Blue Cross Blue Shield of Massachusetts Foundation Expanding Access to Behavioral Health Urgent Care

Blue Cross Blue Shield of Massachusetts Foundation Expanding Access to Behavioral Health Urgent Care 2019 Grant Program-Quick View Summary Access to behavioral health care services for patients across the full spectrum of severity remains one of the Commonwealth s greatest health care challenges. In addition, many patients with mental health issues, substance use disorders and co-occurring conditions who require immediate crisis stabilization and assessment lack access to a community-based continuum care following their immediate need. The Blue Cross Blue Shield of Massachusetts (BCBSMA) Foundation is focused on ensuring that the Commonwealth s existing behavioral health urgent care services are supported and strengthened in order to expand access to immediate crisis stabilization, as well as facilitation of timely ongoing resources and services that promote treatment and recovery. The Foundation is particularly focused on low-income and vulnerable adults having access to services provided in an environment that is most conducive to patients stabilization and recovery. The BCBSMA Foundation aims to work with community-based providers to advance a shared vision of enhancing the capacity, responsiveness, quality and scope of behavioral health urgent care (BHUC) in Massachusetts for adults while building upon the existing Emergency Services Program (ESP) system. The Foundation s goal is to support established collaborations consisting of ESPs, and other community-based affiliated providers. By funding an initial planning year, the Foundation s goal is to develop a shared vision of a model for the delivery of BHUC in the Commonwealth. We intend to support existing ESP/CP organizations abilities to provide access to 24/7/365 behavioral health crisis stabilization and assessment for adults; same-day access for acute, but not emergent care, and improve the capacity to facilitate the appropriate next level of outpatient or inpatient care based on the patients needs, and their participation in treatment decisions. The Foundation s preliminary concept of a robust BHUC system includes comprehensive on-site same-day stabilization and assessment, including short-term inpatient mental health, detox services and mobile assistance, as well as addressing co-occurring conditions; medication-assisted treatments and psychiatric prescribing; strong partnerships that ensure timely and appropriate next level of care following the crisis stabilization encounter; relationships that help to ensure diversion from hospital emergency departments (EDs); on-site peer support and recovery coaching, and additional services appropriate to the population. ESPs who are on the front-lines of delivering urgent care are certain to have an image of an improved system, and the critical gaps that need to be addressed. Funded programs will work with the Foundation during the initial planning year 1) contemplating and documenting what is needed to develop and implement an enhanced model; 2) identifying what can be built by the grantee and what can be accomplished with the right partnerships; 3) verifying the barriers and challenges to improving the system, and potential solutions, and 4) determining the appropriate milestones and measures of success during a subsequent multi-year grant program. At approximately nine months during the planning year, funded programs will be required to submit a detailed work plan for implementing the newly-developed strategy. 1

Essential Proposal Elements Applications will be accepted from existing ESPs/CPs (referred to henceforth as Providers ) Who describe in detail their current model for providing immediate 24/7/365 access to crisis stabilization and assessment to adults with mental and substance use disorders, and co-occurring conditions; Whose current programs include linkages with other essential community-based resources and institutions to ensure triage and access to timely referral to the appropriate next level of care; Who describe the necessary enhancements to their current programs to provide an array of on-site services, including medication-assisted treatment for substance addiction, on-site or on-call psychiatric prescribing, and strategies to expedite timely access to an affiliated community resource for both outpatient and in-patient treatments, including the provision of ongoing care management and support services; That serve a clearly defined geographic area through both a specific facility that provides 24/7/365 services, and mobile services anchored by a community-based Provider; Who describe the demographics of the population served, provisions for linguistic diversity, any programmatic attributes that are unique to your program based on population and/or geography; Who describe how they will address diversions from avoidable ED utilization and law enforcement encounters; That draw upon experiences and lessons learned to further identify and candidly describe challenges, barriers and deficits in the current implementation and how a planning year investment would advance their capabilities as a BHUC center; Are able to capture, analyze and report data; utilize data for continuous program improvement, and to inform opportunities for regulatory and policy changes that reduce barriers to BH urgent care and ongoing services/treatment. Foundation Activities and Technical Assistance The Foundation will retain the necessary external technical assistance resources to work with grantees to facilitate a shared vision for an enhanced BHUC system. Grantees will participate in learning communities hosted by the Foundation to share best practices, gain technical assistance from external resources, and identify opportunities for supportive Foundation-led research and policy initiatives. The Foundation will convene key state officials and experts from outside of Massachusetts to help inform the work of the grantees, as well as the broader behavioral health crisis response community. At the nine-month mark of the planning year, the Foundation-contracted resources will assist the grantees in developing a logic model and appropriate implementation phase measures and reporting requirements to determine the efficacy of the program enhancement, and to inform an evaluation plan for the subsequent multi-year grant program. Grantees will host site visits by the Foundation staff. Eligible Applicants and Selection Criteria Eligible applicants are Emergency Service Program (ESP) providers to help ensure that enhanced and integrated behavioral health urgent care is not provided outside of the current system of emergency and care coordination. ESP providers that are serving several different geographic areas of the Commonwealth may submit more than one proposal, but will only be eligible to receive one grant. Providers must describe a current or proposed clinical model that provides mental health services, substance use disorders, and co-occurring conditions. 2

