Improving Health Status through Behavioral Health Interventions
|
|
|
- Carol Golden
- 5 years ago
- Views:
Transcription
1 Comorbidity in the Dual Eligible Population: Improving Health Status through Behavioral Health Interventions PREPARED FOR THE CALIFORNIA ASSOCIATION OF HEALTH PLANS 2013 SEMINAR SERIES JUNE 25, 2013 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
2 Agenda 1. Beacon s Point of View 2. Understanding di the Behavioral Health Needs of Dual Eligiblesibl A. Serious Mental Illness and Substance Use Disorder B. Chronic Illness and Behavioral Health Comorbidity 3. CA Duals Model A. Building bridges between Cal MediConnect Plans & County Partners 4. A Few Parting Thoughts BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
3 Beacon is engaged throughout demonstration states to address the behavioral health needs of the dual eligible population DIVERSE GEOGRAPHY AND EXPERIENCE 8.2 million covered lives in 15 states, UK DUALS ELIGIBLE HEALTH PLAN PARTNERS Massachusetts 2.4 million Medicaid members 625,000 ABD and dual enrollees Includes +150,000 SPMI members 10 Medicaid programs: TX, CA, DC, FL, KY, MA, MI, NH, NY, RI California Operating or implementing with 9 health plan partners in 5 demonstration states Readiness with NORC underway: MA, IL, CA Illinois, Virginia and Ohio Rhode Island BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
4 Agenda 1. Beacon s Point of View 2. Understanding the Behavioral Health Needs of Dual Eligibles A. Serious Mental Illness and Substance Use Disorder B. Chronic Illness and Behavioral Health Comorbidity 3. CA Duals Model A. Building bridges between Cal MediConnect Plans & County Partners 4. A Few Parting Thoughts ht BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
5 Serious mental illness and substance use disorder are more prevalent among the dual eligible population than either Medicaid-only or Medicare-only groups PREVALENCE OF SERIOUS MENTAL ILLNESS PREVALENCE OF SUBSTANCE USE DISORDER 30.0% 10.0% 8.0% 20.0% 60% 6.0% 10.0% 4.0% 00% 0.0% < Duals Medicare-Only Medicaid-Only 2.0% Duals Medicare-Only 00% 0.0% < Medicaid-Only Clark, R.E., Leung, Y.H., Lin, W-C., Little, F.C., O Connell, E., et al (2009). Twelve-Month Diagnosed Prevalence of Mental Illness, Substance Use Disorder, and Medical Comorbidity in Massachusetts Medicare and Medicaid Members Aged 55 and Over, 2005 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
6 Behavioral health conditions contribute to higher medical and long-term care costs DUAL ELIGIBLE ANNUAL COSTS PER BENEFICIARY $60,000 $51,000 $40,000 $20,000 $0 $19,400 Medicaid $10,800 Medicare $8,600 All Duals $31,000 Medicaid $17,500 Medicare $13,500 1orMoreChronic $38,500 Medicaid $23,200 Medicare $15,300 1 or More Chronic, 1Behavioral Medicaid $32,500 Medicare $18,500 At Least 1BHand1LTSS Source: July 2010 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
7 Duals with serious mental illness and/or substance use disorder are substantially more likely to be admitted and readmitted inpatient PERCENTAGE OF BENEFICIARIES ADMITTED INPATIENT 30-DAY HOSPITAL READMISSION RATES 100.0% 80.0% 90% 84% 40% 30% 37% 32% 60.0% 40.0% 20.0% 22% 17% 45% 46% Dual Eligib ble Only Medicare 20% 10% 16% 13% 24% 22% 0.0% No SMI SMI SMI & SUD 0% No SMI SMI SMI & SUD SOURCE: SCAN Foundation, DataBrief Series, February 2013, Issue 36 SOURCE: SCAN Foundation, DataBrief Series, Februrary 2013, Issue 37 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
8 Case Study from Western New York: The community mental health system offers a powerful set of services, if engaged g effectively % OF HIGHEST RISK SERIOUSLY MENTALLY ILL MEMBERS RECEIVING COUNTY SERVICES 40.0% 39.0% 30.0% APPROACH County care management and delivery system retrained on principles of person-centered planning Analytics used to select and prioritize members for engagement and treatment with intensive services Medical necessity criteria developed in concert with community providers inpatient and diversionary services 20.0% 21.0% Integrated Virtual Gateway (SPOA) for social services into clinical management system RESULTS 10.0% 59% decrease in ER utilization 62% decrease in inpatient mental health average length of stay 0.0% Highest Risk Quartile MH only Highest Risk Quartile All BH and Medical 34% decrease in self-harm incidents 32% decrease in physical harm to others 50% decrease in suicide attempts Source: NY Care Coordination Program, 2010 Note: Erie, Monroe and Onandoga Counteis 44% increase in gainful employment BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
9 Plans must partner with the SMI system of care to bring managed care insight to a more traditional public system mentality 1. Community Mental Health Centers (CMHCs) provide highly impactful services, but often without regard to risk, appropriate p tenure, or overall capacity needs A. LA County Example: 45 55k SMI; 16k+ engaged with county rehab option services 2. Substance use services are particularly variable, particularly fragmented and in some cases may not even exist in the Medicaid program (FL, CA) 3. Behavioral health services remain carved out in a number of demonstrations (CA, MA, MI), not withstanding grand objectives regarding alignment 4. Provider politics always matter (SNFs, PCAs, homecare, etc.), but the SMI advocates are especially organized and effective A. Care management efforts by duals plans cannot be seen as weakening the existing safety net B. Must leverage installed base CMHC care management services i. Limited experience with managed care and limited medical capability ii. Health Home (ACA Section 2703) or behavioral health homes, etc. - OH, NY, RI BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
