© 2014 Community Care Behavioral Health Organization
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Achieving Integrated Systems: How a Behavioral Health
MCO Partners with Community and Medical Services
Featuring:
Dr. Jeffrey Brenner
Dr. James Schuster
Phil Keating
Chris Minnich
Carmine Picarelli
© 2014 Community Care Behavioral Health Organization
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Good Care Collaborative Steering Committee:
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Dr. Jeffrey Brenner, Camden Coalition of Healthcare Providers
Dr. Ruth Perry, Trenton Health Team
Michael Anne Kyle, Greater Newark Healthcare Coalition
Ev Liebman, AARP NJ
Linda Schwimmer, NJ Health Care Quality Institute
Jeffrey Brown, Affiliated Accountable Care Organizations
Joe Fleming, PICO NJ
Ray Castro, New Jersey Policy Perspective
© 2014 Community Care Behavioral Health Organization
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About the Good Care Collaborative:
The Good Care Collaborative is a coalition of providers and advocates
from across the healthcare spectrum in New Jersey. We are
committed to discussing sensible Medicaid reform and defining a
collaborative vision of good care.
Our goal is to improve the quality of Medicaid services while
decreasing costs of the system. In an effort to do so, we will focus on
a comprehensive legislative agenda that includes short-, mid- and
long-range Medicaid reforms.
© 2014 Community Care Behavioral Health Organization
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Behavioral Health Managed Care
and Community Collaborations
James Schuster, MD, MBA
Phil Keating
© 2014 Community Care Behavioral Health Organization
Community Care Quick Facts
• A nonprofit recovery-oriented behavioral health
managed care company
• Provider-owned (UPMC)
• Incorporated in 1996 and headquartered in
Pittsburgh, PA
• Federally tax exempt non-profit 501(c)(3)
• Major focus is publicly-funded behavioral health care
© 2014 Community Care Behavioral Health Organization
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PA Managed BH Quick Facts
• Counties have right of “first opportunity”
• Counties have a variety of partnerships with
Managed Care Organizations
• County direction facilitates close collaborations
between MCO and:
– County human services
– Children and Youth
– Forensic Services
– State and county BH funding streams
© 2014 Community Care Behavioral Health Organization
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UPMC Operational Structure
University of Pittsburgh Medical Center (UPMC)
UPMC Insurance Services Division
Community
Care
UPMC Health Plan
Askesis
Development
Group, Inc.
Medical Assistance
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© 2014 Community Care Behavioral Health Organization
Membership Trend
FY 2004
FY 2005
FY 2006
FY 2007
FY 2008
570,659
562,436
606,663
954,938
1,043,125
FY 2009
FY 2010
FY 2011
FY 2012
FY 2013
1,097,645
1,297,458
1,377,419
1,528,003
1,603,454
© 2014 Community Care Behavioral Health Organization
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Services in PA and NY
Erie
Warren
McKean
Potter
Tioga
Susquehanna
Bradford
Wayne
Forest
Cameron
Sullivan
Elk
Wyoming
Lackawanna
Lycoming
Clinton
Jefferson
Clarion
Clearfield
Centre
Union
Pike
Pike
Luzerne
Columbia
Monroe
Montour
Carbon
Hudson River
Region
Snyder Northumberland
Mifflin
Allegheny
Schuylkill
Juniata
Blair
Berks
Huntingdon
Adams
York
Chester
Southwest Region
Southeast Region
North Central Region: County
Lehigh-Capital Region
North Central Region: County
North Central Region: County
Northeast Region
North Central Region: County
North Central Region: State
© 2014 Community Care Behavioral Health Organization
Community Care Office
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Focus on Recovery
Peer & Family
Involvement
Recovery
Transformation
Person with
Lived
Experience
Physical &
Behavioral
Health
Integration
Focused Care
Management
Model
© 2014 Community Care Behavioral Health Organization
Respecting
Individual
Differences
Systems
Integration
(Children &
Youth)
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Examples of Recovery-Focused Initiatives
• Children’s Accountable Clinical/Health Homes
• Adult (SPMI) Accountable Clinical/
Health Homes
• Addictions Expansion (Recovery Oriented
System of Care)
• Physical Health/Behavioral Health
Multiple Models
© 2014 Community Care Behavioral Health Organization
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Systems Redesign
© 2014 Community Care Behavioral Health Organization
Identifying and Coordinating
Physical Health Concerns
© 2014 Community Care Behavioral Health Organization
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Two Complementary Approaches
• Insurance collaboration supporting member
engagement and enhanced provider
coordination (Connected Care)
• Creation of behavioral health home model in
mental health and drug and alcohol settings
(Behavioral Health Home Plus)
© 2014 Community Care Behavioral Health Organization
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Connected Care
• Initiative to improve the connection and coordination of care
for those with Serious Mental Illness among health plans,
PCPs, and behavioral health providers in outpatient,
inpatient, and ED care settings
• Based on Patient Centered Medical Home model with
integrated care team and care plan to address all medical,
behavioral and social needs
• Partnership between:
– Center for Health Care Strategies (CHCS)
– Department for Public Welfare (DPW)
– UPMC for You
– Community Care Behavioral Health
– Allegheny County Department of Human Services
© 2014 Community Care Behavioral Health Organization
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Reduction in MH Hospitalizations
All Members
Late Cohort
Study
Comparison
Study
Comparison
Pre-Intervention Rate per
1,000 Member Mos.