Applicants must have a relationship with a hospital, or a plan to develop a partnership that helps to ensure appropriate ED utilization and behavioral health inpatient treatment. Applicants must have onsite services or referral system for comprehensive continuum of care/care management, including partnerships with primary care and medical specialists. Funding Organizations may request up to $200,000 for the planning year for six to seven organizations. Deadlines and Submission Requirements Webinar: June 22,2018 Full proposals due: August 22, 2018, 5:00 p.m. Review period, site visits and interviews: August 27 to October 11, 2018 Grantees notified: December 20, 2018 Grant Period: December 31, 2018 to December 31, 2019 3

Expanding Access to Behavioral Health Urgent Care 2019 Grant Program Guidelines Program Overview and Goal KEY DATES: Webinar: June 22, 2018 Full Proposals Due: August 22, 2018, 5 pm Site Visits/Interviews: August 27 to October 11, 2018 While there are providers across Massachusetts engaged in delivering urgent behavioral health care services to MassHealth members on a 24/7/365 basis, most agree that the system Emergency Services Program (ESP) is not adequate for the high need that persists, and that more can be done to improve timely access and continuity of care. There is no common definition or standard model of behavioral health urgent care (BHUC), and no standardized models for measures of success available to practices. However, there are indications that the current system could benefit from 1) better integration between ESPs and a wider array of community-based providers and partners that have an impact on a patient s urgent and ongoing behavioral health needs; 2) tighter linkages between ESPs, community-based providers, and hospitals to help control avoidable ED utilization and ensure longer-term care management; 3) enhanced capacity to address co-occurring conditions, and 4) wider visibility and awareness of the availability of behavioral health urgent care services to help address challenges in outpatient behavioral health access. Many people with behavioral health needs still experience access challenges, particularly following a crisis stabilization encounter when timely engagement and ongoing care management is required. The existing ESP model for immediate crisis stabilization and assessment has existed in the Commonwealth for more than 30 years, and was revamped by the Massachusetts Behavioral Health Partnership (MBHP) in 2009, in partnership with MassHealth and the Department of Mental Health (DMH) to better serve MassHealth members with mental health issues, substance use disorders, and co-occurring conditions. While the 2009 reforms improved the system, the need for access to timely comprehensive behavioral health care in Massachusetts persists -- particularly in light of the opioid crisis. Conditions dictate the need for further enhancements to BHUC that build upon the current ESPs and help to ensure patients receive appropriate next level of care following a crisis. The BCBSMA Foundation will fund a one-year planning grant for behavioral health providers currently operating as ESPs to build upon their existing models in order to provide more comprehensive urgent care services for adults, as well appropriate and timely follow-up care and ongoing treatments. The Foundation s goal is to determine and address the facilitators and the barriers to providing a more seamless, expeditious, comprehensive, and effective continuum of care for the greatest number of adults with mental health, substance use, and co-occurring needs. The Foundation will work with grantees to develop a shared vision for BHUC improvements and identify the steps needed to develop and promulgate promising practices, and advance the implementation of a strong behavioral health urgent care system in the Commonwealth. This planning year will support programmatic, operating, data management and communications expenses for six programs. The Foundation will use this time for exploration, assessment and documentation to help reveal success factors, barriers and challenges, and opportunities for improvement. The planning year will inform implementation plans for a subsequent multi-year grant program. Context There are currently 21 Emergency Services Programs (ESPs) catchment areas covering every city and town in the Commonwealth. In 2016, there were nearly 120,000 encounters provided to individuals of all ages through the ESPs. Three quarters of the individuals served were adults, and a quarter were children and youth below age 20. While 4

