A ValueOptions Presentation to:
Chapter
titleAssociation
New
York
of Psychiatric
Rehabilitation Services
Explanation of chapter here
Presented by:
Richard Sheola,ValueOptions’ Senior Vice President,
Public Sector Division
April 28, 2011
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Agenda
• ValueOptions Corporate Overview
• Public Sector Experience and Related Systems Integration
Successes
• Partnering with Peers to Transform Systems
• The Emerging Landscape: ACO Partnerships
• Provider Positioning for the Road Ahead
• Housing First
• Preserving the Integrity of our Public Behavioral Health
System
2
ValueOptions Corporate Overview
• Singular focus on behavioral health and wellness
• More than 24 million members nationwide
• Medicaid represents 80% of our annual revenue
• Medicaid programs in 14 states, covering 5.3 million Members
• 15 years of Public Sector Experience
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Public Sector Landscape
States with a ValueOptions Medicaid Contract
Service Center locations
Support office locations
4
Medicaid Program Successes
• Reducing costs while improving outcomes
• Facilitating long-term systems change through re-alignment of
financial incentives
• Reducing children’s institutionalization (Hospital and PRTF
level of care)
• Reducing adult psychiatric inpatient, state hospital admissions,
and nursing facility usage
• Expanding holistic treatment for high-cost/high-risk members
through Complex Chronic Care Management
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Ahead of the Curve: Partnering with
1999 - Launched self-help peer support groups, including Recovery Workbook meetings,
DoubleTrouble addictions meeting and W.E.L.L. meetings for women experiencing trauma, addictions,
and psychiatric conditions
Peers to Transform Systems of Care
ValueOptions, through its Massachusetts
Behavioral Health Partnership, has worked with
peers since1998 to build individual and
organizational KNOWLEDGE and LEADERSHIP
for wellness and recovery.
Expanded peer support
services and peer
leadership training.
1999 - Launched statewide support of Dual Recovery Anonymous peer facilitated meetings in
clubhouses, now a national and international ICCD model program
1999 - Launched the first Massachusetts Leadership Academy to develop peer-trained peer
leadership, now a national model in outreach and training of diverse language and cultural groups,
including Deaf and Hard of Hearing
1999- Supported development of peer infrastructures for training and support, including peer
mentoring, peer-to-peer education, cross-training, and the development of peer facilitator and peer
educator training, which led to the development of the peer-operated Massachusetts Certified
Peer Specialist training program, a national model
1999 - Consumer Quality Initiatives Launched consumer satisfaction evaluation of provider services, a
national model, now an independent peer-run, nationally-recognized organization
Consumer Advisory Council
proposed peer specialists in
emergency services, contributing
to MBHP policy, procedures and
member materials since 1996.
Family Advisory Council
proposed family training
infrastructure, contributing to
MBHP policy, procedures and
member materials since 1996.
Rehabilitation
& Recovery,
a dedicated
MBHP business
unit since 1996
Provided seed-funding
and developmental
support for peeroperated organizations
and service models.
1999 - The Transformation Center Peer-operated hub of statewide Recovery Learning
Communities, Certified Peer Specialist training, and MBHP-funded peer and provider
training
2003 - MBHP coordinated peer planning process and developed the first proposal for Recovery
Learning Communities In Massachusetts, a peer-operated wellness and recovery infrastructure, a
national model
2008 - Pat Deegan PhD & Associates and MBHP launched CommonGround in Massachusetts, a
consumer/prescriber shared medication decision-making program with peer-support, a national model
2002 - Peer Support in Aftercare clubhouse peers bridging to inpatient units and providing aftercare
support and integration into peer and recovery activities
Created, expanded,
and supported peer
workforce capacity.
2005 - Enhanced Day Treatment created peer specialist positions in day treatment programs
2009 - Certified Peer Specialists hired to work in redesigned community-based Emergency Service
Programs statewide, a national model
1999-2008 - Partnering for Recovery, large statewide conference creating dialogue among peers,
providers, families, and state agencies, a national model
(800) 495-0086
100 High St, 3rd Floor
Boston, MA 02110
A ValueOptions Organization
Trained providers in
rehabilitation, recovery
and the integration of
peer services.
2009-present - Three regional forums per year focused on recovery, wellness, and peer specialist
integration, produced by The Transformation Center
2010 - MBHP and The Transformation Center began collaborating on training for Emergency
Service Provider teams statewide, a national model
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Health Care Reform:
Colorado’s Accountable Care Initiative
• Program Objectives:
–
–
–
–
Expand access to comprehensive primary care
Build patient-centered Medical Home capacity
Ensure a positive member and provider experience
Effectively apply an unprecedented level of statewide data and
analytics functionality
• Performance Goals:
–
–
–
–
Achieve cost neutrality
Reduce unnecessary ER utilization
Reduce preventable hospitalizations
Reduce unnecessary imaging
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Health Care Reform:
Colorado’s Accountable Care Initiative
• Colorado ACO/ASO Services
– Member enrollment and referral services
– Network development and integration
– Practice supports (patient-centered Medical Homes)
– Medical management and care coordination
– Performance improvement
– Reporting
– Financial management
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Health Care Reform:
Colorado’s Accountable Care Initiative
• Region 4: Southeastern Colorado
– 70+ k Members
– >$6.5M total contract
revenue
• New LLC—Integrated
Community Health
Partners
– 3 Federally Qualified
Health Centers
– Colorado Community
Managed Care Network
– 4 Community Mental
Health Centers
– ValueOptions –
Management Services
Partner
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Provider Positioning for the Road Ahead
• Promote collaboration
• Learn about new health care landscape and educate about
recovery
• Form/join coalitions regarding parity/Health Care Reform
• Involve/promote/advance individuals in recovery and promote
consumer-directed care
• Identify gaps in coverage and services
• Promote high-quality and integrated care
• Promote prevention and wellness
• Understand economic environment and provide guidance—tough
choices for States
• Stay focused on people we serve
-- Pamela S. Hyde, J.D., Administrator,
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Housing First
• Community Support Program for People Experiencing
Chronic Homelessness (CSPECH)
– CSPECH is a behavioral health model that supports members who
are chronically homeless
– Pioneer Award-winning “housing first” program
– Partnership between Massachusetts Behavioral Health Partnership
(MBHP), Massachusetts Housing and Shelter Alliance (MHSA) and the
Department of Transitional Assistance.
– Estimated savings of $3M annually
Pre-CSPECH
CSPECH-Year 2
Savings
BH Costs
$12,388
$10,702
$1,686
ED Utilization
$2,795
$1,144
$1,651
Medical Costs (MHSA)
$28,436
$6,056
$22,380
Total
$43,619
$17,902
$25,717
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Preserving the Integrity of our Public
Behavioral Health System
• Containing costs while strengthening our Systems of Care
• Expectations of our BHO partners/Raising the bar
• Performance contracting: “Doing Well by Doing Good”
• The Importance of Visionary Leadership
• The Road Ahead
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Thank You
If you have any questions, please feel free to contact:
Richard Sheola, Senior Vice President, Public Sector Division
(617) 790-4081(office)
Richard.sheola@valueoptions.com
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