10 A few additional takeaways for the under 65 SMI population 1. Delegation of care management and effective oversight are acquired skills 2. Out-of-plan benefits cannot be out of sight, out of mind 3. Developing a large-scale peer support program is a key programmatic objective for the advocacy and provider community Evidence suggests that this is a good idea Effective means of finding and engaging this population 4. Housing, housing, housing BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
11 Behavioral health co-morbidity is relatively high among the >65 population, though probably understated PREVALENCE OF BH COMORBIDITY BY RATE CELL 100% 88.4% 80% 60% 62.5% 40% 40.1% BH Co-Morbid 20% 14.0% 0% Community Well Nursing Home Eligible Institutional ADCMI SOURCE: Beacon client data prior to Beacon engagement g BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
12 In the over 65, costs are also about mental health as an accelerator, not a primary condition PMPM SPENDING DIFFERENTIAL TOTAL COST OF CARE (BH COMORBID VS. NON) 1.3x $10,000 $8,521 $8, x $6,387 $6,000 $5, x $4,000 $2,844 $2,061 $2,000 Chronic Mental Illness $1,037 $0 Community Well Nursing Home Eligible Institutional SOURCE: Beacon client data prior to Beacon engagement g BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
13 Behavioral health conditions complicate transitions, and contribute to far higher costs within non-bh categories of service PMPM SPENDING DIFFERENTIAL BY CATEGORY OF SERVICE (BH COMORBID VS. NON) 17.2x $2,000 $1,864 $1, x $1,000 $1, x 3.0x $500 $0 $269 $290 $321 $108 $152 $82 Hospital SNF/LTC Professional DME SOURCE: Beacon client data prior to Beacon engagement g BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
14 The SPMI population among duals has a greater co-morbidity burden at an earlier age. High likelihood of nursing home placement with no ADLs DUALS WITH 5 OR MORE CHRONIC ILLNESSES 60.0% 54.4% 58.8% 40.0% 20.0% 13.0% 31.0% 16.2% 41.0% 26.2% 33.9% BH Populat tion SMI + Chronic 0.0% vclark, R.E., Leung, Y.H., Lin, W-C., Little, F.C., O Connell, E., et al (2009). Twelve-Month Diagnosed Prevalence of Mental Illness, Substance Use Disorder, and Medical Comorbidity in Massachusetts Medicare and Medicaid Members Aged 55 and Over, 2005 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
15 Good news: notwithstanding diagnostic challenges, HCC scores allow investment in behavioral health services and management AVERAGE MEDICARE RISK SCORE Non-BH, Non-Chronic BH Only Chronics BH + Chronic SOURCE: Beacon client data prior to Beacon engagement g BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
16 Improving behavioral health treatment for mild to moderate conditions requires a more flexible provider network model 1. Provider network of LTSS, BH-focused services must deepen Home based BH therapy Mobile assessment, rapid response and stabilization capability to any setting Training and continued awareness to the family and caregivers 2. Clear ROI on spending the money to have BH fully involved in the interdisciplinary team Inside care management team Field-based care team 3. Demand and contract for BH competency in the provider setting 4. BH training of low-skill, high touch work force Homemaker, care attendant, transportation, etc. 5. Jury is out on the best way to infuse primary care into the existing BH delivery system. Key source of innovation and testing in wave 1 Beacon uses nurse supervisors and NPs in the pod, but that s still unproven BH Health Homes BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
17 Agenda 1. Beacon s Point of View 2. Understanding the Behavioral Health Needs of Dual Eligibles A. Serious Mental Illness and Substance Use Disorder B. Chronic Illness and Behavioral Health Comorbidity 3. CA Duals Model A. Building bridges between Cal MediConnect Plans & County Partners 4. A Few Parting Thoughts ht BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
18 Cal MediConnect Implementation Bridge with county BH PROVIDING SEAMLESS ACCESS TO CARE 1. Alameda County A. Alameda Alliance for Health B. Anthem Blue Cross Alameda County Behavioral Health Care Services 2. Los Angeles County Beacon A. LA Care B. CareMore C. Care 1st LA County Dept of Mental Health LA County Dept of Public Health BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
