Behavioral Health Value Based Payment Readiness Program Workplan - - PowerPoint PPT Presentation

New York State Behavioral Health Value Based Payment Readiness Program

Workplan and Budget Templates

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Table of Contents

• Purpose
• Upcoming Dates
• Preliminary Workplan
• Organizational Structure
• Data Analytics
• Quality Oversight
• Clinical Integration
• Annual Budget
• Resources

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Purpose

• This funding opportunity aims to help prepare behavioral health

providers to engage in Value Based Payment arrangements.

• The final deliverable is to contract in a Level 2 or higher

arrangement as a Level 1 provider network or as a contracted entity in a Level 2 or higher arrangement.

• A main goal is to improve the integration of physical and behavioral

health.

• The funds are intended to be used to enhance quality care through

clinical and financial integration and the use of community- based recovery support services.

• Funds will also allow the BHCC to collect, analyze, and respond to

service data to improve behavioral and physical health outcomes.

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Upcoming Dates

First Year One Payment: Upon contract signature between BHCC lead entity and MCO partner* Preliminary Workplan Due: March 22, 2018 Second Year One Payment: After preliminary workplan approved

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VBP Readiness Preliminary Workplan

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Major Workplan Areas

The BHCC preliminary workplan template includes each of the four BHCC readiness areas:

• Organization Structure
• Data Analytics
• Quality Oversight
• Clinical Integration

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Preliminary Workplan

• Release of BHCC Year One Second Payment,

and any subsequent funding is contingent upon submission and approval of the preliminary workplan.

• Submitted preliminary workplan must include a

timeline for each workplan area, which ties back to the proposed budget.

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Organizational Structure

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Organizational Structure and Rules

1. Describe in detail BHCC Entity Type, i.e. IPA, independent network of providers, etc. (current or projected); and directional purpose of the BHCC 2. Describe and detail a plan, including a schedule and activities for communication and engagement activities

A. Within the BHCC B. With the BHCC MCO partner -This must include a discussion about submission of: Quarterly summary status report and other means of engagement (e.g. phone call(s) if needed)

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BHCC Network and Affiliate Providers

• 1. Update and submit the BHCC Member Submission

Template (Excel)

https://www.omh.ny.gov/omhweb/bho/bhcc_member_submission_template_09152017.xlsx

• 2. Submit initial organizational chart
• 3. Describe plan to:

1. Address BHCC gaps, if any, in care continuum 2. Create BHCC Membership Standards 3. Create a process for Joining/Leaving/filing a grievance with the BHCC

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Financial Structure

Plans and timelines to support:

1. Bringing in the input of BHCC: OMH Art 31, OASAS Art 32, and designated HCBS BHCC provider partners in decisions regarding funds allocation and for funds distribution to support BHCC activities in the four readiness areas 2. Collecting dues (if any) 3. Identifying funding sources beyond the BH VBP Readiness Program 4. Developing a Sustainability Plan

Submit proposed State-provided budget

Budget should include summary of items and activities for each readiness area as described, but not limited to those, in the budget template provided by the State.

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Data Analytics

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Data Management and Reporting

Plans and timelines to support: 1. Identifying, by MCO, total MMC enrollees served by the BHCC 2. Identifying ongoing service utilization trends in Physical Health, Behavioral Health, Medication Assisted Treatment for Substance Use Disorders (SUD), Social Determinants of Health, and BH Home and Community Based Services

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Data Analysis and Sharing

Plans and timelines to support:

1. An Assessment of IT capability, including:

• Applications/software used (e.g. EMRs)
• Plan for sharing IT infrastructure
• Plan for addressing confidentiality and consent issues
• Data necessary for dashboard development, clinical data sharing, cost

and quality reports for relevant stakeholders

2. Selection or design of a shared IT platform

• Analysis should consider relationship to potential VBP contract

requirements and existing regional IT resources

3. Overcoming barriers to the above IT goals

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Shared IT platforms and tools

• Ability to support internal and external:

– Care coordination

• Analytics

– Communication

• Customizable
• NYS strongly encourages BHCCs to partner with
• ne another and/or other regional entities such as:
• Performing Provider Systems
• Medicaid managed care plans
• PSYCKES
• Hospitals
• RHIOs
• Primary Care Providers

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Using data

Plans and timelines to support:

1. Using data to develop a BH and support services gap analysis for BHCC services areas 2. Implementing performance dashboards 3. Implementation and ongoing monitoring of care planning 4. Evaluating improvement opportunities and collaborate with MCOs 5. All data activity must be HIPAA and 42 CFR Part 2 compliant

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PSYCKES

• PSYCKES has developed three utilization

reports for VBP:

• 1. Payer Mix
• 2. Provider Network
• 3. Volume and Service Setting
• See recorded webinar and slide deck at:

http://www.ctacny.org/training/psyckes- utilization-reports-webinar

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PSYCKES Utilization Reports

• 1. Payer Mix

– Which Managed Care Plans and product lines are my clients enrolled in? – Which plans and product lines should I focus on? WHY?