most of the services provided for youth took place in the community or at home, 75% of the ESP encounters for adults were provided in hospital EDs. As a result of ESP services in the ED, 63% of adults were referred for community-based outpatient services. 1 However, it is uncertain how many of these patients followed through with the referrals, how long the wait time was between the referral and first appointment, or the support services available to patients to ensure a continuum of care for all of their behavioral health needs, as well as any medical conditions that might impact their mental health or addiction status. It is also known that not all ESPs are able to provide substance use disorder or co-occurring condition treatment. The absence of such information about the nature and quality of referrals and ongoing services, and the lack of substance use disorder treatment across the entire ESP network, reveals the need for further attention to and investment in bolstering the state s behavioral health urgent care capabilities. Individual paths to recovery differ, treatment plans and supportive services for mental and substance use disorders should be tailored to fit individual patients needs, and for many people with behavioral health issues the most effective approach often involves a combination of counseling and medication 2. Partnerships with appropriate clinical and human services organizations help to ensure a less fractured system, eliminating gaps in shared information and communication that detract from timely quality care, patient engagement and recovery. Foundation s Proposed Framework The BCBSMA Foundation wishes to support and enhance the state s existing behavioral health urgent care system as currently provided through the ESPs, to help ensure coordinated services across the continuum of care for people with significant mental health needs, substance use disorders, and co-occurring conditions. Based on the Foundation s understanding of the existing system, research on other initiatives in the state and around the country, and feedback from the Foundation s Behavioral Health Advisory Group, the following is a high-level vision for a BHUC model for adults that could fulfill several objectives for enhanced services, scalability and sustainability. The Foundation is committed to working with the grantees to collaboratively develop a vision that may include the following attributes, and other elements cited by the grantees as essential: assured crisis care for adults with mental health issues, substance use disorders, and co-occurring conditions comprehensive onsite clinical and peer support for mental health and substance use disorder services substantive community partnerships that ensure timely and appropriate next level of care and ongoing care management same-day access for acute, but not emergent behavioral health episodes culturally competent care and linguistic capacity diversion from hospital EDs localized care, delivered in the community and close to patients homes Essential Proposal Elements The key features below describe an enhanced BHUC that augments, rather than competes with the existing ESP system in Massachusetts. The goal of this planning year is to work with grantees to develop a shared vision for a revised model that addresses the gaps in the current system, ensures a comprehensive continuum of care, 1 Massachusetts Behavioral Health Partnership/ESP/MCI FY 2016 Public Statewide Data Summary 2 Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatments and Services, Treatments and Supportive Services. 5

encourages innovation through technology and expanded partnerships, and promotes the development of a project plan that describes implementation following the planning period. Successful proposals will address and expand upon the Foundation s above-mentioned framework. The Foundation will accept proposals from existing ESPs (referred to henceforth as Providers ) Who describe in detail their current model for providing immediate 24/7/365 access to crisis stabilization and assessment to adults with mental and substance use disorders, and co-occurring conditions; Whose current programs include linkages with other essential community-based resources and institutions to ensure triage and access to timely referral to the appropriate next level of care; Who describe the necessary enhancements to their current programs to provide an array of on-site services, including medication-assisted treatment for substance addiction, on-site or on-call psychiatric prescribing, and strategies to expedite timely access to an affiliated community resource for both outpatient and in-patient treatments, including the provision of ongoing care management and support services; That serve a clearly defined geographic area through both a specific facility that provides 24/7/365 services, and mobile services anchored by a community-based Provider; Who describe how they will address diversions from avoidable ED utilization and law enforcement encounters; Who describe the demographics of the population served, provisions for linguistic diversity, any programmatic attributes that are unique to your program based on population and/or geography; That draw upon experiences and lessons learned to candidly describe deficits in the current system and how a planning year investment would advance their capabilities as a BHUC center; Are able to capture, analyze and report data; utilize data for continuous program improvement, and to inform opportunities for regulatory and policy changes that reduce barriers to providing BH urgent care and ongoing services/treatment. Foundation Activities and Technical Assistance The Foundation will retain the necessary technical assistance resources to work with grantees to facilitate a shared vision for an enhanced BHUC. Grantees will participate in learning communities hosted by the Foundation to share best practices, gain technical assistance from external resources, and identify opportunities for research and policy initiatives. The Foundation will convene key state officials and experts from outside of Massachusetts to help inform the work of the grantees, as well as the broader behavioral health crisis response community. The Foundation-contracted resources will assist the grantees in developing a logic model and appropriate planning year measures and reporting requirements to inform an evaluation plan for the subsequent multiyear grant program. Grantees will host site visits by the Foundation staff. Eligible Applicants and Selection Criteria Emergency Service Program (ESP) providers to help ensure that enhanced and integrated behavioral health urgent care is not provided outside of the current system of emergency and care coordination system ESP providers that are serving several different geographic areas of the Commonwealth may submit more than one proposal, but will only be eligible to receive one grant Providers must describe a current or proposed clinical model that provides mental health services, substance use disorders, and co-occurring conditions Applicants must have a relationship with a hospital, or a plan to develop a partnership that helps to ensure appropriate ED utilization and behavioral health inpatient treatment 6