19 Division of Medicare and Medi-Cal Behavioral Health Benefits CAL MEDICONNECT PLAN BENEFITS SPECIALTY MEDI-CAL CARVED OUT BENEFITS 1. Inpatient psychiatric care 1. Mental health services (rehabilitation and 2. Psychiatric testing/assessment care plan development) 3. Outpatient psychiatry 2. Day treatment intensive and day rehabilitation 4. Therapy (group and individual) 5. Partial hospitalization program and intensive outpatient program (IOP) 6. Pharmacy 3. Crisis intervention and crisis stabilization 4. Adult Residential treatment services 5. Crisis residential treatment services 6. Targeted Case Management 7. Alcohol misuse counseling in primary care 7. Crossover claim for psychiatric inpatient 8. Alcohol and/or drug services in intensive hospital services outpatient treatment center 8. Methadone maintenance therapy 9. Detoxification 9. Day care rehabilitation 10. Naltrexone treatment for narcotic 10. Outpatient individual and group counseling dependence 11. Perinatal residential services BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
20 Cal MediConnect BH Coordination BH COORDINATION LOCAL MOU 1. Roles and responsibilities 2. Care coordination Behavioral Health Care Management Team (BHCMT) Interdisciplinary Care Team 3. Process for information i exchange 4. Shared financial accountability strategies BEACON S ROLE 1. Assessment and lead care management for primary BH members 2. Collaboratively develop individual care plans. 3. Credential & Contract with networks (including county & countycontracted CBOs) 4. Authorize services & pay claims 5. Coordinated care teams and lead data exchange with county BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
21 Agenda 1. Beacon s Point of View 2. Understanding the Behavioral Health Needs of Dual Eligibles A. Serious Mental Illness and Substance Use Disorder B. Chronic Illness and Behavioral Health Comorbidity C. Understanding the Full Scale of MR/DD Involvement in the Demo 3. A Few Parting Thoughts ht BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
22 Ensuring improved behavioral health management under the Duals demonstration requires a multi-faceted approach LESSONS FOR IMPLEMENTATION OF DUALS DEMONSTRATIONS 1. Focus BH is only one of many areas in which health plans must execute Disproportionate importance with regard to complexity and cost Identify BH leadership, ensure they are at the table 2. Collaboration and Scale Providers have limited bandwidth for engagement Consistency breeds strong outcomes Group purchasing may provide a simple solution and mitigate adverse selection 3. Local Knowledge Every local system of care has its own providers, services, and capacity Variation state-to-state to and often county-to-county to One-size does not fit all 4. Pace: Crawl, Walk, Run BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 26,
Managed Medi-Cal Behavioral Health Benefits. Alliance Board Meeting October 23, 2013
Managed Medi-Cal Behavioral Health Benefits Alliance Board Meeting October 23, 2013 Purpose Discuss role of ACA in expanding benefits Review philosophy of integrated health care Review State policy process
Beacon Health Strategies Primary Care Provider Training
Beacon Health Strategies Primary Care Provider Training REFERRAL AND RESOURCE GUIDE Updated June 2015 BEACON HEALTH STRATEGIES beaconhealthstrategies.com June 15, 2015 1 Agenda 1. Review Medi-Cal Managed
MEDI-CAL MANAGED CARE OVERVIEW
MEDI-CAL MANAGED CARE OVERVIEW July 2018 Sandy Damiano, PhD Deputy Director DHS Primary Health Eligibility & Enrollment Apply for Medi-Cal year round: County Department of Human Assistance (DHA) Online,
Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training
Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan Effective January 1, 2015, Anthem Blue Cross
SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery. o--,-.m-a----,laa~-d-c~~~~~~~~~~-
Page 11 of 8 SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery Departmental Policy and Procedure Section Sub-section Alcohol and Drug Program (ADP) Policy Drug Medi-Cal
Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver
Drug Medi-Cal Organized Delivery System (DMC-ODS) Waiver Medi-Cal Managed Care Advisory Committee Uma K. Zykofsky, LCSW Director, Behavioral Health Services Alcohol & Drug Administrator Waiver Authority
Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012
Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6
Health Plans and LTSS. NASUAD April 20,2011 Mary Kennedy, ACAP Medicare Vice President 1
Health Plans and LTSS NASUAD April 20,2011 Mary Kennedy, ACAP Medicare Vice President 1 Agenda ACAP Background Health Plan Interest in LTSS Developing Plan Capacity Relationship Building What should states
Improving Service Delivery for Medicaid Clients Through Data Integration and Predictive Modeling
Improving Service Delivery for Medicaid Clients Through Data Integration and Predictive Modeling Getty Images David Mancuso, PhD July 28, 2015 1 The Medicaid Environment Program costs are often driven
Medical Care Meets Long-Term Services and Supports (LTSS)
Medical Care Meets Long-Term Services and Supports (LTSS) Cal MediConnect Providers Summit January 21, 2015 Moderator: Rebecca Malberg von Lowenfeldt, Director LTSS Practice, Harbage Consulting www.chcs.org
Model Of Care: Care Coordination Interdisciplinary Care Team (ICT)
Cal MediConnect 2017 Model Of Care: Care Coordination Interdisciplinary Care Team (ICT) 2017 CMC Annual Training Learning Objectives Define the L.A. Care Cal MediConnect (CMC) Model of Care Describe the
