ramp-up CCIT, EDI, and ther technlgy ramp-up Infrmatin sharing within the BH CP and with ACO/MCO partners Service access particularly psychiatry Culture differences between primary care and BH Managing multiple relatinships, ne BH CP may be wrking with 10+ ACOs Cmplex relatinships CPs must navigate ACO, MCO & MBHO Differential requirements by ACOs and MCOs, e.g., different reprting timeframes fr identical requirements, different data elements, different reprting platfrms, reprting t bth ACO and MCO in partnered relatinship, etc. Mst BH CPs are bringing DMH Adult Cmmunity Clinical Services (ACCS) mdel nline n 7/1 Similar challenges t CP in terms f wrkfrce and mre cmplex relatinships