Care Coordination: An Opportunity to Help Drive Change S ept ember - - PowerPoint PPT Presentation

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Care Coordination: An Opportunity to Help Drive Change

S ept ember 18, 2014

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Healthy Counties Initiative S ponsors

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Today’s S peakers

Cherryl Ramirez Executive Director Association of Oregon Community Mental Health Programs Larry Seltzer General Manager, CareManager Business Unit Netsmart Technologies

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How many people are attending this webinar from your computer?

• a. 1
• b. 2
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• d. 4
• e. 5 or more

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Are you a(n)…

• a. Elected county official
• b. Behavioral health care official/ staff
• c. Health and/ or human services official/ staff
• d. Law enforcement official/ staff
• e. Other

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Does your county currently have a care coordination plan for individuals living with behavioral health conditions?

• a. Y

es

• b. No
• c. Not sure

Care Coordination: An Opportunity to Help Drive Change

OREGON’S MODEL

Oregon has a multitude of landscapes: Coast

Waterfalls

Mountains

Forests

Urban Areas

Rural

Frontier

Oregon Healthcare Reform

The “Coordinated Care Organization”

• A community-based and governed organization
• Hybrid of a Health Plan and an ACO
• Includes medical, behavioral health,

dental, public health, social services, housing, and more

Core Elements of a CCO

• 1. Network of all types of health care providers who have agreed to

work together in their local communities

• 2. Have the flexibility to support new models of care that are patient-

centered, team-focused, and reduce health disparities

• 3. Coordinate services and also focus on prevention, chronic illness

management and person-centered care

• 4. Have flexibility within a predictable global budget to provide

community based services in addition to the traditional Medicaid benefits

1115 CMS Waiver – Vehicle for Medicaid Reform

Effective July 5, 2012 Establishment of CCOs as Oregon’s Medicaid delivery system in order to improve health and healthcare, and to lower per capita costs Flexibility to use federal funds for improving health Federal investment: $1.9 billion over five years

Oregon is accountable to CMS for:

Savings

• 2% reduction in per capita Medicaid trend of 5.4%
• State to achieve 4.4% by end of year 2 and 3.4% there after
• No reductions to benefits and eligibility in order to meet targets
• Financial penalties for not meeting targets

Quality

• Measurement and benchmarks
• Financial incentives for CCOs

Transparency (See www.oregon.gov/oha/metrics) Workforce development

• $2 million per year for primary care loan repayment
• Training of minimum 300 additional community health workers by

end of 2015

Ment ntal H Health Or Organiz izations ( (MHO HOs) Servic vice Areas

January 2012 Deschutes Crook Jefferson Wasco Gilli am Morrow

Union

Wheeler Grant Baker Malheur Harney

Clackamas

Clatsop Columbia Tillamook Yamhill Polk Mari

• n

Linn Bent

• n

Lincoln Lane Douglas Coos Curry Jackson Klamath Lake

ABHA (Pink) Benton Deschutes

Crook Jefferson Lincoln

Clackamas (Blue) Clackamas Family Care (Blue, Orange, Gold)

Clackamas Multnomah Washington

GOBHI (Green) Gilliam Baker

Lake Clatsop Malheur Columbia Umatilla Grant Harney Wallowa Wheeler Douglas Morrow Union Hood River Wasco Sherman

JBH (Tan)

Coos Jackson Curry Josephine Klamath

LaneCare (Yellow)

Lane

MVBCN (Aqua) Linn

Polk Marion Tillamook Yamhill

Washington (Orange)

Washington

THA (Orange) Washington Verity (Gold) Multnomah

Hoo d Rive r Joseph ine

Oregon Coordinated Care Organizations

100% Integrated Care

CCOs will be required to have 100% of their members enrolled in Person Centered Medical Homes with fully integrated behavioral health services. Will be responsible for tracking and assisting with elements of a person’s well-being and health-related quality of life including:

• Transportation
• Housing
• Employment and Financial Security
• Nutrition
• Education

Oregon Health Authority 2013 Benchmarks

CCO Incentive Measures Statewide Baseline (CY 2011) Benchmark Access to Care: Getting Care Quickly (CAHPS survey composites for adult and child) 83% 87% Average of the 2012 Medicaid 75th Percentile for adult and child rates. Adolescent well-care visits (NCQA) 27.1% 53.2% 2011 National Medicaid 75th percentile, administrative data

• nly.

