From HARPs to DSRIP to VBP: What Do They Mean To You? North Country NYAPRS 2016 Winter Forum Harvey Rosenthal Executive director 1
New York Association of Psychiatric Rehabilitation Services (NYAPRS) A peer-led statewide coalition of people who use and/or provide community mental health recovery services and peer supports that is dedicated to improving services, social conditions and policies for people with psychiatric disabilities by promoting their recovery, rehabilitation, rights and community integration and inclusion. harveyr@nyaprs.org www.nyaprs.org 2
How s Your Healthcare Now? Health Behavioral Health: mental health and addiction related conditions Social Determinants: housing, employment, social support, cultural competence 3
Affordable Care Act: National Healthcare Reform The Triple Aim: improving outcomes, improving quality, reducing cost Key features: expansion of Medicaid and managed care, behavioral health parity, home and community based services including self-directed care 4
Affordable Care Act State Healthcare Reform Focus on Coordination Integrated physical and behavioral healthcare Outcomes Prevention Wellness Hospital diversion Individualized care 5
New York State s Challenge $54 billion Medicaid program with 5 million beneficiaries 20% (1 million beneficiaries) use 80% of these dollars: hospital, emergency room, medications, longtime chronic services o Over 40% with behavioral health conditions 20% of those discharged from general hospital BH units are readmitted within 30 days: NYS avoidable Medicaid hospital readmissions: $800 million to $1 billion annually 70% with behavioral health conditions; 3/5 of these admissions for medical reasons 6
The Mantras of the MRT From fee for service to outcome based care Diversion from emergency room and inpatient hospital use 7
NYS Medicaid Redesign Managed Care for All Universal Access to High Quality Primary Care; Integrate physical and BH services Targeting the Social Determinants of Health Health Homes: Teams of providers working together to coordinate care for Medicaid consumers who use lots of services
Managed Care Plans Now Offer Medicaid funded BH Services Inpatient - SUD and MH Clinic SUD and MH Personalized Recovery Oriented Services Assertive Community Treatment Partial Hospitalization Comprehensive Psychiatric Emergency Program Targeted Case Management Opioid treatment Outpatient chemical dependence rehabilitation Rehabilitation supports for Community Residences (phased in in 2016) 9
Health and Recovery Plans Designed for people with more extensive mental health and/or substance use related conditions Covers all benefits provided by Medicaid Managed Care Plans, including expanded behavioral health benefits Also provides additional Home and Community Based Services to help people live better, go to school, work and be part of the community 10
Who s Eligible for a HARP? SSI Recipient ACT, TCM, PROS, PMHP in past year 30+ days of psych hospitalization, 3+ admissions or 3+ month stays in OMH housing over the past 3 years 60+ days in OMH psych center Incarceration w BH treatment past 4 years 2+ SUD ER visits, detox stays for SU related inpatient stays
Who s Not Eligible for HARPs? Have both Medicaid and Medicare Live in a nursing home Are in a Managed Long Term Care Plan Are under age 21 Have services from the Office for People with Developmental Disabilities (OPWDD) 12
Health Plans in the North Country Empire Blue Cross Excellus Health Plan Fidelis Care New York HealthNow NY (BlueCross BlueShield) MVP Health Care CDPHP 13
HARP Beneficiaries Care is Managed via Health Homes Health homes are a home for your healthcare Everyone gets a care coordinator who conducts an assessment and works with each individual to develop their own goal and service plan which are intended to be shared electronically with all providers and social services that support them Health home responsibilities include: Active engagement 24-7 response Focus on well coordinated discharge and treatment planning What are your experiences with Health Home Care Management? 14
Adirondack Health Institute Families First In Essex Adirondack Medical Center St Joseph s Rehab Center Conifer Park Four Winds Mental Health Association In Essex County St. Mary's Healthcare Adirondack Community Action Program 15
Adirondack Health Institute Behavioral Health Services of Glens Falls Hospital Catholic Charities Citizen Advocates/North Star Behavioral Health Community Health Center of The North Country Council For Prevention Of Alcohol And Substance Abuse Essex County Coordinated Services/NY Connects Essex County High Peaks Hospice and Palliative Care Friendship House 16
