Behavioral Health Services Through Health First Colorado (Colorado s Medicaid Program)

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1 Behavioral Health Services Through Health First Colorado (Colorado s Medicaid Program)

2 What is Medicaid? The program, known as Medicaid, became law in 1965 as a jointly funded cooperative venture between the Federal and State governments to assist States in the provision of adequate medical care to eligible needy persons. Eligibility depends on income, disability, pregnancy, and family circumstances. Eligibility expanded in 2010 as a result of the Affordable Care Act.

3 Current Trends in Colorado Medicaid Over 1.3 million people in Colorado receive Medicaid- about 1 in 5 people in the state, 1 in 3 children In June of 2016 Colorado Medicaid changed its name to Health First Colorado

4 What is a Behavioral Health Organization? The community behavioral health services program is a statewide program that provides comprehensive mental health and some substance use disorder services to Colorado Medicaid members. Members are assigned to a Behavioral Health Organization (BHO) based on where they live. BHOs are contracted by the state to manage and provide medically necessary behavioral health services. 4

5 BHOs Manage and Administer Behavioral Health Benefits Through a Managed Care System The BHOs: Manage their own provider networks consisting of community mental health centers and private providers Operate their own authorization processes Appear in court for client appeals Pay providers directly Perform audits and quality functions 5

6 Medicaid Behavioral Health Services 5 Service Areas 5 Behavioral Health Organizations Colorado Access Behavioral Health Care (Denver) Behavioral Health Care, Inc. (Adams, Arapahoe, Douglas) Colorado Health Partnerships (West Slope, Southeast and Pikes Peak regions) Foothills Behavioral Health Partners (Boulder, Broomfield, Jefferson, Gilpin and Clear Creek) Colorado Access Northeast (Northeastern Colorado)

7 BHO s Service Areas Sedgwick Moffat Jackson Larimer Weld Logan Phillips Routt Morgan Rio Blanco Grand Boulder Broomfield Gilpin Adams Washington Yuma Garfield Eagle Denver Clear Creek Summit Jefferson Arapahoe Mesa Pitkin Lake Park Teller Douglas Elbert Kit Carson Delta Gunnison Chaffee El Paso Lincoln Cheyenne Montrose Fremont Crowley Kiowa San Miguel Ouray Hinsdale Saguache Custer Pueblo Otero Bent Prowers Dolores San Juan Mineral Rio Grande Alamosa Huerfano Montezuma Las Animas La Plata Archuleta Conejos Costilla Baca Northeast: Access Behavioral Northeast Colorado Medicaid Capitation Behavioral Health Organizations by Geographic Service Area Northeast: Northeast Behavioral Health Metro: Colorado Access Behavioral Care Metro West: Foothills Behavioral Health Metro East: Behavioral Healthcare, Inc. Western/Southern: Colorado Health Partnerships 15

8 Managed Behavioral Health Care Physical Healthcare Separated from Behavioral Capitated Versus Fee for Service (800) (Medical) What Does Capitated Mean?

9 What Services are Provided? Assessment Inpatient hospital mental health care (not SUD) Outpatient mental health services Outpatient Substance Use Disorder (SUD) services Psychiatrist services Emergency/crisis services Intensive Outpatient Services for SUD Medication management Social Detoxification services (not medical) Drug testing collection and counselling only Medication Assisted Treatment (methadone only) 9

Care Standards Medicaid behavioral health providers are required to offer an intake and initial assessment of any Medicaid client requesting routine services within seven

10 Care Standards Medicaid behavioral health providers are required to offer an intake and initial assessment of any Medicaid client requesting routine services within seven business days of the initial request The client must be offered three appointments within the first 45 days of treatment Service must be medically necessary Least restrictive setting 10

Medically Necessary Non Medicaid Providers Substance Use Disorder Services other than: Outpatient

11 Major Coverage Exclusions Medicaid is Secondary to any other Insurance (Medicare/Private Insurance) Intellectual/Developmental Disabilities (by themselves) Organic Conditions (by themselves) Not Medically Necessary Non Medicaid Providers Substance Use Disorder Services other than: Outpatient (Level 1 ASAM) Social Detox (non hospital based) Medication Assisted Treatment (Methadone only) Intensive Outpatient 11

12 Questions, Comments and Discussion

13 Let s Talk Behavioral Health CORHIO Behavioral Health Exchange March 23, 2017 Toria Thompson Behavioral Health Information Exchange Coordinator 1