Alcohol and drug misuse: screening, brief intervention and referral for treatment (SBIRT) 0.02% 13% Determined by Metrics & Scoring Committee, based on prevalence

• f risky drinking behaviors and

screening rate from the highest

Ambulatory care: outpatient and emergency department utilization *Emergency department utilization rate will be used to determine quality pool payment. ED Utilization: 61.0/1,000mm Outpatient Utilization: 364.2/1,000mm ED Utilization: 44.4/1,000mm Outpatient Utilization: 439/1,000mm 2011 National Medicaid 90th percentile CCO Incentive Measures Statewide Baseline (CY 2011) Benchmark Colorectal cancer screening (HEDIS) Baseline and benchmark are final. 15.8 / 1,000 member months No benchmark. 3 percent improvement only. Developmental screening in the first 36 months of life (NQF 1448) Baseline and benchmark are final. 20.9% 50.0% Determined by Metrics & Scoring Committee, based on results from 2007 National Survey of Children’s Health.

Follow up after hospitalization for mental illness (NQF 0576) 65.2% 68.0% 2012 National Medicaid 90th percentile Follow-up care for children prescribed ADHD medications (NQF 0108) *Initiation component will be used to determine the quality pool payment Initiation: 52.3% C&M: 61.0% Initiation: 51.0% C&M: 63.0% National Medicaid 90th percentile Mental and Physical Health Assessments within 60 days for Children in DHS Custody 53.6% 90% Determined by Metrics & Scoring Committee CCO Incentive Measures Statewide Baseline (CY 2011) Benchmark

Patient-Centered Primary Care Home (PCPCH) Enrollment Calculated by: [(# of members in Tier 1)*1 + (# of members in Tier 2)*2 + (#

• f members in Tier 3)*3 ] /

(The total number of members enrolled in the CCO*3) 51.8% Goal: 100% of members enrolled in Tier 3 PCPCHs The percentage of dollars available to each CCO for this measure will be tied to the percentage of enrollees in PCPCHs, based on the measure formula. Prenatal and postpartum care: timeliness of prenatal care (NQF 1517) 65.3% 69.4% 2012 National Medicaid 75th percentile, administrative data

• nly

CCO Incentive Measures Statewide Baseline (CY 2011) Benchmark

Satisfaction with Care: Health Plan Information and Customer Service (CAHPS survey composites for adult and child) 78% 84% Average of the 2012 Medicaid 75th Percentile for adult and child rates. EHR adoption Baseline and benchmark is final. Baseline reflects final measure specifications using local providers only. 28.0% 49.2% 2014 Federal benchmark for Medicaid. Elective Delivery Preliminary: 10.1% 5% or below Determined by Metrics & Scoring Committee.

CCO Incentive Measures Statewide Baseline (CY 2011) Benchmark

Incentive Pool was $46 M in first year.

CCOs making progress

• - Decreased emergency department visits. Emergency department visits by people

served by CCOs has decreased 17 percent since baseline data were collected in 2011. The corresponding cost of providing services in emergency departments decreased by 19 percent over the same time period.

• - Developmental screening during the first 36 months of life. The percentage of

children who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21 percent to 33 percent in 2013, an increase of 58 percent.

• - Increased primary care. Outpatient primary care visits for CCO members increased

by 11 percent and spending for primary care and preventive services are up over 20

• percent. Enrollment in patient-centered primary care homes has also increased by 52

percent since 2012, the baseline year for that program.

• - Decreased hospitalization for chronic conditions. Hospital admissions for

congestive heart failure have been reduced by 27 percent, chronic obstructive pulmonary disease by 32 percent and adult asthma by 18 percent.

