Ohio s Direct Workforce Initiative and Health Care Integration: Exploring Job Roles & Competencies

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1 Ohio s Direct Workforce Initiative and Health Care Integration: Exploring Job Roles & Competencies University of Cincinnati Department of Internal Medicine The BeST Center Northeast Ohio Medical University (NEOMED)

2 Research Team Members University of Cincinnati Ronnie Horner, PhD: PI, Healthcare Epidemiology Seong-yi Baik, PhD, RN: Researcher, Community Mental Health Nursing BeST Center, NEOMED Director Lon Herman, MA: Senior Investigator, Public Administration Danelle Hupp, PhD: Researcher, Clinical Psychology Decision Support Services, Inc Phyllis Panzano, PhD: Co-PI, Industrial/Organizational Psychology Annapolis Coalition, Inc. Michael Hoge, MD: Yale, Consultant

3 How is the study related to the transformation of the health care system?

4 Health Care Transformation Fundamental Question: and the Workforce Will there be a qualified workforce in place to meet the pent-up demand posed by the millions of people who will now have Medicaid coverage? Center for Medicaid and Medicare Services: Has 1 billion dollars available to support innovation, including innovative approaches to workforce development Research Question: What will the future direct service workforce* (DSW) look like in the health care industry? * (e.g., Community Psychiatric Support Treatment workers)

5 Related Initiatives Health Care Reform: Affordable Care Act Lays groundwork for new Medicaid Health Home benefit Focuses on providing Primary and Behavioral Health Care Integration (PBHCI) for Medicaid recipients with severe and persistent mental illness (SPMI) to improve quality of care & reduce cost Rationale Medicaid is the largest payor of behavioral health care services Medicaid enrollees with SPMI tend to be very costly (e.g., 3x the $ for adults with schizophrenia)* Physical health care needs of adults with SPMI often go untreated, including preventable conditions * BeST/HFGC Study, Fall 2011

6 Related Initiatives Response Health Home benefit provides funding stream for care coordination to enhance efforts to integrate care for adults with SPMI First Step States must apply to Center for Medicare and Medicaid Services (CMS) to add this new benefit Key incentive: CMS will reimburse 90% of the cost for this service (for 2 years) compared to the 60% reimbursement rate for other Medicaid services States must propose: populations to be served; eligible medical conditions; reimbursement methodologies; eligible providers

7 State Level Response Ohio is pursuing the addition of a Health Home benefit Due to multi-morbidity and high cost (i.e., financial and quality of life), Ohio has established Medicaid enrollees with SPMI as a priority population to be offered Health Homes Health Home benefit may offer a key financing strategy to make quality PBHCI services feasible and sustainable over time for adults with SPMI PBHCI demonstration projects underway in Ohio provide an opportunity to evaluate relevant alternative models for delivering quality integrated care for adults with SPMI

8 Potential Opportunities for Project Partners Opportunity for shared learning active experimentation is underway to identify effective approaches to workforce training (e.g., evaluation of problem areas, what s working, what s not, what needs to change) strategies for developing and strengthening a whole-health focus research and practice-based collaboration to generate new knowledge

9 Potential Opportunities for Project Partners Generate ideas about strategies for achieving cultural shifts to support this new, whole-health approach to healthcare Envision new ways DSWs can make important contributions to Integrated Health Care (IHC) programs for adults with SPMI Opportunity for collective voice: Policy guidance Opportunities.yet to be discovered

10 The Study

11 Purpose To explore emerging job roles, responsibilities and competencies of DSWs* associated with PBHCI Programs for adults with SPMI * (e.g., Community Support Psychiatric Treatment workers)

12 Research Sites: 5 Ohio BHO* SAMHSA-funded PBHCI Grantees Children and Family Services, Cleveland CEO: Sharon Sobol Jordan Southeast, Inc., Columbus CEO: Bill Lee Shawnee Mental Health Center, Portsmouth CEO: Don Thacker Greater Cincinnati Behavioral Health Services CEO: Tony Dattilo Community Support Services, Akron CEO: Terry Dalton * Behavioral Healthcare Organizations

13 Care BEHAVIORAL HEALTH* e.g. Case Mgr. PRIMARY CARE* e.g., Nurse Aide Care Coordination WELLNESS* e.g., Peers Other Other PBHCI Program Elements for Adults with SPMI Other Other PREVENTION* SPECIALTY CARE- Referral* * Core/required of SAMHSA Grantees

14 Research Questions Do (or should) the job requirements (e.g., duties, skills, knowledge) of DSWs working on these PBHCI teams (e.g., case managers, nurse aides) differ from requirements of comparable positions in traditional programs (e.g., behavioral health)? Does the answer to the question above depend on attributes of the particular PBHCI model being implemented (e.g., integrated medical record; co-located or referral-based services; particular wellness or prevention programming)? Can envisioned job requirements be prioritized for all DSWs to support training of the workforce to more effectively respond to the rapidity of healthcare integration?

15 Timeline and Methods Time frame: 12 months Exploratory; Qualitative Expert informants (needed from participating sites): BHO and PBHCI program management, supervisors and/or service providers most familiar with PBHCI program implementation and current and projected staffing needs

16 Timeline and Methods Sequence of Activities Each site to complete background survey Hard copy Selected PBHCI program attributes (e.g., staffing pattern) and relevant background questions Method can vary; goal is to minimize burden Secure archival data (for review by researchers) Written information describing PBHCI program (e.g., from proposal) Work flow schematic for program (if available) Job descriptions for core and adjunct PBHCI program staff

17 Timeline and Methods Sequence and Methods Conduct 2 small group interviews On-site; about 3 hours each First: In-depth focus on work flow; overview of job roles Second: In-depth focus on worker qualifications, duties, competencies, responsibilities (current & envisioned) for selected core and adjunct DSW positions Wrap-up: Cross-site focus group In Columbus 4 hours, including lunch

18 What are the potential policy implications of this research for the Health Home benefit and/or Ohio s DSW Initiative?

19 Implementing PBHCI models in behavioral health care settings for adults with SPMI is likely to require new ways of doing business and to entail changes in the roles and responsibilities of health care providers, including DSWs, and other practitioners across the integrated health care spectrum

20 Within a PBHCI context, traditional and emerging case management and related direct care services for adults with SPMI may be aligned with services linked to the emerging Medicaid Health Home benefit: Ohio needs to avoid duplication of Health Home benefit services with those linked to the existing Medicaid Case Management (CPST) benefit

21 New job requirements for direct service workers may emerge within PBHCI programs designed for adults with SPMI that are important and relevant to identifying core and specialized competencies for a variety of long-term, direct service worker positions, have implications for human resource and workforce development initiatives in Ohio (e.g., detailing of the Career Lattice) and related state and federal initiatives as well

22 Questions? For more information or references contact: Ronnie or ronnie.horner@uc.edu Phyllis or panzano.2@osu.edu Lon or lherman@neomed.edu