• 2. Provider Network

– Which other providers do I share clients with, for what service types?

• For example, my mental health clinic clients use which SUD

services, medical ERs, or outpatient medical services?

– Who should I partner with?

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PSYCKES Utilization Reports

• 3. Service Setting and Volume

– What services are my clients using?

– from me – from other providers?

– How many encounters per year, by service type (at my agency, at other providers, and in total)? – How can I use this volume data to model costs?

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Quality Oversight

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Quality Measurement and Reporting

• 1. Plans and timelines to support:
• A. Determining measures to use to monitor internal

performance for continuous quality improvement

• B. Reporting collected metrics and outcomes to BHCC

partners

• 2. A description of current VBP outcome and/or

performance arrangements in the BHCC Member Submission Template

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Clinical Integration

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Clinical Integration Protocol and Standards

• 1. Plans and timelines to support:

A. Development of clinical practices, protocols and service coordination activities that support care coordination and clinical activity integration across the BHCC B. Responding when access issues or quality indicators are not being met among the BHCC providers C. Monitoring individual programs for compliance with BHCC quality expectations and for corrective action when problems are identified among the BHCC providers

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Annual VBP Budget

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Release of Funds

Program Year One:

• First Payment upon final contract between BHCC entity and the BHCC

plan Partner.

• Second Payment upon submission, review and approval of preliminary

workplan Program Year Two and Three: Parallel the State Fiscal Year (4/1/xx – 3/31/xx)

• Payments released at two points in program year (anticipated release

at six month intervals)

• Payment release contingent upon submission, review and approval of

updated workplans and deliverables. Note: Unspent funds may be carried forward into the next program year

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BHCC and Lead Agency Acceptance of Funding Terms and Conditions

1. BHCC funds will be used only for approved readiness

• activities. Funds will be distributed based on BHCC policy and

rules. 2. The lead agency, on behalf of the BHCC, will submit all required program items to the designated MCO. 3. The State reserves the right to retroactively review work plan activities and deliverables, and recoup BHCC funds from the lead provider in the event it is determined it inaccurately represented activity and/or progress.

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BHCC and Lead Agency Acceptance of Funding Terms and Conditions

Readiness Area : Organization Items eligible for funding include but are not limited to:

Connectivity with entities across and beyond the BHCC, Formation of committees within the BHCC to ensure compliance and consistency, Creating governance and decision-making structures, Developing plans to address network gaps, Dues payment including any arrangements for smaller agencies, Plans to manage BHCC member concerns and issues, and Contracting with legal/business consultants

Activities / Items (insert rows as necessary) SFY 2017-18 SFY 2018-19 SFY 2019-20 Total Total for BHCC:

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Organization

Items eligible for funding include but are not limited to:

• Connectivity with entities across and beyond the BHCC
• Formation of committees within the BHCC to ensure compliance and

consistency

• Creating governance and decision-making structures
• Developing plans to address network gaps
• Dues payment including any arrangements for smaller agencies
• Plans to manage BHCC member concerns and issues, and
• Contracting with legal/business consultants

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Data Analytics

Items eligible for funding include but are not limited to:

• Purchase of data analytics and warehousing software/hardware for

collaborating providers

• Training in data management and analytics
• Connections to RHIOs
• Fees for consultants or other entities with access to Medicaid data

that can provide analytics to the BHCC

• Data may inform dashboard development, clinical data sharing, cost,

and quality reports for relevant stakeholders

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Quality Oversight

Items eligible for funding include but are not limited to:

• Identification and implementation of measures (VBP and others),

data collection tools, and systems to facilitate quality assurance and

• versight.

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Clinical Integration

Items eligible for funding include but are not limited to:

• Consulting fees for care coordination training and protocol/policy

development

• Costs for meetings to convene stakeholders/workgroups to develop

protocols/policies

• Costs to support provider meetings related to care coordination

practices

• Costs for training, implementing, and monitoring the delivery of

evidence-based practices

• Costs for establishing co-occurring treatment practices including

screening, treatment, and referral

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Resources Available

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Resources / Questions

• VBP-Readiness@omh.ny.gov
• https://www.omh.ny.gov/omhweb/bho/bh-

vbp.html

– Field Offices – PSYCKES Utilization Reports: http://www.ctacny.org/training/psyckes-utilization- reports-webinar – PPS Partners