14 Overview of CORHIO 2

15 CORHIO and QHN: Colorado s two HIEs Denver Grand Junction 3

16 About CORHIO Founded in 2008, CORHIO was developed under the American Recovery and Reinvestment Act to provide health information exchange (HIE) services on the front range and eastern plains. CORHIO s HIE technology provides medical records to community providers throughout the state, regardless of system they use. Transformation Support Services group provides assistance with EHR selection and adoption, incentive programs and Meaningful Use, medical home recognition and clinical quality reporting. CORHIO empowers people, providers, and communities by providing the information they need to improve health. 4

17 How HIE Works Paper & phone based with some limited electronic connections One electronic connection to the HIE to access/share patient information across the state 5

18 How HIE Works Public Health Departments Laboratories Hospitals Radiology Centers Reportable Conditions Immunizations Hospital ADT info Consult Reports Transcription Notes Lab/Rad Newborn Screening Results Lab Results Pathology Reports Community Health Record Radiology Reports 6

19 CORHIO Services Available Today PatientCare 360 Provider Portal (Query) Results Delivery (Push into EHR) 7

20 CORHIO By the Numbers Last updated 3/13/17 61 Hospitals Connected (11 more underway) 4,300+ Providers Connected (9,900+ total users) 4,000,000+ Patients in the Community Health Record CORHIO empowers people, providers, and communities by providing the information they need to improve health. 8

21 What s Different About Sharing Behavioral Health Information Through an HIE? 9

22 2011 Regulatory Changes for Behavioral Health Information Sharing in Colorado CORHIO empowers people, providers, and communities by providing the information they need to improve health. 10

23 2011 Regulatory Changes for Behavioral Health Information Sharing in Colorado This revision allowed behavioral health professionals to follow the information sharing best practices utilized by their colleagues in the medical profession, namely: Share mental health data under the guidance of HIPAA, using the same protections as the guidance for exchange of physical health. Colorado s Office of Behavioral Health consolidated eight volumes of rules to one volume and added language to reinforce that HIPAA and 42 CFR Part 2 are to be followed. 11

24 After the 2011 State Statute Change HIPAA and Opt-Out Through HIE Exchange of behavioral health information (w/o consent) for treatment, payment and operations by authorized users with a need to know. Patient Consent to Release Information All other behavioral health information requires patient consent in order to exchange BH Information Psych notes Substance use data Plus exceptions 12

25 CORHIO and Mental Health Center of Denver Pilot Project 13

26 Behavioral Health Exchange Pilot Partners: Mental Health Center of Denver Signal Behavioral Health Network FEI Systems (Choose2Share) CORHIO Goals: Embed in clinics that serve total of 300 patients (adult and children) Touch 100+ clients 30+ clients enact consent Engage with 3+ external provider organizations 14

27 CORHIO Behavioral Health Exchange Workflow ONC s Advance Interoperable HIT Services to Support HIE Grant Substance Use Tx Provider Community Mental Health Center HIV Clinic Ambulatory & LTPAC CCD Patient Consent Portal Protected, non-hipaa Sharable Data Sharable only via Consent CORHIO Provider Portal (PatientCare 360) 15

28 CORHIO Consent Portal: Choose2Share Patient Workflow: Enabling Consent 16

29 Consent Example Patient Workflow Mental Health Center of Denver From behavioral health practice Bruner Family Medical Center To primary care practice Data to be shared For what purpose For what time period 17

30 Consent Example 18

31 CORHIO Provider Portal: PatientCare 360 Provider Workflow: Retrieving MHCD Documents 19

32 Provider Workflow: PatientCare 360 Provider Selects the Documents Window 20

33 Sample Continuity of Care Document Mental Health Center of Denver Continuity of Care Document 21

34 CORHIO Consent Portal: Choose2Share Patient Consent Education Video: 22

35 Discussion and Questions? Toria Thompson Behavioral Health Information Exchange Coordinator, CORHIO

36 1

37 The Problem: A Severe Deficiency in Psychiatry

38 Colorado Conditions Estimated number of Colorado CO children with mental health conditions is 177,000 (13%) to 273,000 (20%) Very few practicing child psychiatrists Primary Care Clinics are the most common setting where children present with behavioral health needs 3

39 C-PACK Program Components Psychiatric Curbside Consultation available to ALL children ages 0-21 in an enrolled practice, regardless of insurance status and available within 30 minutes of the request. Care Connection is available when patients need more care than the primary care provider can offer within their clinic. C-PACK care coordinators are available for complex care referrals or coordination. The C-PACK team will work with the physician and/or family until the provider connection has been met. Education and Training involves structured training for PCPs on specific children s behavioral health topics including psychopharmacology. This is performed in formats that work for the specific physicians. 4

40 C-PACK Service Area Colorado (serving 43 of 64 counties)

Evaluation Results The results of the evaluation for the two year grant period suggest C- PACK is reaching and supporting both prescribers and patients.

