WESTERN REGION BEHAVIORAL HEALTH ORGANIZATON
WITH BEACON HEALTH STRATEGIES, LLC
AND COORDINATED CARE SERVICES, INC.
WESTERN REGION
BEHAVIORAL HEALTH
ORGANIZATION
PROVIDER MEETING
December 9, 2011
Welcome and Introductions
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Howard Hitzel, Psy.D., Chair, Western Region BHO Provider
Group
Adele Gorges, Executive Director, New York Care
Coordination Program, Inc.
Mark Deasy, Director of Account Operations, Beacon Health
Strategies, Inc.
Christine Mangione, RN, BS, CCM, Clinical Manager, Beacon
Health Strategies, LLC
Counties in the Western Region for the BHO: Allegany,
Cattaraugus, Chautauqua, Chemung, Erie, Genesee,
Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler,
Seneca, Steuben, Tioga, Tompkins, Wayne, Wyoming, Yates
Today’s Agenda
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Introduction to the Western Region Behavioral
Health Organization
 New
York Care Coordination Program, Inc., with
Beacon Health Strategies, Inc. and Coordinated Care
Services, Inc.
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Review of the work of the Western Region BHO
with the behavioral health system in the 19 counties
and the roles for various provider types.
Additional session for inpatient providers this
afternoon.
NEW YORK CARE COORDINATION
PROGRAM, INC.
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A brief history
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Formed in 2000, six western and central counties, with support
from the NYS Office of Mental health
Multi-county, multi-stakeholder collaborative undertaking to
improve outcomes for individuals with serious behavioral health
issues
Operational in mid-2002 with project management through
Coordinated Care Services, Inc.
Partnered with Beacon Health Strategies, LLC in 2009 for
managed care
Expanded in 2010 to include Westchester County
Incorporated in 2011; Western Region Behavioral Health
Organization
NYCCP TRANSFORMATION TIMELINE
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Structures for Change
Practice and Regulatory Reform
Finance Reform
Managed Care
Operations
July
2000
2001
2002
July
2002
2003
2004
2006
2008
2010
2011
2012
STRUCTURES FOR CHANGE
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Participatory process for governance of the initial
multi-stakeholder, multi-county collaborative
Performance measurement
Data access, analysis and reporting capacity
Platform for disseminating best practices
Incorporation in 2011
 Expanded
multi-regional focus for Board of Directors
 Same multi-stakeholder composition: 25.5 % Peers and
Family Members, 25.5 % Providers, 49% County
Directors
PRACTICE AND REGULATORY REFORM
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Culture change to a person-centered,
recovery-focused system of care
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Education and training, learning communities, online practice
tool www.recoveryskillbuilder.com, measuring, training
trainers and champions, webinars, onsite mentoring
Care coordination
Practice of care coordination
 Workforce development for “Providing Integrated, PersonCentered Care Coordination for Individuals with Complex
Needs”
 Workforce development for Transitioning from Targeted
Case Management to Health Home Care Coordination
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PRACTICE AND REGULATORY REFORM
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Physical Health Integration
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Enrollee Surveys 2004 and 2008
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Individuals want to make the changes necessary to improve
overall health
Well-Balanced in Wyoming County and Monroe County
People can’t be benchmarked against non-SMI populations.
Progress is possible, but it takes more time and more intensity
 Sustainability must be addressed – e.g. peer wellness coaches
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Peer Services
Steady expansion from 2002 – the present
 BHO will assess use of peer services for individuals with an
admission
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FINANCIAL REFORM
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Pay for performance
Managed behavioral health
To conserve dollars for behavioral health, use dollars
flexibly, access and use information
 Work from 2003 forward on managed systems of care for
individuals with serious behavioral health issues
 Pilot with Monroe Plan 2007 – 2008
 Contract with Beacon 2009 – 2011
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Foundations – LOC Criteria, online SPOA application, other
 Complex Care Management
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Western Region Behavioral Health Organization 2011
OUTCOMES FOR NYCCP
Full report available at www.carecoordination.org
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Better
quality care
• 46% decrease in emergency room visits per enrollee*
• 53% reduction in days spent in a hospital*
• 78% of enrollees report “dealing more effectively
with problems” (2009 Enrollee Survey)
Better social
outcomes
• 31% increase in gainful activity*
• 54% decrease in self harm among enrollees*
• 53% reduction in harm to others*
* 2009 Periodic Reporting Form Analysis
OUTCOMES FOR NYCCP (cont.)
