WESTERN REGION BEHAVIORAL HEALTH ORGANIZATON
WITH BEACON HEALTH STRATEGIES, LLC
AND COORDINATED CARE SERVICES, INC.
Western Region Behavioral
Health Organization
QUARTERLY ALL-STAKEHOLDER MEETING
FEBRUARY 29, 2012
NEW YORK CARE COORDINATION PROGRAM
WITH BEACON HEALTH STRATEGIES, LLC
AND COORDINATED CARE SERVICES, INC.
WRBHO All Stakeholder Meeting
Welcome and Introductions
Kathleen Plum, Ph.D., RN, NPP
Director, Monroe County Office of Mental Health
Chair, New York Care Coordination Program
BHO Oversight and Implementation Committee.
New York Care Coordination Program, Inc.
Kathleen Plum, Ph.D., RN, NPP, Director, Monroe County Office of Mental Health,
Rochester, NY. Chair, NYCCP BHO Oversight and Implementation Committee.
Treasurer, NYCCP Board of Directors.
Patricia Brinkman, LMHC, MBA, Director, Chautauqua County Mental Health
Services, Mayville, NY. Chair, NYCCP BHO County Directors Group. Member,
NYCCP Board of Directors
Joe Woodward, CASAC, Executive Director, Housing Options Made Easy Buffalo,
NY. Chair, NYCCP Peer Service and Family Support Group. Member, NYCCP Board
of Directors.
Howard Hitzel, Psy.D. President, Lake Shore Behavioral Health, Buffalo, NY. Chair,
NYCCP Provider Group. Co-chair, NYCCP Board of Directors
Adele Gorges, Executive Director
Valerie Way, LCSW-R, Senior Program Associate
Robert Dempsey, Peer/Family Coordinator
Kathy Berthod, Program Assistant
Beacon Health Strategies, LLC
Mark Deasy, Director of Account Operations
John Lee, Program Director for Western Region Behavioral
Health Organization
Christine Mangione, Manager for Clinical Operations for
Western Region Behavioral Health Organization
Coordinated Care Services, Inc.
Anne Wilder, President, CCSI
Facilitators
Clyde Comstock, Chief Operating Officer, Hillside Children’s Center
Rochester, NY, Member NYCCP Board of Directors
Don Kamin, Ph.D., Chief, Clinical & Forensic Services, Monroe County
Office of Mental Health
Neilia Kelly, Chief, Policy and Planning, Monroe County Office of Mental
Health
Paul McArthur, Administrator, Strong Behavioral Health, Rochester, NY;
Member, NYCCP Board of Directors
Today’s Objectives
 Learn more about the WRBHO and what we are
trying to accomplish together
 Provide feedback on your experience with the
WRBHO to date
 Begin the work of creating effective inpatient/
outpatient transition processes for each region in
support of High Need/ High Risks individuals
 Get to know others in the region across stakeholder
groups- engage in new partnerships
Today’s Agenda
All Stakeholder Meeting – 1:00 pm – 2:00 pm
 Updates from the State
 WRBHO
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News and Updates
Review of program goals
Review of data being collected and reports to be created
Sub-regional Meeting- 2:15 – 4:00
 Breakout groups
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Provide feedback on your experience with the WRBHO
Assess current inpatient /outpatient transition
Develop recommendations for improvement and next steps
News and Updates: New York State
NYS Office of Mental Health
Thomas Smith, M.D
Director of Operations, NYS Behavioral Health
Organizations; Associate Professor of Clinical Psychiatry,
Columbia University New York State Psychiatric
Institute
NYS OASAS
Steve Hanson
Acting Associate Commissioner
News and Updates:
Western Region Behavioral Health Organization
Activity of WRBHO – As of Week Eight
 Task 1- Volumes, outreach, getting the kinks out
 Task 2- SED Data submission webinars this week
 Task 3- First round to be ready by April 30
 Task 4 – Meetings and conference calls
Complementary work of NYCCP
 Health Homes
 BHO Phase 2
Why Regional Behavioral Health Organizations?
 Opportunity to prepare for a redesigned
Medicaid Program in Phase 2: A fully
managed system of care.
 Understand what the current system
looks like.
 Understand the critical success factors
are related to a Phase 2.
 Implement needed changes.
Objectives for the Regional Behavioral
Health Organizations
 Review BH inpatient length of stay for all Medicaid
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Fee-For Service admissions
Reduce BH inpatient readmission rates
Improve rates of engagement in outpatient
treatment post discharge
Better understand children diagnosed as SED
Report on performance for the region as a whole and
for providers individually in the region
Encourage cross-systems linkages that will improve
outcomes
WRBHO Data and Reports
 Data collected and reports to be generated link
back to the goals
 Review data elements: inpatient stay info,
discharge process info, transition to outpatient
info
 Review of quarterly reports planned
 Sample reports
WRBHO Data and Reports
 Data collected tie directly to WRBHO goals
 Regular reports will describe our region in terms
of strengths, service gaps and opportunities to
improve
 Reporting and analysis will be done at the
regional, sub-regional, county, and provider levels
What Data Are Being Collected?