Applicants must have onsite services or referral system for comprehensive continuum of care/care management, including partnerships with primary care and medical specialists. Foundational selection criteria for these grants include: The degree to which proposed efforts focus on low-income and vulnerable populations in Massachusetts. Evidence of services for adults with mental health, substance use and co-occurring disorders. Demonstrated organizational leadership support across all partners. A commitment to and vision for expanding the current model. Strong and dedicated project management capacity. Strong and dedicated data management capacity. Strength of the internal evaluation capacity and attention to performance management, including the logic model and data collection, management and analysis capacity to assess the program effectiveness, impact and improvements. Collective accountability for the success or failure of funded activities across all partners. Statement of how the program helps to advance the efficacy of behavioral health urgent care as a vehicle for achieving access to care for low-income and vulnerable patients. Quality and clarity of program objectives and budget. Funding Organizations meet the above-mentioned criteria may request up to $200,000 for a year. This does not commit the Foundation to funding at this level, as decisions will be made based on individual program merit and alignment with the above-mentioned criteria. Proposals can include such items as support to offset salaries for existing essential positions, or new hiring while recognizing this is only a one-year grant commitment with no guarantee of subsequent funding; augmenting data collection, management and analysis capacity; enhancements to technology that are essential to implementing an urgent care program; trainings and staff development pertinent to behavioral health urgent care and subsequent care management, and other essential program management and operations expertise that can help to ensure the development of an implementation work plan for subsequent years. The program budget supported by this grant should be realistic, balanced, and include further explanations in the assumptions, as necessary, on the Project Budget Worksheet included on the portal. This grant period is December 31, 2018 to December 31, 2019. Deadlines and Submission Requirements Prior to the proposal due date, the Foundation will host a webinar to for potential applicants to receive more in-depth information about the grant program, and to ask questions that will help them to submit a complete application. Proposals are due Wednesday, August 22, 2018 at 5:00 p.m. Review of, and due diligence on the proposals will be conducted from August to October 2018. This will include site visits, or interviews conducted at the Foundation s office. Full proposals must be submitted through the Foundation s online portal according to the following schedule: 7

PROPOSALS ARE DUE WEDNESDAY, AUGUST 22, 2018 (A FIRM DEADLINE. NO EXCEPTIONS.) Proposals are to be submitted via the portal available at https://www.foundationconnect.org/grantsmanager/pages/v3/portal/ Login/Login.aspx?OrgID=00Dd0000000dsn2&ReturnUrl=%2fgrantsm anager%2fpages%2fv3%2fportal%2fgrantapplication.aspx%3forgid %3d00Dd0000000dsn2%26RequestRT%3d0120V000001lDI2%26Is Direct%3dtrue. The Foundation will acknowledge receipt of proposals within two business days. Only complete proposals, including all letters of support, budgets, and other attachments noted on the portal will be considered for funding. Project Budget Worksheet Utilizing the budget worksheet available on the portal, include an annual budget to be supported by this grant. Please add line items and budget assumptions, as needed. Organizational Budget Include your organization s board or department-approved operating budget for the year in which funding is being requested. Logic Model Include a logic model of your current program. Statement from Organization Leadership Include a statement from your organization's senior leadership that demonstrates commitment to and knowledge of the program. Leadership and Program Management Team Include a list of leadership and program management team including names, titles and a brief description of responsibilities if title does not clearly indicate. Letters of Support and Commitment Include a minimum of three letters of support that illustrate your organization s capacity for making a measurable impact on the issue to be addressed by the program. Also include a statement from the senior leadership of all major partners that demonstrates commitment to and knowledge of the program. 8

Questions Applicants are strongly encouraged to participate in a webinar on Friday, June 22 at 12:30 a.m. to 2:00 p.m. to review the requirements of this grant program and answer questions of potential applicants. Please register in advance for this session by contacting grantinfo@bluecrossmafoundation.org. Program related questions: Celeste Lee, Senior Director of Grantmaking 617.246.8406 Celeste.Lee@bcbsma.com Technical and logistical questions related to the online portal: Evelyn Monteiro, Administrative and Grants Coordinator 617.246.4850 evelyn.monteiro@bcbsma.com The Foundation will post answers to frequently asked questions (FAQ) at www.bluecrossmafoundation.org/grant/expanding-access-behavioral-health-urgent-care after the webinars. The Foundation will notify all applicants of funding decisions on December 20, 2018. 9