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Lower
mental
health costs
• A comparison of 2008 Medicaid mental health costs for
Case Management and ACT populations in NYCCP counties
to same populations in 6 comparison counties shows NYCCP:
• 92% lower for inpatient services
• 42% lower for outpatient services
• 13% lower for community support
• The same study shows per person cost increase from 2003 –
2008 was 15% for NYCCP counties and 24% for
comparison counties. (NYS OMH 2010)
Lower
mental and
physical
health costs
• The cumulative rate of increase between
2003 and 2008 for Medicaid costs for case
management recipients is 8% for Erie county
and 13% for Monroe County, compared to a
20% increase for individuals in the
classification of NYS SSI/Disabled-Rest of
State. (CCSI 2010)
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GOING FORWARD
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New York Care
Coordination Program, Inc.
Western
Region
Behavioral
Health
Organization
Crossregional,
multistakeholder
learning
community
Data
analysis and
evaluation
Training, skill
building,
workforce
development
Health Home
Introduction to
Coordinated Care Services, Inc.
WESTERN REGION BHO PROVIDER MEETING
DECEMBER 9, 2011
Coordinated Care Services, Inc. (CCSI)
 Not-for-profit 501(c)(3) management services
organization with more than 25 years of experience
in providing support to organizations in the
behavioral health and human services fields
 Based in Rochester, New York, with staff deployed in
Broome, Chautauqua, and Onondaga counties.
Our Services
 Management Services
 Project and Program Management
 Contract Management
 Financial Contract Management
 Service Contracts
 Technical Assistance
 Financial Services
 Evaluation & Services Research
 Continuous Quality Improvement
 Cultural and Linguistic Competence
Our Customers
 CCSI works closely with public sector and not-for-
profit organizations throughout New York State,
including:
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County mental health and social services departments
Behavioral health provider agencies
Membership organizations (e.g., the Conference of Local
Mental Hygiene Directors)
New York State agencies, including the Office of Mental Health
and Department of Health
Our Work with the NYCPP
 CCSI has supported the NYCCP since its inception
with services including:
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Project management staffing;
Information technology and data analysis;
Financial management; and
Facilities management, including providing appropriate office
space
Introduction to Beacon Health Strategies
Western Region BHO Provider Meeting
December 9, 2011
Beacon serves 6 million lives in 13 states on behalf of over
50 health pans and State Partners
MEDICAID
MEDICARE
MULTI-SECTOR
December 2011 | 20
BEACON HEALTH STRATEGIES | 200 State Street Suite 302, Boston, MA 02109 | t. 617.747.1230 | beaconhealthstrategies.com
Beacon is NY’s largest public population MBHO
BEACON’S NEW YORK FOOTPRINT
642K
Medicare SNP
SMI/Duals
KEY NEW YORK BUSINESS HIGHLIGHTS
Working in the Hudson Valley since 1997
7 Health Plan Partners
7,000 Contracted Providers in New York State
2009 Case Management and Quality Improvement partnership
with NYCCP/ CCSI and 7 County systems:
•
Chautauqua, Erie, Genesee, Monroe, Onondaga,
Westchester, and Wyoming
Medicaid
>30 New York Clinicians Based Locally in NY:
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UR, CM and Physician Advisors
December 2011 | 21
BEACON HEALTH STRATEGIES | 200 State Street Suite 302, Boston, MA 02109 | t. 617.747.1230 | beaconhealthstrategies.com
Quality Matters
Beacon Consistently Outperforms the State HEDIS/QARR Scores
30 DAY FOLLOW-UP RATE AFTER IP ADMISSION
SOURCE: NY DOH
7 DAY FOLLOW-UP RATE AFTER IP ADMISSION
SOURCE: NY DOH
December 2011 | 22
BEACON HEALTH STRATEGIES | 200 State Street Suite 302, Boston, MA 02109 | t. 617.747.1230 | beaconhealthstrategies.com
Engaging community service providers improves care and
social well-being
% OF HIGHEST COST SPMI MEMBERS RECEIVING COUNTY SPMI CARE MANAGEMENT PROGRAM
SERVICES
59% decrease in ER utilization
62% decrease in IPMH ALOS
34% decrease in self harm incidents
32% decrease in physical harm to others
50% decrease in suicide attempts
44% increase in gainful employment
Enrollees
654
704
December 2011 | 23
BEACON HEALTH STRATEGIES | 200 State Street Suite 302, Boston, MA 02109 | t. 617.747.1230 | beaconhealthstrategies.com
Beacon engages high risk members using a team-based
approach
OVERVIEW OF THE WESTCHESTER CARES ACTION PROJECT (CIDP)
MEMBER:
High risk, multiple chronic
diseases, 39% homeless, FFS
COMMUNITY-BASED
ORGANIZATIONS NETWORK:
>29 organizations signed
confidentiality agreements
and provide referrals
OUTREACH PERSONNEL:
outreach to club houses,
shelters, churches, libraries,
parks, etc.