Medicaid Managed Care Readiness For Agency Staff --
Medicaid Managed Care Readiness 101 -- For Agency Staff -- To Understand: Learning Objectives Basic principles of Managed Care as a payment vehicle for health care services The structure of the current
Medicaid Reform: The Opportunities for Home and Community Based Providers. All Rights Reserved
Medicaid Reform: The Opportunities for Home and Community Based Providers ILS Background & Experience Care Management Company founded in 2001 Focuses on Duals, Medicaid ABD and Managing Medicaid Long term
Drug Medi-Cal Organized Delivery System
Drug Medi-Cal Organized Delivery System Presented by Elizabeth Stanley-Salazar, MPH CMS Approval of DMC-ODS Waiver under ACA August 13, 2015 Pathway to Parity 2010 President Obama Signs the Affordable
SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Program Grantees: Part 2
SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Program Grantees: Part 2 Ken Bachrach, Ph.D., Clinical Director Jim Sorg, Ph.D., Director of Care Integration and IT Tarzana Treatment Centers
June 25, Shamis Mohamoud, David Idala, Parker James, Laura Humber. AcademyHealth Annual Research Meeting
Evaluation of the Maryland Health Home Program for Medicaid Enrollees with Severe Mental Illnesses or Opioid Substance Use Disorder and Risk of Additional Chronic Conditions June 25, 2018 Shamis Mohamoud,
Coordinated Care Initiative (CCI) ADVANCED I: Benefit Package and Consumer Protections
July 29, 2014 Coordinated Care Initiative (CCI) ADVANCED I: Benefit Package and Consumer Protections Amber Cutler, Staff Attorney National Senior Citizens Law Center www.nsclc.org 1 The National Senior
Understanding the Initiative Landscape in Medi-Cal. IHA Stakeholder Meeting September 23, 2016 Sarah Lally, Project Manager
Understanding the Initiative Landscape in Medi-Cal IHA Stakeholder Meeting September 23, 2016 Sarah Lally, Project Manager Agenda Welcome / Introduction Sarah Lally, Project Manager Inland Empire Health
The Money Follows the Person Demonstration in Massachusetts
The Money Follows the Person Demonstration in Massachusetts Use of Concurrent 1915(b)(c) Waivers to Serve Elders and Adults with Disabilities Transitioning from Long-Stay Facilities HCBS Conference Arlington,
California s Duals Demonstration: A Transparent and Inclusive Stakeholder Process. Peter Harbage President Harbage Consulting
California s Duals Demonstration: A Transparent and Inclusive Stakeholder Process Peter Harbage President Harbage Consulting 1 Today s Agenda 1. California Context 1. California s Stakeholder Engagement
2015 CMS National Training Program Workshop Monika Vega, MSW Harbage Consulting, LLC Representing California s Department of Health Care Services
California s Coordinated Care Initiative 2015 CMS National Training Program Workshop Monika Vega, MSW Harbage Consulting, LLC Representing California s Department of Health Care Services Roadmap Nationally
Overview and Current Status of Program of All-inclusive Care for the Elderly (PACE) Dr. Cheryl Phillips, M.D. Chief Medical Officer, On Lok Lifeways
Overview and Current Status of Program of All-inclusive Care for the Elderly (PACE) Dr. Cheryl Phillips, M.D. Chief Medical Officer, On Lok Lifeways 1 What is On Lok? Original Vision: Help the low-income
30-day Hospital Readmissions in Washington State
30-day Hospital Readmissions in Washington State May 28, 2015 Seattle Readmissions Summit 2015 The Alliance: Who We Are Multi-stakeholder. More than 185 member organizations representing purchasers, plans,
White House Parity Task Force Provides Guidance on Mental Health and Substance Use Disorder Parity Law
White House Parity Task Force Provides Guidance on Mental Health and Substance Use Disorder Parity Law On October 27, 2016, The White House Mental Health and Substance Use Disorder Parity Task Force (the
Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018
Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify
MEDICARE COVERAGE SUMMARY: OUTPATIENT PSYCHIATRIC AND PSYCHOLOGICAL SERVICES
OPTUM MEDICARE COVERAGE SUMMARY: OUTPATIENT PSYCHIATRIC AND PSYCHOLOGICAL SERVICES MEDICARE COVERAGE SUMMARY: OUTPATIENT PSYCHIATRIC AND PSYCHOLOGICAL SERVICES Guideline Number: Effective Date: April,
Summary of California s Dual Eligible Demonstration Memorandum of Understanding
April 2013 Summary of California s Dual Eligible Demonstration Memorandum of Understanding The Nation s Largest, Most Aggressive Plan for Integration On March 27, 2013, the Centers for Medicare and Medicaid
Coordination of Physical and Mental Health Care SECTION 11: COORDINATION OF PHYSICAL AND MENTAL HEALTH CARE
SECTION 11: COORDINATION OF PHYSICAL AND MENTAL HEALTH CARE 11.0 CalViva Health Medi-Cal Managed Care Plan 11.0.1 Referral for Mental Health Services A CalViva Health Medi-Cal beneficiary of Fresno County
CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team. Physician Group Webinar Series
CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team Physician Group Webinar Series Today s Webinar This webinar is part of a series designed specifically for physicians.
Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery
Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery Betty Shephard Lead VP, Care Management HealthCare Partners National Health Policy Forum October 19, 2012 HCP
Mild-to-Moderate Mental Health Coverage in Medi-Cal: The Challenge and Promise of Coordination between Counties and Health Plans
Advancing innovations in health care delivery for low-income Americans Mild-to-Moderate Mental Health Coverage in Medi-Cal: The Challenge and Promise of Coordination between Counties and Health Plans December
Medicaid Innovation Accelerator Program (IAP)
Medicaid Innovation Accelerator Program (IAP) HCBS Conference IAP Session: Where We ve Been and Where We re Going September 2, 2015 Karen LLanos, David Shillcutt, & Michael Smith Center for Medicaid and
California s Coordinated Care Initiative: An Update
California s Coordinated Care Initiative: An Update Background On April 1, 2014, health plans in selected counties began enrolling beneficiaries as part of the Coordinated Care Initiative. This fact sheet
Best Practices for Integrated Care Teams
Best Practices for Integrated Care Teams Cal MediConnect Providers Summit January 21, 2015 Moderator: Alexandra Kruse, Senior Program Officer, CHCS www.chcs.org Interdisciplinary Care Teams Providers have
Readmission Prevention Programs. Vice President, Strategy & Development June 6, 2017
Readmission Prevention Programs Paul M. Duck @paulduck Vice President, Strategy & Development June 6, 2017 About Beacon Health Options Headquartered in Boston; more than 70 locations in the US and UK 5,000
Acute Crisis Units. Shelly Rhodes, Provider Relations Manager
Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation
AETNA MEDICAID. Respondent Demonstration to the Oklahoma Health Care Authority Care Coordination for the Aged, Blind, and Disabled.
AETNA MEDICAID Respondent Demonstration to the Oklahoma Health Care Authority Care Coordination for the Aged, Blind, and Disabled August 26, 2015 Copyright Administrators, LLC 2015 Presenters Pam Sedmak
California s Coordinated Care Initiative
California s Coordinated Care Initiative Sarah Arnquist Harbage Consulting Presentation on 4/22/13 2 Overview Federal and State Movement toward Coordinated Care Update on California s Coordinated Care
The Current State of Behavioral Health Opportunities for Integration and Certified Community Behavioral Health Clinics (CCBHC)
Behavioral Health Transition to Managed Care Update The Current State of Behavioral Health Opportunities for Integration and Certified Community Behavioral Health Clinics (CCBHC) APRIL 2015 The Current
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is 1 of 15 states that has signed a Memorandum of Understanding
MEDI-CAL MANAGED CARE OVERVIEW
MEDI-CAL MANAGED CARE OVERVIEW September 2016 Sandy Damiano, PhD Deputy Director DHHS Primary Health Eligibility & Enrollment Open year round Based on income and family size Simplified procedures Income
Optum/OptumHealth Behavioral Solutions of California Facility Network Request Form / Credentialing Application
Optum/OptumHealth Behavioral Solutions of California Is the facility currently in the Optum network? Yes No Acceptance into the Optum/OptumHealth Behavioral Solutions of California (Optum) provider network
OneCare Model of Care
OneCare Model of Care Note: Content of this course was current at the time it was published. As Medicare policy changes frequently, check with your immediate supervisor regarding recent updates. 2018 Learning
DRUG MEDI-CALWAIVER STAKEHOLDER FORUM
October 27, 2015 DRUG MEDI-CALWAIVER STAKEHOLDER FORUM Patrick Zarate Division Manager, Alcohol & Drug Programs Objectives for Today Learn About the Drug Medi-Cal Organized Delivery System waiver Gain
UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS
UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS November 18, 2013 NYS OMH Behavioral Health Transition 2 Key MRT initiative to move fee-for-service populations and services into managed
Rehabilitation Research and Training Center on Aging with Developmental Disabilities Department of Disability and Human Development University of Illinois at Chicago http://www.rrtcadd.org/ By 2010 Managed
Santa Clara County, California Medicare- Medicaid Plan (MMP)