Increased identification of undiagnosed mental health 3. Increased number of children screened for mental health conditions 4.

41 Evaluation Results The results of the evaluation for the two year grant period suggest C- PACK is reaching and supporting both prescribers and patients. Eight initial primary objectives of the C-PACK were reached: 1. Increased access to child psychiatric specialty consultation 2. Increased identification of undiagnosed mental health 3. Increased number of children screened for mental health conditions 4. Increased access to evidence-based medication/psychotherapy 5. Increased PCP confidence in their diagnostic and treatment skills 6. Increased access to specialty services in complex cases 7. Increased appropriate use of psychiatric medications in primary care 8. High provider satisfaction 6

42 Thank you 7

43 Improving access to evidence-based mental health therapy Ieso Overview: Colorado Health Partnerships Program Healthy Transitions Colorado March 23, 2017

44 What do we do? Cognitive behavioral therapy Therapy in real time via instant messaging in a secure online environment Strict clinical and information governance Evidence-based patient pathway and recovery metrics No waiting list Appointment times according to patient choice 2

45 The Ieso Advantage Improve access to people who may experience stigma, lack of transportation, or lack of providers Improve productivity so each therapist can treat more patients while maintaining good outcomes Enhance quality through rigorous use of data analytics and clinical supervision 3

46 What is Cognitive Behavioral Therapy? Cognitive behavioral therapy (CBT) is a structured way of working with a therapist to explore the unhelpful thought processes that can lead to mental health problems. CBT works by helping patients to realize that it is often not the situation that causes painful feelings, but the perception of the situation and the way that can make them respond. By changing the way that patients perceive something, or changing behavior, patients may ultimately change the way that they feel. In both online and face-to-face CBT, the focus is often on current situations and giving patients strategies for managing these differently 4

47 Suitable Patients Aged 18 and older Access to internet and internet enabled device Depression (including post-partum) and/or Anxiety Rural and remote Experiencing stigma Busy Schedule and/or is a caregiver Not experiencing active psychosis No active substance use 5

Colorado Health Partnerships Care Pathway Patient Referred Patient Registers Suitability Assessment Therapist Match Assessment Therapy Treatment Step2 mild-moderate Step3 moderate-severe Step3+

48 Colorado Health Partnerships Care Pathway Patient Referred Patient Registers Suitability Assessment Therapist Match Assessment Therapy Treatment Step2 mild-moderate Step3 moderate-severe Step3+ severe Step chosen based on assessment tools and professional opinion Step 2: - 30 min sessions - Goal setting - Homework Step 3: min sessions - Goal setting - Homework Step 3+: - 60 min sessions - Goal setting - Homework 6

49 7

50 Who Provides the Ieso Service? Colorado licensed and credentialed masters and doctoral level providers Trained in cognitive behavioural therapy for people with moderate and severe depression and anxiety disorders 8

51 Patient Profile Diagnoses Age Major Depressive Disorder General Anxiety Disorder Adjustment Disorder Gender Female 81% Male 18% Metrics Completed Assessment: 192 Entered Treatment: 132 Eligible for Success Evaluation: 47 Rate of Improvement: 61% * Source: February 2017 Ieso Digital Health Monthly Report 9

52 Patient Feedback Why did you choose online therapy rather than face to face therapy? I didn t have to travel I can open up more online I cannot leave my house easily How did you find using the therapy website? Very easy Please use this space to tell us about your experience of our service: Felt confident opening up as well as trusting the advice my therapist gave. Great appointment times to meet my schedule and personal needs. It was also great knowing I could message a question, concern or update anytime without an appointment. 10

Improving access to evidence-based mental health therapy www.iesohealth.

53 Improving access to evidence-based mental health therapy Sheeba Ibidunni, US Director of Operations Development t e s.ibidunni@iesohealth.com

CSOC SCHOLARSHIP PROGRAM DESCRIPTION ONLY IN-STATE SCHOOLS ARE ELIGIBLE

County Sheriffs of Colorado (Mail or deliver application to the Sheriff s Office in the county of your permanent residence) CSOC telephone: 720-344-2762 Web: www.csoc.org CSOC SCHOLARSHIP PROGRAM DESCRIPTION