CLINICIAN:
actively engage clients with
initial intake, weekly
telephonic coaching,
quarterly face to face
appointments, re-assessment
every 6 months.
SOCIAL
SUPPORTS
PEER NAVIGATOR:
makes connection to social
and medical services, adds
credibility, serves as a role
model of recovery
MEDICAL
APPOINTMENTS
December 2011 | 24
BEACON HEALTH STRATEGIES | 200 State Street Suite 302, Boston, MA 02109 | t. 617.747.1230 | beaconhealthstrategies.com
HOUSING
Beacon’s partnership with NYCCP and CCSI in the Western
Region Behavioral Health Organization – and our work with
the behavioral health systems in the 19 counties -- will inform
participation in Phase II of the NY’s Medicaid Redesign
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Beacon brings managed care preparedness, IT infrastructure and
clinical and analytic leadership to its RBHO work
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Health Home review and consideration underway
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Expanding staff in the Western Region to support provider, County, peer
and health plan engagement
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Fully operational January 1, 2012
December 2011 | 25
BEACON HEALTH STRATEGIES | 200 State Street Suite 302, Boston, MA 02109 | t. 617.747.1230 | beaconhealthstrategies.com
WESTERN REGION BEHAVIORAL HEALTH ORGANIZATON
WITH BEACON HEALTH STRATEGIES, LLC
AND COORDINATED CARE SERVICES, INC.
What is a Regional Behavioral Health Organization?
AND WHAT WILL THEY BE DOING?
What are BHOs? BHOs are entities with experience and demonstrated expertise managing
behavioral health services for individuals with substance use and serious mental illness. In
January 2011 Governor Cuomo created a Medicaid Redesign Team to find ways to increase
quality and efficiency in the Medicaid program and reduce cost. One of the
recommendations enacted into law gives the Commissioners of the Office of Mental Health
(OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) the authority to
contract jointly with Managed Behavioral Health Organizations. BHOs are entities with
experience and demonstrated expertise managing behavioral health services for individuals
with substance use and serious mental illness.
What will BHOs do? Phase 1 BHOs will monitor inpatient behavioral health services within their
regions for Medicaid-enrolled individuals whose inpatient behavioral health services are not
covered by (i.e., “carved out” of) a Medicaid Managed Care plan and who also are not
enrolled in Medicare. In most cases, Phase I BHOs will begin operations in the fall of 2011 and
will be fully implemented by January 2012. Phase 2 BHOs will begin in 2013 and will include some
form of risk-bearing Medicaid managed care for adults and children with serious mental health
issues or substance use disorders.
Source: Office of Mental Health, RBHO Fact Sheet, October 2011
http://www.omh.state.ny.us/omhweb/News/2011/bho_forums_fact_sheet.html
What will a BHO be doing?
THE WORK OF THE BHO IS BROKEN INTO FOUR TASKS
• Task 1 – Concurrent review of Inpatient Admissions, Monitoring of
Discharge Planning and Post Discharge Services
• Task 2 – Tracking of Children with SED
• Task 3 – Provider Profiling
• Task 4 – Facilitation of Cross System Linkages
• NYCCP will be fully operational by Jan 1, 2012 in the Western
Region
What admissions will the BHO be responsible for
reviewing?
TASK 1
• BHOs will review the following populations:
• All fee-for-service admissions to OMH-licensed psychiatric
units (all ages) in general hospitals (Article 28 hospitals).
• Fee-for-service children and youth admitted to OMH licensed
private psychiatric hospitals (Article 31 hospitals).