Rewarding CCOs for improving care

• For the first time, the State of Oregon is

rewarding CCOs for better care instead of number

• r type of services delivered.
• CCOs will receive all or part of the payments held

back (incentives).

• To earn their full payment, CCOs had to show

improvements on 17 measures – Eleven out of 15 met 100% of their improvement targets.

On the right track to Triple Aim

• Coordinated Care Organizations are moving from

medical care to health care in the services delivered and through redesign of the delivery system.

• We recognize the importance of foundational

involvement of behavioral health in CCO development and operation.

• We are developing an upstream agenda of

better personal health, prevention, and health promotion by understanding the impact of social determinants of health.

LMHA Role in Coordination of Care

For successful system reform, it is important for the CCO to support the LMHA’s coordination and management responsibilities for the community safety net:

• Jail and State Hospital Diversion programs
• Mental health residential programs
• Supportive Housing development
• Management of children and adults at risk of entering or who are transitioning

from the Oregon State Hospital or from residential care

• Maintain or improve the Crisis System
• Management of community-based specialized services, including but not limited

to: supported employment, supported education, early psychosis programs, assertive community treatment, other types of intensive case management programs, and home-based services for children.

• Management of specialized services to reduce recidivism of individuals with

mental illness in the criminal justice system.

Oregon Health Authority – USDOJ Agreement: Performance Measures

• 1. Availability of Community-based Services
• 2. Utilization of Community-based Services
• 3. Residential Setting and Community Housing
• 4. Other Program Outcome Measures – Adults with SPMI
• In less restrictive settings
• With regular Primary Care visits
• Receiving SBIRT
• With improved quality of life
• With decreased alcohol use, homelessness, criminal justice involvement
• Reporting satisfaction with care and outcomes
• 5. Funding of Community-based Services
• 6. Quality Management System
• 7. Work Plans

Mental Health – Justice Initiative

Issue: Preadjudicated inmates in Jail with terminated or suspended Medicaid benefits Oregon County Jail Survey with 24/30 jails responding found:

• 61.5% of the Oregon county jail population is preadjudicated/pretrial.
• Two-thirds of the pretrial detainees have mental illness or substance

use disorders.

• The average length of stay for pretrial detainees is two weeks.
• Most pretrial detainees are uninsured (73% at the time of the survey

in Fall 2013).

• Healthcare costs, including jail healthcare staff, are an average of $412

per month per inmate.

Mental Health – Justice Initiative

Recommendations:

• Advocate for changing the federal statute to allow pretrial detainees

to retain Medicaid benefits through national initiatives and by requesting an amendment to Oregon’s 1115 waiver for a state pilot program.

• Implement statewide policy and procedures to ensure consistent

application of the Medicaid enrollment – suspension – and reinstatement process across local law enforcement agencies.

• Collect healthcare cost and coverage, mental illness, substance use

disorder and Veteran status data from jails routinely, using uniform definitions and measures across the state for reporting the data, in

• rder to inform health policy initiatives for inmates and to assess

whether or not changes to policies and procedures are effective.

Mental Health – Justice Initiative

Progress Report:  Drafted legislation to change federal statute in order to allow pretrial detainees to retain Medicaid benefits.  Recruiting co-sponsors from Congress to introduce and support the bill.  Worked with the state Medicaid agency (MAP) to create guidelines and a process for jails to enroll inmates in Medicaid, suspend and reinstate Medicaid as they are hospitalized or released.  Conducted statewide trainings on Medicaid and the enrollment process for local law enforcement agencies and community partners; continue to improve the process and update enrollment assisters and key community stakeholders.