Adirondack Health Institute Hamilton County Behavioral Health Services Hudson Headwaters Health Network Ryan White Program Liberty House Foundation NY Connects Saratoga County Alcohol And Substance Abuse Saratoga County Mental Health Center Southern Adirondack Independent Living Center Transitional Services Association 17
Adirondack Health Institute Voices Of The Heart Warren County High Peaks Hospice And Palliative Care Warren County Social Services Warren Hamilton County Office For The Aging Warren Washington Association For Mental Health, Inc Aids Council Of Northeastern New York Lakeside House, Inc. High Peaks Hospice And Palliative Care, Inc. 18
Health Homes Make Referrals for Medicaid funded Recovery Supports Rehabilitation Psychosocial Rehabilitation Residential Supports Habilitation Non- Medical Transportation Manage Stress, Prevent Crises Short-Term Crisis Respite Intensive Crisis Intervention Employment Support Services Prevocational Transitional Employment Intensive Supported On-going Supported Educational Support Services Peer Supports Family Support and Training Self-Directed Care (2017) 19
NYS Medicaid Redesign Response: Managed Integrated BH & Medical Care OASAS STATE MEDICAID AGENCY DOH OMH Health and Recovery Plan (HARP) Health and Recovery Plan (HARP) Payers Health and Recovery Plan (HARP) Health Home Team Health Home Team: Provider Network Health Home Team Health Home Team = Physical and/or behavioral health care provider 20
NYS Medicaid Waiver $7.1 billion over 5 years for DSRIP $650 million to play for Home and Community Based Services 21
Delivery System Reform Incentive Payment Program (DSRIP) Promotes community-level collaborations that improve the quality and outcomes of care, while achieving a 25% reduction in avoidable hospital use from 2015-20. Safety net providers are expected to collaborate to implement innovative projects focusing on system transformation and population health improvement. All DSRIP funds will be based on performance linked to achievement of project milestones. 22
Adirondack Health Institute Counties served: Clinton, Essex, Franklin, Fulton, Hamilton, St. Lawrence, Saratoga, Warren, Washington Attribution for Performance: 81,090 Total Award Dollars: $186,715,496 23
Mental Health Services Behavioral Health Services North Berkshire Farm Center and Services for Youth Capital District Psychiatric Center Catholic Charities of Saratoga, Warren And Washington Counties Clinton County Community Services Board Essex County Mental Health Liberty House Foundation Mental Health Association in Essex County 24
Mental Health Services Mental Health Association in Fulton And Montgomery Counties Mental Health Association of Franklin County Northern Rivers Family Services PEOPLe, Inc. St. Lawrence Psychiatric Center Saratoga County Mental Health Center Warren Washington Association for Mental Health 25
Addiction Recovery Services Alcohol & Substance Abuse Prevention Council of Saratoga County Champlain Valley Family Center for Drug Treatment and Youth Services Citizen Advocates Hospitality House St. Joseph's Addiction, Treatment and Recovery Centers The Substance Abuse Prevention Team of Essex County Saint Lawrence Addiction Treatment Center Seaway Valley Council for Alcohol/Substance Abuse Prevention 26
Nursing Homes Adirondack Tri-County Nursing and Rehabilitation Center Capital Living & Rehabilitation Centres Centers for Specialty Care Washington Center for Rehab & Specialty Healthcare Clinton County Nursing Home Fort Hudson Home Health, Home Care and Nursing Center Moses Ludington Nursing Home Highland Nursing Home Wells Nursing Home Wesley Health Care Center 27
Medical Care Adirondack Health Adirondack Medical Practice St. Lawrence Health System Hudson Headwaters Health Network Newcomb Health Center North Country Physicians Organization Belvedere Health Services 28
Hospitals Alice Hyde Medical Center Champlain Valley Physicians Hospital Medical Center Nathan Littauer Hospital Elizabethtown Community Hospital Glens Falls Hospital 29
Developmental Disability Services Center for Disability Services NYSARC, Essex, Clinton, Warren, Washington, St Lawrence, Albany Counties CWI United Cerebral Palsy Association Of The North Country Lexington Community Services. Living Resources 30
Services for the Aging Clinton County Office for the Aging Essex County Office for the Aging Hospice And Palliative Care Of St. Lawrence Valley Hospice Of The North Country, Inc. Mountain Valley Hospice 31