• Fee-for-service direct admissions to OMH State-operated
children’s psychiatric centers or children’s units of psychiatric
centers.
• Fee-for-service OASAS Certified Part 816 Inpatient
Detoxification Services (Article 28/32).
• Fee-for-service OASAS certified hospital (Article 28/32) or
freestanding (Article 32 only) Part 818 Chemical Dependence
Inpatient Rehabilitation Services.
The BHO Process
TASK 1 - NOTICE OF ADMISSION / INITIAL AND CONCURRENT REVIEW
1. Within 24 hours of admission the facility will notify NYCCP/Beacon of the recipients admission.
• Notification will be done electronically via the secure online Beacon Notice of Admission
(NOA) tool or via telephone.
• Electronic notification will speed the process for the providers, cutting down on phone
wait time and information exchange and will also allow for the electronic submission of
discharge information.
• The admission is a notification and not a clinical review of the recipients condition.
2. Following the notice of admission Beacon will generate a Comprehensive Member Utilization
Profile (CMUP) Report that will be shared with the admitting provider.
•
3.
Within 72 hours of the recipients admission Beacon will conduct the initial clinical review with
the provider.
•
4.
CMUP will include information on the recipients past physical, behavioral, and
pharmacy treatment history.
Purpose of the review is to assess the recipients current clinical status against the
Beacon level of care criteria, discuss the treatment plan, and begin discharge
planning if appropriate.
Additional reviews will be scheduled at a frequency that makes clinical sense based on the
recipients condition and treatment plan.
The BHO Process cont.
TASK 1 - INITIAL AND CONCURRENT REVIEW
5. Application of Level of Care Criteria
• All reviews will be conducted against the Beacon Level of Care (LOC)
Criteria and medical necessity.
• Beacon Utilization Review (UR) Clinicians will assess a recipients clinical
presentation against the LOC criteria to determine if continued stay is
warranted at the current level of care. All concurrent reviews are based on
the severity and complexity of the recipient’s condition. A clinical
evaluation for medical necessity is conducted at each concurrent review as
well as a determination for when the next review will be due. Concurrent
reviews are not routinely conducted on a daily basis.
• If the recipient does not meet the LOC criteria or the provider and UR
Clinician can not reach agreement on the continued course of treatment
the case will be forwarded to a Beacon Physician Advisor (PA). The Beacon
PA reviews all the information collected by the UR Clinician. If there is not
enough information to make a decision, s/he may request additional
documents and/or contact the requestor or other party for further
information.
The BHO Process cont.
TASK 1 - NOTICES
6. Notice of Preliminary Finding
• If the Beacon PA disapproves the request, Beacon will verbally furnish the
provider with a Notice of Preliminary Finding.
• During this notice the Provider will be informed that they have the right to a
reconsideration and to submit additional information to support the
continued stay at the current LOC within 24 hours.
7. Notice of Clinical Determination
• If the recipient is not discharged within 48 hours of the Notice of Preliminary
Finding, or the notice that the Beacon continues to disagree with the
reconsideration request; Beacon will issue a formal Notice of Clinical
Determination indicating such determination and its clinical basis. Beacon
will forward such Notice of Clinical Determination to the provider and to
the Offices.
• There is no financial impact to the determination and if the provider
disagrees with the BHO, they may continue to treat the patient and receive
Medicaid payment, documenting their reasons for medical necessity in the
patient’s records.
The BHO Process cont.
TASK 1 - DISCHARGE PLANNING / REVIEW AND SUPPORT
8. Beacon will be responsible for reviewing and assessing the discharge planning activities of
providers, including key elements such as:
• The
status of the individual and the expected length of stay.
• The content of the treatment plan.
• The anticipated discharge date.
• The completion of assessments of physical and Behavioral Health needs with referrals as
needed to meet the needs identified.
• Contact with case management if applicable.
• Assessment of the need for case management.
• Assessment of need for post-discharge treatment; whether post-discharge physical or
behavioral health services will be required and whether contact has been made with
outpatient providers of such services to schedule first appointments for such services.
• Assessment of housing status, including but not limited to the housing status of the
individual at the time of admission and the anticipated status upon discharge.
• Assessment of consumer/family participation. (Did the consumer/family (for individuals
under the age of 18) have substantial involvement in the development of the discharge
plan? )
• Assessment of post-discharge linkage of children with other service systems, e.g., juvenile
justice, education, child welfare.