Challenges to Coordinating Care

Adequate Behavioral Health Workforce

• Numbers
• Retraining

Common Challenges to Health, Education and Public Safety Reform

• Poverty
• Adverse Childhood Experiences (ACEs)/Trauma

Multi System Coordination

• Health Care, Education and Public Safety Reform
• Payment Reform
• Sharing Personal Health Information across Systems

Confidential

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Care Coordination

NaCo Presentation 9/17/2014 Larry Seltzer, General Manager, CareManager

Confidential

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Netsmart At A Glance



Founded in 1968



Largest healthcare IT company serving Health and Human Services sector



42 state systems; 22,000 providers



1,000+ clinics, hospitals



Serving 20,000,000 Americans



#1 in behavioral health



#1 in public health



Complete suite of solutions

Electronic Medical Record

Patient Billing

Practice Management

Care Coordination

Managed Service Offering

Consumer Engagement

Connectivity/HIE



Broad range of Managed Services

IT Hosting/SaaS

IT Outsourcing

Revenue Cycle Management



800 Associates in 4 locations

Kansas City, New York, Chicago, Columbus

Confidential

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Why have a population health strategy

Confidential

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Diabetes BMI > 25 s Medication If you are only looking at part of the person you’re missing the point

Confidential

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Depressio n

Housin g Diabete s BMI > 25

Health Plan

ED Admission

Parenti ng Issues

Medication

Pull back, to see the needs, not just the diagnoses

Confidential

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Depression

Housing Diabetes BMI > 25 Health Plan

ED Admission

Parenting Issues

Medication Depression

Hou Health Plan Health Plan

ED Admission

Parenting Issues

Depression

Housing h Diabetes BMI > 25

n

25 g Issues Medicati

• n

Pull farther back to see more of the population and their needs.

Confidential

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Confidential

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Diabetes and Depression

Confidential

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Schizophrenia and BMI > 25

Initiatives that can help improve the Health Status for all

Confidential

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What are your Care Coordination requirements

Confidential

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What is CareManager

Population Health



Air Traffic Control



Care Planning



Care Coordination



Alerts & Notifications EMR Agnostic EMR Independent

Confidential

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myHealthPointe

Individual Pharmacies

• Soc. Svcs.

SU Inpatient MH CMHC PCP

Case Management Utilization Management

Enrollment Assessments Care Plan Referrals

Analytics

Outcomes Consent Authorizations Outbound Claims

Clinical Registries Provider Registry

HIEs

Provider Portal

Treatment Guidelines Population Based Evidence Clinical Research Medicai d Medicar e BC/BS MCO

Local Health Dept.

Patient Decisio n Suppor t

Inbound Claims

Hospital

Provider Network Clinical Workflow Financial Reporting and Analytics

Registries

Confidential

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Management of Multiple Chronic Conditions Behavioral Health Integration with an ACO Integration of Child and Family Services

Health Homes of Upstate New York

Supports multiple content libraries

Management of the Seriously Mental Ill (SMI) Population

Confidential

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The Real World

Care Coordination examples to formulate strategy

Confidential

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Behavioral Health Co-Morbidities Have Significant Impact

• n Healthcare Costs

$8,000 $9,488 $8,788 $9,498 $15,691

$24,598 $24,927 $24,443 $36,730 $35,840

Asthma and/or COPD Congestive Heart Failure Coronary Heart Disease Diabetes Hypertension

Annual Per Capita Costs

No Mental Illness and No Drug/Alcohol

Confidential

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Case Study – Tampa Coordinated Care

Confidential

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Confidential

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Confidential

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Region 4

Seniors > 65 Behavioral Health Adult Chronic Physical Children

Region 5

Seniors > 65 Behavioral Health Adult Chronic Physical Children

Region 7

Seniors > 65 Behavioral Health Adult Chronic Physical Children

Washington State

• Care Management Agencies by population
• Regions exist across Washington State

CM

• Exchanging both Physical and Behavioral Health data
• All Care Coordination Agencies will utilize CareManager

CC

Confidential

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Multicare Health System (Chronic Physical) Catholic Community Services (Children) Greater Lakes Mental Health (Adult SMI)

INPATIENT MH FACILITY CMHA LOCAL HEALTH DEPT SOCIAL SERVICES SUBSTANCE USE PCP HOSPITAL ED HIE (EDIE)

