NYAPRS 7th Annual Executive Seminar on Systems Transformation
Integration Strategies for Behavioral Health:
Managing Care, Outcomes, and Costs
While Preserving our Recovery Vision
Turning Health Homes Into Recovery Homes
James Schuster, MD, MBA
Chief Medical Officer
Community Care Behavioral Health Organization
Albany, NY
April 27, 2011
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About Community Care
• Behavioral health managed care company founded in
1996; part of the University of Pittsburgh Medical Center
• Federally tax exempt non-profit 501(c)(3).
• Major focus is publicly-funded behavioral health care
services; currently doing business in PA and NY.
• Licensed as a Risk-Assuming PPO in PA; NCQA
Accredited Quality and Disease Management Programs.
• Serving over 1.3 million individuals in 36 Pennsylvania
counties through a statewide network of over 1,800
providers.
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Community Care Counties
Erie
Warren
McKean
Tioga
Potter
Susquehanna
Bradford
Wayne
Crawford
Wyoming
Forest
Elk
Venango
Cameron
Pike
Lycoming
Mercer
Clinton
Jefferson
Clarion Jefferson
Clarion
Lawrence
Luzerne
Clearfield
Butler
Centre
Centre
Union
Armstrong
Beaver
Mifflin
Mifflin
Indiana
Allegheny
Cambria
Snyder
Juniata
Juniata
Perry
Blair
Westmoreland
Columbia
Montour
Northumberland
Monroe
Carbon
Northampton
Schuylkill
Lehigh
Dauphin
Huntingdon
Huntingdon
Washington
Berks
Bucks
Lebanon
Cumberland
Montgomery
Lancaster
Bedford
Greene
Lackawanna
Lackawanna
Sullivan
Fayette
Somerset
Fulton
Franklin
Adams
Chester
York
Philadelphia
Delaware
Community Care Contract
Community Care Office
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Recovery Initiatives
• Multi-year plan to change the clinical
approach and culture of clinical systems
• Annual Recovery Institute for consumers and
providers.
• Shared decision-making focus.
• Learning Collaborative model.
• Steps of Hope: Focus on wellness.
• Statewide Member Advisory Board.
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Models for Integrating
Physical and Behavioral Health
• Co-location of physical health and behavioral
health providers.
• Integrated system.
• Coordination among disparate providers.
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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:
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Center for Health Care Strategies (CHCS)
Department of Public Welfare (DPW)
UPMC for You
Community Care Behavioral Health
Allegheny County Department
of Human Services
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Connected Care™
• Data sharing: care plan
viewable by staff from both
health plans.
• Team meetings for
integrated care.
• Resulted in reduced medical
and BH admissions and
reduced use of ER.
• Improvement opportunities
include more structured
provider health home and
more consistent function of
health navigators.
Community
Care
PCP
Pharmacist
Patient
BH
Provider
UPMC
for You
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Toward Integrated/
Well-Coordinated Care: Next Steps
• Expand Steps of Hope to include smoking
cessation and weight management.
• Train peers and case managers to support
members as “system navigators.”
• Build health homes for consumers with
serious mental illness or substance
dependency that can functionally integrate
care.
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Recovery Homes Based
in Behavioral Health Agencies
• Provide a person-centered system of care.
• Develop a “virtual team” for each individual.
• Enhance physical health competencies in the
behavioral health team.
• Develop person-centered plans with individuals.
• Coordinate physical, behavioral, and supportive
services.
• Manage integrated reporting.
• Integrate health focused activities into existing
recovery initiatives to create true health homes.
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Like Politics,
“All Health Care is Local”
The challenge:
Create local and
regional models of
Physical Health/
Behavioral Health
recovery homes.
Participants include:
• Counties/local governments.
• Behavioral health and physical
health provider systems.
• Consumers.
• Advocacy organizations.
• Behavioral health managed
care/payers.
• Physical health managed
care/providers.
• Content experts.
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Contact Information
James Schuster, MD, MBA
Chief Medical Officer
Community Care Behavioral Health Organization
One Chatham Center, Suite 700
112 Washington Place
Pittsburgh, PA 15219
412-454-2120; www.ccbh.com
Schusterjm@ccbh.com
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