Excellence in Mental Health Act
and the Emerging
Health Reform Landscape
(Moving from Sick Care to Health)
Dale Jarvis, CPA
dale@djconsult.net
Last November I Spoke About…
1. Medi-Cal Expansion +
Covered California.
2. New Behavioral Health $
Going to Medi-Cal Health
Plans and Plans in the
Exchange.
3. Broad Expansion of Drug
Medi-Cal Benefits.
4. Major Changes in ShortDoyle Medi-Cal.
5. Integrated Care is becoming
the Expectation.
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Questions
• How many of you were
at my session last
November?
• How many of you have
any recollection of
what I spoke about?
• How many of you
thought I was full of
hot air?
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Last November I Suggested…
• County MH & A&D
Programs are no longer
living in a bubble.
• (e.g. You no longer have
a monopoly on the
behavioral health
money for the safety
net population.
• What you do (or don’t
do) affects risk-bearing
health plans to a much
larger degree than ever.
Key Idea!
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And Pondered With You…
• Remember, your adult
clients are the most
expensive Medi-Cal
enrollees in California.
• If you provide care that
is dis-integrated,
fragmented, or doesn’t
achieve health
outcomes…
• At-Risk health plans
(Medi-Cal & Exchange)
will lose money.
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The Evolution/Revolution Continues
1. Behavioral Health Centers of Excellence
2. Excellence in Mental Health Act
3. Section 2703 Health Homes
Together these three initiatives will support the
transformation of the U.S. and California’s
behavioral health delivery system!
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1. Behavioral Health Centers of Excellence
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Why the BHCOE Project?
• “In health care, the days of
business as usual are over.”
• “It’s time for a fundamental new
strategy.” “We must…
Shift the focus from volume to
patient outcomes achieved
Replace today’s fragmented
system with a system in which
services are concentrated in
health-delivery organizations”
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Our Journey: A Dozen
Activities over 5 Months
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Our Current BHCOE Definition
• A Behavioral Health Center of Excellence is known by the entire
community as a great place to get care and a great place to work.
• A BHCOE offers easy access to affordable, comprehensive care for
persons experiencing behavioral health issues.
• Clients experience respectful, self-directed, team-based, and
holistic care that addresses their problems and achieves
outcomes important to them.
• Excellence is created by each staff member who has a heartfelt
connection to their community and the people they serve,
• Based on a deep understanding of
trauma, best clinical practices,
• And an unshakable commitment
to resiliency and recovery.
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Our Current BHCOE Elements
•
•
•
•
We have identified five elements…
That we think will evolve over time.
The following is not an exhaustive list,
But we believe that organizations will not be viewed by the
community as a great place to get care and a great place to
work without getting high marks in all areas.
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“Together pursuing the best we can imagine.”
World
Class
Customer
Service…
• Easy
Access (1)
Built on a
Culture of
Engagement
and
Wellness (2)
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Are we seen as the Mayo Clinic of BH?
Comprehensive Care (3)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Healthcare Home/Physical Health
Prevention and Wellness
Engagement Services
Outpatient & Medication Services
Community and Recovery Support
(Rehabilitative)
Other Supports (Habilitative)
Intensive Support Services
Out-of-Home Residential Services
Acute Intensive Services
With Care Management as
the Connective Tissue
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“Take responsibility for making sure I
receive the best possible health care.”
Excellent Outcomes (4) and Excellent Value (5)
1. The services are
effective in achieving
individual outcomes
or system-wide
outcomes;
2. The services are
more cost-effective
than alternatives that
may have been
selected;
3. The service are “lean,”
meaning that waste
(excess costs) have been
removed through process
improvement activities.
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For more info, check out the paper
• https://www.t
henationalcou
ncil.org/confer
ence365/2014/05/
09/centers-ofexcellencefinal-paper/
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This all sounds pretty cool…
• But will it
really
happen
and how
do we pay
for it?
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2. Have you Heard about Certified
Community Behavioral Health Clinics?