Area Agency

• f Aging

(Seniors)

Managing Entity

Confidential

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Downstream Providers Leads Managing Entity

HHUNY HHUNY Southern Tier Chautauqua HHUNY Western ADDSTX HHUNY Finger Lakes Huther Doyle HHUNY Central Onondoga CMS

Hospital(s) Social Services Inpatient MH Facilities BH Provider(s) PCP(s)

Care Coordination: Adult and Child

Confidential

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Downstream Providers Partners Leads

Amerigroup CMHC 1 CMHC 2

. . .

CMHC 26

Hospital(s) Social Services Inpatient MH Facilities BH Provider(s) PCP(s)

Kansas: Chronic Conditions and Adult

UHC

Sunflowe r

Confidential

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Behavioral Health Care Coordination Care Management Agency Care Coordination Plan Problems Objectives Interventions Physical Health Care Coordination Care Management Agency Care Coordination Plan Problems Objectives Interventions

Healthix

Health Information Exchange

• Supporting workflow of Behavioral Health
• Supporting workflow of Substance Abuse

CM

• Exchanging both Physical and Behavioral Health data
• Exchanging CDA electronically (Care Coordination Plan)

CC

Sending and Receiving a Care Plan

Confidential

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Downstream Providers Partners Managing Entity

Advantage Behavioral Health Tennessee Voices for Children Centerstone

• f

Tennessee Centerstone Research Institute Volunteer BH Care System

Hospital(s) Social Services Inpatient MH Facilities BH Provider(s) PCP(s)

Early Connections Network: Systems of Care

Confidential

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Care Coordination: “Transitions of Care”

Focus:

• Re-Admissions
• Emergency Department

Admissions

• Transitional Care Management
• Maintain Visibility of Discharges

Health System Physical Health Behavioral Health

Outpatient Substance Abuse Clinic Outpatient Behavioral Health Clinic

1 2

Confidential

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Health Record Integration

CareConnect

• 1. Push Based Referrals

and Transitions of Care

• 2. Increase Data to

Include Behavioral Health Data

• 3. Implement Point of

Care Consents for Query

• 4. Embed Netsmart into

their Systems

Confidential

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Conclusion

• Top Down and Bottom up approach
• Needs change depending on the population
• Strategy needs to focus on Behavioral, Physical

and Social needs

• Integration should be where your value is

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Y

• u may ask a

question using the questions box on the right side of the webinar window.

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Upcoming Healthy Counties Webinar

Mental Health Parity: What it Means for Counties as Providers

• When: Thursday, October 02, 2014, 2:00 PM -

3:15 PM Eastern Time

• Speakers:

– David Evans, Chief Executive Officer, Austin

Travis County Integral Care

– Adam Easterday, Deputy General Counsel,

Optum

• Go to www.naco.org/ webinars to register and for

more information

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NACo 2015 Health, Justice and Public S afety Forum: Optimizing Health, Justice and Public S afety in Y

• ur County

Join us in Charleston County, S C to learn how to bolster leadership in local health and j ustice systems. We will discuss:

– Behavioral health interventions – Health coverage and the j ustice system – Collaborative partnerships – Emergency management roundtable

• When: January 21-23, 2015
• Go to www.naco.org/2015healthjusticeforum for more

information

• Contact: Emmanuelle S
• t. Jean, Program Manager at

estj ean@ naco.org or 202.942.4267

68

NACo 2015 Health, Justice and Public S afety Forum: Optimizing Health, Justice and Public S afety in Y

• ur County

Join us in Charleston County, S C to learn how to bolster leadership in local health and j ustice systems. We will discuss:

– Behavioral health interventions – Health coverage and the j ustice system – Collaborative partnerships – Emergency management roundtable

• When: January 21-23, 2015
• Stay Tuned for Registration Information
• Contact: Emmanuelle S
• t. Jean, Program Manager at

estj ean@ naco.org or 202.942.4267