Santa Clara County, California Medicare- Medicaid Plan (MMP) Behavioral health overview topics Topics covered: o Behavioral health (BH) covered services overview o BH noncovered services o Early and Periodic
L.A. COUNTY COORDINATED CARE INITIATIVE (CCI) Stakeholder Workgroup MEETING MINUTES
L.A. COUNTY COORDINATED CARE INITIATIVE (CCI) Stakeholder Workgroup MEETING MINUTES Wednesday, April 15, 2015; 1-3 p.m. Braille Institute 741N. Vermont Ave., Los Angeles, CA 90029 Facilitator: Susi Rodriguez
Implementing Coordinated Care for Dual Eligibles: Conflicts and Opportunities Prepared by James M. Verdier Mathematica Policy Research
Implementing Coordinated Care for Dual Eligibles: Conflicts and Opportunities Prepared by James M. Verdier Mathematica Policy Research Workshop on Effectively Integrating Care for Dual Eligibles World
Connecting Value-Based Services to Whole Person Care
Advancing innovations in health care delivery for low-income Americans Connecting Value-Based Services to Whole Person Care Caitlin Thomas-Henkel, Senior Program Officer The National Council December 6,
Whole Person Care Pilot Update
Whole Person Care Pilot Update Kathleen A. Clanon, MD Alameda County Board of Supervisors Health Committee March 14, 2016 Whole Person Care Pilot in Alameda County Lead County Must match 50% Funding Statewide,
FACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is one of 12 states that has signed a Memorandum of Understanding
Behavioral Health Concurrent Review
Today s date: Contact information Level of care: psych Anthem Blue Cross and Blue Shield Healthcare Solutions Please fax to 1-877-434-7578 on the last authorized day. detox chemical dependency Psychiatric
Michigan Health Link Integrated Care Dual Eligible Pilot. Nora Barkey MDCH Kyleen Gray SWMBH Roxanne Perry Audrey Smith DWMHA
Michigan Health Link Integrated Care Dual Eligible Pilot Nora Barkey MDCH Kyleen Gray SWMBH Roxanne Perry Audrey Smith DWMHA 1 Today s Agenda Welcome and Introductions Nora Barkey MI Health Link Overview
Medicare: 2018 Model of Care Training
Medicare: 2018 Model of Care Training Training Objectives This course will describe how Centene and its contracted providers work together to successfully deliver the duals Model of Care (MOC) program.
Demonstration to Integrate Care for Dual Eligible Individuals (One Care - CCA) CY 2016 Final Rate Report February 26, 2016
MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2016 rates for the Massachusetts Demonstration to
The benefits of the Affordable Care Act for persons with Developmental Disabilities
Tuesday, 2:30 2:00, B5 The benefits of the Affordable Care Act for persons with Developmental Disabilities Objectives: Notes: Audrey E. Smith, MPH 33-402-9608 Asmith2@waynecounty.com. Identify effective
Cal MediConnect Providers Summit Wednesday, January 21, :00 AM - 4:00 PM 555 West Temple Street Los Angeles, CA
Speaker Bios Breakout Session 1A: Best Practices for Integrated Care Teams Joseph Garcia Joseph Garcia is the Chief Operating Officer for Community Health Group, a not for-profit health plan in San Diego
Patient-Centered Primary Care
Patient-Centered Primary Care Greg Moody, Director Office of Health Transformation July 30, 2014 www.healthtransformation.ohio.gov Agenda 1. Health System Challenges 2. Health System Trends in Primary
Improving Care for Dual Eligibles through Health IT
Los Angeles, October 31, 2012 Presentation Improving Care for Dual Eligibles through Health IT The National Dual Eligibles Summit Duals Market is sizable Medicare and Medicaid Populations Medicaid Total
Alcohol Drug & Mental Health Services INPATIENT SERVICES
Alcohol Drug & Mental Health Services INPATIENT SERVICES WHEN MUST COUNTY FUND MENTAL HEALTH SERVICES? 2 INPATIENT INCREASES DRIVERS Lack of psychiatric beds state & nation Increase in patients Court Ordered
Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note:
Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note: If you are a Medicaid beneficiary and have a serious mental illness, or serious emotional disturbance, or developmental
Coordinated Care Initiative Information for Advocates
Coordinated Care Initiative Information for Advocates 1 Medicare and Medi-Cal Today What You Will Learn Your Health Care Coverage Options Cal MediConnect Medi-Cal Managed Care Plan Who Can Join Benefits