Homecare Greater Adirondack Home Aides North Country Home Services, Inc. Visiting Nurse Service Of Northeastern New York VNA Home Health Warren County Health Services Certified Home Health Agency Washington County Public Health Nursing Service 32
Other Aids Council of Northeastern New York Community Maternity Services Planned Parenthood 33
AHI BH Projects Implementation of Patient Activation Activities: an individual s knowledge, skills, ability, and willingness to manage his or her own health and health care. Development of Withdrawal Management: To develop withdrawal management services SUDs within community-based addiction treatment programs that allow rapid transfer into the associated SUD services 34
AHI BH Projects Integration of Primary and Behavioral Health Services can serve to identify behavioral health needs early, to ensure treatments for medical and behavioral health conditions are compatible and to de-stigmatize treatment for behavioral health needs. Care for all conditions is delivered under one roof by known health care providers. 35
AHI BH Projects Behavioral Health Community Crisis Stabilization Services to allow access to appropriate level of service and providers, supporting a rapid de-escalation of the crisis. Strengthen Mental Health and Substance Abuse Infrastructure across Systems: To collaborate with traditional and nontraditional providers to promote mental, emotional, behavioral (MEB) wellbeing 36
Value-Based Payment Reform Required to ensure long term sustainability of DSRIP investments By waiver Year 5, all MCOs must employ non-feefor-service payment systems that reward value over volume for at least 90% of their provider payments Required to ensure that value-destroying care patterns (avoidable admissions, ED visits, etc) do not simply return when the DSRIP funding stops in 2020 37
VBP: Sharing in the Savings To share in savings, you eventually need to take on risk Partnering with other providers is essential to being able to take on risk We need to join forces with other providers to have enough cash reserves to take on Level 2 risk, which applies 90% of the savings to reward effective providers. 38
Value-Based Propositions Proposals to: Integrate physical and behavioral healthcare get ahead of relapse and readmissions and support crisis stabilization promote mental, emotional and behavioral (MEB) well-being in communities; prevention and strengthening MH/SA infrastructure across system 39
Value-Based Propositions An example NYAPRS proposed to provide peer bridger services aimed at helping people with serious mental health and addiction related conditions to: Reduce avoidable emergency room and inpatient visits by 40% Increased self-management and participation with chosen medications, services and supports NYAPRS has successfully applied this model within a managed care contract to reduce hospital use by 48% and Medicaid spend by 47% 40
NYAPRS Advocacy: Social Determinants of Health NYAPRS added OMH services and a BH focus to the list of interventions We ve urged that all Level 2 and 3 plans or providers must address at least one social determinant. We ve pushed for the state to provide infrastructure dollars and technical assistance for community based providers We ve insisted that VBP outcomes include recovery and social determinant related ones Strong emphasis on cultural competence 41
NYAPRS Advocacy: Advocacy and Engagement Development of Member Incentive Programs Creation of an Expert Group for Achieving Cultural Competence in Incentive Programs Use of Patient Reported Outcomes (PRO) Expansion of ombuds program Plan for how best to communicate VBP to consumers/members 42
If You Remember Nothing Else The world is changing from volume to value This is an opportunity for CBOs We are advocating for the right resources for CBOs to fully take advantage of this opportunity The key to the role for CBOs is ensuring the importance of measuring SDH outcomes 43
If You Remember Nothing Else We are continuously inserting and insisting on meaningful protections for and input from consumers In order to do so, CBOs must explore partnerships that improve their ability to demonstrate value (with data) and take on risk 44
NYAPRS Member Services Advocacy: HCBS Waiver/Medicaid funding for community recovery services, including rehabilitation, peer support and self-directed care; Transitional financial and technical assistance support; Safety net status for HCBS providers; Services: MSO initiative, Matrix Events: January 28-9 VBP Conference; Regional Forums; February 23 Legislative Day; April 21-22 Executive Seminar; September 14-16 Annual Conference 45