 Patient and inpatient provider Identifiers:
 BHO Activity – Time frames for completion, etc.
 Episode of Care Characteristics
 Content of Discharge Plan
 Was an appointment for outpatient MH/SUD
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treatment part of the discharge plan?
Indicator that physical health care needs requiring
post hospital follow up were identified:
Consumer Family Involvement
Adult AOT
SPOA Application
Quarterly Reports Designed to Answer Key
Systems Questions
 Monitor, Review and Assess Use of
Behavioral Health Inpatient Care
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Who is receiving care at the highest level?
Are the individual’s needs being identified and addressed?
Are individuals being connected with care post-discharge?
Why are individuals being readmitted to inpatient care?
How many admissions are classified as “long stay” – and what
resources are lacking in communities such that longer stays
are required?
Quarterly Reports will be Designed to Answer
Key Systems Questions
 Children’s Outpatient SED Tracking
 Who is being diagnosed as SED?
 Where are children/youth with SED receiving outpatient care?
 Cross-System Linkages
 What types of cross-systems linkages are needed for
individuals receiving inpatient behavioral health care?
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What types of linkages are needed with physical health care
services? Are they happening?
Quarterly Reports will be Designed to Answer
Key Systems Questions
 Provider Profile Reports
 Display data, at the provider level, on key descriptive and
performance dimensions:
Demographic and clinical characteristics
 Provider / WRBHO staff interaction
 Length of stay
 Connection to outpatient care
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Reports will include comparisons to regional average and track
changes over time
Sample Report – Inpatient Episode
Sample Report – Outpatient Engagement
Sample Report – Length of Stay
Charge for the Sub-Regional Meetings
Work together via facilitated discussions to:
 Provide feedback concerning your
experience with the WRBHO
 Begin the development of a cross-system
plan to impact inpatient /outpatient
transitions
….As you have your sub-regional
discussions, please consider the
following information being
provided by John and Chris…..
Practices that Support Effective
Inpatient to Outpatient Transitions
Some facts:
 Only 42% of initial appointments following
psychiatric hospitalization are kept nationally.
Missed appointments increase the likelihood of
re-hospitalization and increase costs of
outpatient care. (Kreyenbuhl, Nossel, & Dixon,
2009).
 Between 25% and 50% of patients who miss
mental health appointments disengage from
treatment entirely (Killaspy, 2007).
Practices that Support Effective
Inpatient to Outpatient Transitions
Some facts…
 Dropping out of treatment after a psychiatric
hospitalization increases the likelihood of rehospitalization from 1 in 10 to 1 in 4 (Mitchell
& Selmes, 2007).
 Keeping one outpatient appointment reduces the
risk of re-hospitalization (Nelson, Maruish, &
Axler, 2000).
Practices that Support Effective Inpatient to
Outpatient Transitions – What Works….
• A pre-discharge transition interview with the
patient to identify and address barriers to
attendance.
• Patient telephone contact pre-discharge with
the outpatient provider.
• Communication about the patient’s discharge
plans between inpatient and outpatient
clinicians.
Practices that Support Effective Inpatient to
Outpatient Transitions – What Works….
• Return to their previous outpatient provider…
unless the individual prefers another provider or
when specific clinical needs would suggest an
alternative.
• Scheduling appointments within a few days of
hospital discharge.
• Reminder letters or phone calls from the outpatient
provider regarding scheduled appointments.
Sub-regional Meetings
Four Sub-Regions:
 Chautauqua Region- Goes to Board Room
 Erie Region - Stays in Atrium
 Finger Lakes Region – Goes to Emerald room
 Monroe Region- Goes to Chrystal Room
You decide the sub-region to join
Sub-regional Meetings
What to Expect
 Breakout by region, with large regions splitting into smaller
groups of approximately 15. Facilitator and scribe for each
group. Each group will:
 Provide feedback on their experience with the WRBHO
 Discuss the current inpatient/outpatient transition process:
what is working well?, What should work better?, What are
the barriers to making it better?
 Identify the three things most important things to change
 Discuss what key stakeholder groups should be asked to do
in order to achieve the desired change
 Decide upon three steps to take between now and the next
meeting
Sub-regional Meetings
What to Expect
 Each group will report back to the sub-
regional group prior to the end of the session.
 Each sub region will provide feedback on the
usefulness of the sub-region structure for
future meetings.
 Information collected will be transcribed and
sent out to all participants after the meeting
Find your rooms!
FYI.. Each sub-region has a lead facilitator. If
there is confusion…. seek them out:
Chautauqua: Christine Mangione
Erie: John Lee
Finger Lakes: Val Way
Monroe: Anne Wilder