Division of Mental Health, Developmental Disabilities & Substance Abuse Services NC Mental Health and Substance Use Service Array Survey
Table 1 Service Name Include any subcategories of service on a separate line In Table 2, please add service description and key terms Outpatient Treatment Behavioral Health Urgent Care (a type of outpatient)
Medi-cal Part 2 Provider Manual For Soc Billing Instructions
Medi-cal Part 2 Provider Manual For Soc Billing Instructions Medi-Cal Provider Manual Contents 7,265 Bytes How to Use This Manual (0Bhwtouse) 18,979 Bytes Contents (Part 2 Medi-Cal Billing and Policy):
Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination
Innovating Predictive Analytics Strengthening Data and Transfer Information at Point of Care to Improve Care Coordination November 15, 2017 RRHA Healthcare Innovations Conference Agenda Arnot Health Overview
Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States
Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States Erica L. Reaves, Policy Analyst State Variation in Long-Term Services and Supports: Location, Location, Location National
Molina Healthcare of Ohio Behavioral and Mental Health Molina Dual Options MyCare Ohio 2014
Molina Healthcare of Ohio Behavioral and Mental Health Molina Dual Options MyCare Ohio 2014 1 Headline Goes Here Mental Health/Behavioral Health Services Cont. Mental and emotional well-being is essential
Advanced Nurse Practitioner Supervision Policy
Advanced Nurse Practitioner Supervision Policy Supervision requirements for nurse practitioners (NP) fall into two basic categories: Full practice and collaborative practice, which requires a Collaborative
Practice Advancement Initiative (PAI) Using the ASHP PAI Ambulatory Care Self-Assessment Survey
Practice Advancement Initiative (PAI) Using the ASHP PAI Ambulatory Care Self-Assessment Survey Jodie Elder, PharmD, BCPS September 14, 2017 Objectives List the key components of the Practice Advancement
A Snapshot of Uniform Assessment Practices in Managed Long Term Services and Supports
A Snapshot of Uniform Assessment Practices in Managed Long Term Services and Supports California Department of Health Care Services, Home and Community Based Services Universal Assessment Workgroup February
Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees
TECHNICAL ASSISTANCE BRIEF J UNE 2 0 1 2 Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees I ndividuals eligible for both Medicare and Medicaid (Medicare-Medicaid
Innovative Ways to Finance Mental Health Services in a Primary Care Setting
Innovative Ways to Finance Mental Health Services in a Primary Care Setting Prepared by: Kathleen Reynolds, MSW, ACSW Executive Director And Virginia Koster, MSW, ACSW Integrated Initiatives Coordinator
Alliance Behavioral Healthcare Level of Care Guidelines for State Funded Adult Mental Health and Substance Abuse Services
Alliance Behavioral Healthcare of Care Guidelines for State Funded Adult Mental Health and Substance Abuse s Mental Health (Effective 10/1/2012) The levels of care criteria provide a framework for the
UPDATE ON THE IMPLEMENTATION OF CALIFORNIA S COORDINATED CARE INITIATIVE
UPDATE ON THE IMPLEMENTATION OF CALIFORNIA S COORDINATED CARE INITIATIVE Eileen Kunz Chief of Government Affairs & Compliance On Lok Carol Hubbard Executive Director of Home & Community Services St. Paul
October 5 th & 6th, The Managed Care Technical Assistance Center of New York
October 5 th & 6th, 2015 The Managed Care Technical Assistance Center of New York What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health
Neighborhood INTEGRITY MMP RIPIN
Neighborhood INTEGRITY MMP RIPIN 9.16.16 Agenda Overview of INTEGRITY Coverage Documents Carved Out Benefits Continuity of Care Provider Directory and Formulary INTEGRITY Overview NEIGHBORHOOD: History
Notice of Adverse Benefit Determination Training
Notice of Adverse Benefit Determination Training Santa Cruz County Behavioral Health Quality Improvement Mental Health Plan / Drug Medi-Cal Plan From here-out to be referred to as Plans 05/1/18 Goal Training
Evidence Based Practice: The benefits and challenges of behavioral health services in primary care settings.
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Evidence Based Practice: The benefits and challenges of behavioral health services in primary care settings.