41.1
33.8
25.8
16.2
Intervention Rate per 1,000
Member Mos.
39.6
37.2
43.3
45.1
Difference
-1.6
+3.4
+17.6
+29.0
Average Enrollment (months)
-4.9
-11.4
Percent Enrolled 18-24 months
0.041
<0.01
Rates for all members dropped 4% in the study group, and increased 10% in
the comparison group
Rates for the late cohort increased 68% in the study group and increased
179% in the comparison group
© 2014 Community Care Behavioral Health Organization
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Reduction in All-Cause Readmissions
All Members
Late Cohort
Study
Comparison
Study
Comparison
30-Day Readmissions, PreIntervention
43.1
39.5
44.7
39.2
30-Day Readmissions,
Intervention Period
38.9
39.7
35.7
40.0
Difference
-4.2
+0.2
-9.0
+0.8
Dif. in Differences
-4.4
-9.8
<0.01
<0.01
p-Value
Readmissions dropped 10% in the study group (all members), and
increased 1% in the comparison group
Readmissions dropped 20% in the late cohort and increased 2% in the
comparison group
© 2014 Community Care Behavioral Health Organization
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Reduction in ED Use
Full TwoYear
Period
By Six-Month Calendar Period
July-Dec
2009
Jan-Jun
2009
July-Dec
2010
Jan-Jun
2011
Pre-Intervention
Rate, Study
184.4
206.6
190.2
182.5
182.5
Intervention Rate,
Study
190.0
250.4
195.3
188.7
169.3
Pre-Intervention,
Comparison
167.1
182.4
176.6
171.1
162.3
Intervention,
Comparison
195.6
232.6
216.1
184.8
184.9
Dif. in Differences
-22.9
-6.3
-34.4
-7.7
-35.8
p-Value
0.052
0.808
0.034
0.583
<0.01
ED visits increased 3% in this study group, and increased 17% in the comparison group
© 2014 Community Care Behavioral Health Organization
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Behavioral Health Home Plus
• Services must be:
– person/family centered
– adhere to recovery principles
– promote self-management skills
– integrate into the individual’s recovery plan
• Individuals do not have to change existing providers
or supports, but rather should enhance and build
upon the individual’s provider and support network
• Integrating Mental health and drug and alcohol care
with physical health care creates good health
outcomes
© 2014 Community Care Behavioral Health Organization
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Behavioral Health Home Plus
• Wellness Coach Training by Peggy Swarbrick for
Health Navigators to address Physical Wellness
domain and Lifestyle Changes
• Health Navigator: Case Manager, Peer Specialist,
RN
• Self-Management Strategies Used
• Focus on ways to integrate and collaborate for
best whole person health
© 2014 Community Care Behavioral Health Organization
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Behavioral Health Home Plus
• Progress to date:
– 4 demonstration sites, including CMSU
– 11 additional sites initiated last year with
support of federal research funding (PCORI)
– 11 additional sites starting later in 2014
© 2014 Community Care Behavioral Health Organization
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© 2013 Community Care Behavioral Health Organization
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To learn more about the Good Care Collaborative:
Visit our NEW website at www.goodcarecollaborative.org
Our next Site Visit will be May 21st, 10:00 am-12:00 pm at Henry
J. Austin’s Ryan White Clinic, Trenton, NJ.
RSVP to shabnam@camdenhealth.org to reserve your place.