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New
Legislation
passed by
Congress on
March 31,
2014
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Certified Community
Behavioral Health Clinics
•
•
•
Began life as Federally Qualified Behavioral Health Centers
(FQBHCs), introduced at the 2010 National Council Conference in
Orlando.
Important strategy for achieving parity at the delivery system
level (with FQHCs).
Create a parallel structure with a single set of national standard
that would serve as a blueprint for the Community Behavioral
Healthcare
Organization of the future.
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What you need to know
today about the new law
•
•
Creates criteria for Certified Community Behavioral Health Clinics
(by 9/1/2015).
Part of the demonstration requires the use of an FQHC-like
Prospective Payment System.
•
•
•
(per encounter payment based on true cost.)
Provides $25M to states to develop applications to apply for the
CCBHC pilot (available by 1/1/2016).
8 states will be selected to participate in
the 2-year pilot by 9/1/2017, receiving
90% FMAP for CCBHC services for the
2 years.
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Nationally this is a REALLY BIG DEAL!
• The Secretary of DHHS has to
submit recommendations to
Congress by 12/31/2021
whether the demonstration
programs should be
continued, expanded,
modified, or TERMINATED.
• i.e., the fate of parity in the
community-based delivery
system rests in the hands of
the 8 state pilots.
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For California this is also
a REALLY BIG DEAL!
• Four Key Leaders in Congress were responsible
for the legislation becoming law
– Senator Stabenow (D)
– Senator Blunt (R)
– Representative Lance (R)
– Representative Matsui (D)
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3. Section 2703 Health Homes
• The Affordable Care Act passed by Congress
and signed into law by the president in
March 2010, provides a variety of
approaches to improving the U.S.
healthcare system.
• Section 2703 of the Act allows
states to amend their Medicaid
state plans to provide
Healthcare Homes for
enrollees with chronic conditions.
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Paving the Way for Healthcare Homes
Missouri’s Healthcare Homes
• Missouri is the first state to amend its Medicaid
state plan to implement Healthcare Homes.
• Missouri will have two types of Healthcare
Homes
– Primary Care Chronic Conditions Healthcare Home
• Federally Qualified Health Centers (FQHCs)
• Rural Health Centers (RHCs)
• Physician practices
– Community Mental Health Center Healthcare Home
• CMHCs and CMHC affiliates
Courtesy of the Missouri Department of Mental Health
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The Missouri Model
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Behavioral Health-Based Healthcare
(The Missouri Model)
• Phase 2: The creation of Community Mental
Health Center Healthcare Homes
– A fundamental redefinition of CMHCs that expands
the scope of service to include addressing the whole
health needs of BH consumers:
1.
2.
3.
Diabetes
Cardiovascular disease
Chronic obstructive pulmonary
disease (COPD)
• Asthma
• Chronic bronchitis
• Emphysema
4.
5.
6.
Overweight (BMI >25)
Tobacco use
Developmental disability
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This looks a lot like many of California’s
Integrated Primary Care/Behavioral Health Projects
• With two major differences:
– It’s statewide.
– There is a substantial amount of funding to support it –
90% FMAP for 8 quarters.
Behavioral Health-Based Healthcare
(The Missouri Model)
• Missouri’s 26 Community Mental Health Center
Healthcare Homes are not necessarily Primary Care
Clinics.
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Behavioral Health-Based Healthcare
(The Missouri Model)
• They have a well defined model that has shifted the system
from Case Management to Care Management and have
brought medical professionals into the clinic to support the
model.
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Connecting the Dots
• The Bar is Being Raised.
• Mental Health and Substance Use Disorder Treatment
Provider Organizations and Plans are now being expected
to be part of the solution.
• Multiple initiatives are rolling
out to support this transformation:
– Integrated Care Initiatives
– Care Coordination Pilots
– Behavioral Health Centers of
Excellence
– Excellence in Mental Health Act
– Section 2703 Health Homes
• County MH and AOD Programs
and Plans are in the critical path
of the fix!
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Two Questions… Be Candid…
• How many of you will
have any recollection
in three months of
what I spoke about
today?
• How many of you think
I am still full of hot air
or, at least think that
this has nothing to do
with you and your
county?
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Other
Questions
and
Comments
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