CHILDREN S MENTAL HEALTH BENCHMARKING PROJECT SECOND YEAR REPORT
CHILDREN S MENTAL HEALTH BENCHMARKING PROJECT SECOND YEAR REPORT APPENDICES APPENDI I DATA COLLECTION INSTRUMENT APPENDI II YEAR 2 DATA SPECIFICATIONS APPENDI III RESPONDENT LIST PREPARED BY: Dougherty
Drug Medi-Cal Organized Delivery System Demonstration Waiver
Drug Medi-Cal Organized Delivery System Demonstration Waiver All County Orientation to Standard Terms and Conditions & Fiscal Provisions Presentation by DHCS and Harbage September 28, 2015 Overview of
OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview
OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview 2018 1 Learning Objectives After completing this module you will: Have gained an awareness and knowledge about
Navigating New York State s Transition to Managed Care
Navigating New York State s Transition to Managed Care December 3, 2014 Mary McKernan McKay, Ph.D Andrew F. Cleek, Psy.D. Meaghan E. Baier, LMSW Agenda Introduction of the Managed Care Technical Assistance
Systems Changes to Maximize the Impact of Supportive Housing on Ending Homelessness
Systems Changes to Maximize the Impact of Supportive Housing on Ending Homelessness Matthew Doherty, Director of National Initiatives August 14, 2014 Roles of USICH Coordinates the Federal response to
HEALTH CARE TEAM SACRAMENTO S MENTAL HEALTH CRISIS
Team Leader/Issue Contact: HEALTH CARE TEAM Laura Niznik Williams, UC Davis Health System, (916) 276-9078, ljniznik@ucdavis.edu SACRAMENTO S MENTAL HEALTH CRISIS Requested Action: Evaluate the Institutions
Behavioral Wellness A System of Care and Recovery
., SANTA BARBARA COUNTY DEPARTMENT OF Behavioral Wellness A System of Care and Recovery P a g e \ 1 of 6 Departmental Policy and Procedure Section Sub-section Policy Alcohol and Drug Program (ADP) Drug
Primary Care/Behavioral Health INTEGRATION. Neal Adams, MD MPH Deputy Director California Institute for Mental Health
Primary Care/Behavioral Health INTEGRATION Neal Adams, MD MPH Deputy Director California Institute for Mental Health Why Integrate BH & PC? BH disorder burden is great BH and physical health problems are
Accomplishments and Challenges in Medicaid Mental Health Services
Accomplishments and Challenges in Medicaid Mental Health Services Innovation, Financing and Change June 5, 2008 Richard H. Dougherty, Ph.D. Accomplishments There has been significant reductions in state
Framework for Post-Acute Care: Current and Future Issues for Providers
Framework for Post-Acute Care: Current and Future Issues for Providers Alan G. Rosenbloom Alliance for Quality Nursing Home Care March 2012 Overview of Presentation Post-Acute Care: Background and Trends
Medi-Cal Managed Care Advisory Committee Split Benefit Overview
Medi-Cal Managed Care Advisory Committee Split Benefit Overview Division of Mental Health Services Stephanie Kelly, MS, LMFT October 23, 2017 1 Molina Anthem Blue Cross Health Net Kaiser Permanente United
Special Needs Program Training. Quality Management Department
10/26/2017 1 Special Needs Program Training Quality Management Department 10/26/2017 2 Special Needs Plan (SNP) Overview 3 SNP Overview Medicare Advantage (MA) plans were created by the Medicare Modernization
Reducing Medicaid Readmissions
Reducing Medicaid Readmissions Webinar 3: High Impact Medicaid-Specific Strategies Amy E. Boutwell, MD MPP Co-Principal Investigator AHRQ Reducing Medicaid Readmissions Project March 25, 2015 Overview:
Transitioning to Community Services: HARPS, Health Homes and SPOA
Transitioning to Community Services: HARPS, Health Homes and SPOA P R E S E N T E R : G L E N N L I E B M A N, C EO Mental Health Association in New York State, Inc. Brief History of Health and Recovery
Preparing California s Community-Based Organizations to Partner with the Health Care Sector by Building Business Acumen:
Preparing California s Community-Based Organizations to Partner with the Health Care Sector by Building Business Acumen: Case Studies from the First Cohort of Linkage Lab Grantees August 2015 Authors:
Lessons Learned from the Dual Eligibles Demonstrations. Real-Life Takeaways from California and Other States
Lessons Learned from the Dual Eligibles Demonstrations 1 May 28, 2015 Real-Life Takeaways from California and Other States Introductions Toby Douglas Consultant, MAXIMUS Former Director of California Department
Fallon Total Care Provider Orientation
Fallon Total Care Provider Orientation 2014 AGENDA Introductions Fallon Total Care Member enrollment Model of Care Doing business with FTC Provider Tools Q&A 2 About Fallon Total Care Fallon Total Care
kaiser medicaid and the uninsured commission on O L I C Y
P O L I C Y B R I E F kaiser commission on medicaid and the uninsured 1330 G S T R E E T NW, W A S H I N G T O N, DC 20005 P H O N E: (202) 347-5270, F A X: ( 202) 347-5274 W E B S I T E: W W W. K F F.
Joining Passport Health Plan. Welcome IMPACT Plus Providers
Joining Passport Health Plan Welcome IMPACT Plus Providers Agenda Passport Behavioral Health Services Overview Steps to Joining Passport Health Plan s Network Getting a Medicaid Number Enrolling in the
Template Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s)
Template Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s) Updated Draft February 14, 2013 In the duals demonstration, participating
Behavioral Health Services in Ohio Hospitals Ohio Hospital Association. Ohio Department of Medicaid January 23, 2018
Behavioral Health Services in Ohio Hospitals Ohio Hospital Association Ohio Department of Medicaid January 23, 2018 1 Outpatient Hospital Behavioral Health Services 2 OPHBH Services in Hospitals Outpatient