The BHO Process cont.
TASK 1 - DISCHARGE PLANNING / REVIEW AND SUPPORT
9. Role of the Beacon Integrated Care Coordinator (ICC) and Multi-System Transition of Care
(MSTC) Specialists
• Beacon will utilize ICC’s and MSTC Specialists to review and support discharge planning
efforts of the providers.
• Facilitate/encourage communication between the individual’s service providers.
• Supplement the treatment team’s knowledge about community resources.
• Support to the Discharge Planner and treatment team; e.g.: complete a SPOA
application as necessary, assist w/coordination with HMO and links to networks.
• Post discharge support via collaboration with outpatient providers to address barriers to
successful implementation of the discharge plan (including support for adherence to
medication regimen, assistance in arranging for transportation, etc.)
• Gather Information regarding linkage.
• Link with applicable Medicaid Managed Care Organization, Health Homes or other
physical health providers involved in the recipients care.
SED Tracking
TASK 2
• The goal of the SED tracking task is to provide The Offices with a better
understanding of the clinical conditions of children diagnosed as having a Serious
Emotional Disturbance (SED).
• OMH licensed clinics that have been designated as Specialty Clinics will be
required to notify the BHO of each new MMC child diagnosed as having a Serious
Emotional Disturbance.
• The BHO will track and report to OMH the number of children so diagnosed. Such
report will classify such data by clinic, diagnosis, functional limitations identified,
and other relevant demographic information.
• Notification will occur through the online Beacon eServices portal.
• Providers will have the ability to enter individual cases or submit batch
uploads for multiple cases.
• Beacon/NYCCP will report data to The Offices on a quarterly basis.
The BHO Process cont.
TASK 3 - PROVIDER AND SYSTEM PROFILING
•Develop Provider Profile Reports, based on data from Task 1 activities and Medicaid data,
related to:
•Characteristics, timeliness and completeness of discharge plans.
•Extent and effectiveness of coordination between inpatient and outpatient health and
behavioral health providers, case managers and Health Homes designated by the
Department of Health in disseminating and implementing discharge plans.
•Interactions between the BHO and the provider.
•Description of the population admitted to inpatient along key dimensions, including
culture, housing, diagnoses.
•Episode management – interaction between the inpatient providers, the BHO and other
providers/significant others in effectively managing the episode of care.
•Inpatient length of stay, including long lengths of stay due to availability of needed
resources.
•Inpatient outlier report, with analysis of factors potentially impacting length of stay, such
as participation in discharge planning by the individual, family, and outpatient providers,
and use of peer services/supports.
•Level and timeliness of engagement in services post discharge, by inpatient provider and
outpatient provider.
•SPOA engagement report.
•Inpatient readmission report, overall and within defined sub-groups.
The BHO Process cont.
TASK 4 - STAKEHOLDER ENGAGEMENT
•BHO Stakeholder Groups
•Provider Group, chaired by Howard Hitzel, President, Lake Shore Behavioral Health
•Peer Services and Family Support Provider Group, chaired by Joe Woodward, President,
Housing Options Made Easy
•County Directors Group, chaired by Pat Brinkman, Commissioner of Mental Health for
Chautauqua County
•BHO Quarterly, Multi-Stakeholder, Sub-regional Operations Meetings
•Inclusive of providers, county directors, peers and family members, managed care
organizations and others
•Identify issues
•Facilitate effective BHO operations
•Encourage cross system linkage
•BHO Semi-Annual Regional All-Stakeholder Meetings
•With OMH and OASAS senior leadership
•Learn from the BHO Provider Profile reports and the OMH/OASAS generated report set
•Develop solutions
•Plan for Phase 2
Contact Information
• Contact Information:
• Jim Spink, Chief Client Officer, BHS
jim.spink@beaconhs.com
• Mark Deasy, Dir. Account Ops. BHS
mark.deasy@beaconhs.com
• Chris Mangione, Clinical Mgr, BHS
christine.mangione@beaconhs.com
• Adele Gorges, Ex Director, NYCCP
agorges@ccsi.org
• Anne Wilder, President, CCSI
awilder@ccsi.org
• www.carecoordination.org
• www.beaconhs.com
• www.ccsi.org