Center for Children St. Catherines Center for Children provides a - - PowerPoint PPT Presentation
St. Catherines Center for Children St. Catherines Center for Children provides a comprehensive range of human services designed to offer hope, foster growth, and improve the lives of the children and families we serve. St. Catherines
a comprehensive range of human services designed to offer hope, foster growth, and improve the lives of the children and families we serve.
a comprehensive range of human services designed to offer hope, foster growth, and improve the lives of the children and families we serve.
not-for-profit human services agency. We are a haven for hope, offering services, treatment, and education for our community’s most at-risk children and families in order to heal and preserve family life.
Comprehensive homeless services for families and
adults
Residential services for children 5-13 Foster care services Day treatment/Special education elementary school Community-based and prevention services
Funded through the Office of Temporary Assistance
and Albany County Department of Social Services
Emergency shelter for 24 families Case management Supported employment On-site childcare/transportation/recreation
Permanent Supportive Housing:
HUD funded for the chronically homeless Serious mental illness and/or substance abuse Scattered sites in Albany/Columbia counties Albany County-houses 12 families/7 singles Columbia County-houses 4 families/4 singles
Project Connect:
Funded through a 3-year Substance Abuse and Mental Health
Services Administration (SAMHSA) grant
Outreach and engagement to homeless individuals Houses 30 single chronically homeless individuals per year
Healthy Outcomes through Supportive Transitions (HOST) NYS Department of Health funded since 2015 (MRT) Houses and provides case management for 30
homeless/unstably housed individuals at scattered sites
Primary focus: decrease Medicaid costs and improve health
Serves high users of crisis services, including those who
struggle with severe mental health, substance abuse and/or chronic illnesses
Based on evidence-based practices, including: Housing First, Motivational
Interviewing, Critical Time Intervention, Supported Employment, Harm Reduction, and SOAR, (SSI/SSDI, Outreach, Access and Recovery)
Client driven service delivery Street outreach Engaging community resources and contacts
Medicaid/Health Homes Shelters Emergency rooms and police Mental Health Units Detox
Quality care to high cost Medicaid patients Utilizing health care resources Clarifying roles and case conferencing
PSH, MCO and Community
Providing high quality services to the highest need
Formalizing the relationship Serving individuals identified by the MCO
MCO has a different threshold than homeless supportive
housing programs
Trust and quality of care established
Establishing level of service provided by CBO Finances
Staffing and Case Load Business model/ consistency
Final talks of contract negotiations Identifying additional MCO’s and PPS’s that want to
contract with CBO’s
Market ourselves and our services through quality of care
and decrease in Medicaid costs to high need clients
Health Homes/Care Coordination Managed Care Organizations
CDPHP Fidelis
Hospitals Program Services Coordinating Committee
(PSCC)
29 highly vulnerable individuals currently housed Supported Employment Case Manager offers employment
assistance
Staff are trained in the SSI/SSDI Outreach, Access and
Recovery (SOAR) model
Albany and Rensselaer County Departments of Social
Services secure mainstream benefits (housing allowance, food stamps and Medicaid)
Peer Support Services connecting clients
to support groups, Drop in Centers
Clients participate in focus groups to
share their story to educate and raise awareness of homelessness, mental illness and addiction.
Client engagement activities
Annual summer cookout Thanksgiving Breakfast with Albany Medical Center Coat drive Client participation in event panels
Secure safe, affordable and stable housing Encourage healthy foods & eating (i.e. Price Chopper
partnership)
Crime & Violence
Albany PD Law Enforcement Assisted Diversion (LEAD) Albany PD Neighborhood Engagement Unit
Currently serving 30 individuals over two counties (Albany and Rensselaer) 67% decrease in ED visits 56% decrease in inpatient days An example of a high utilizer: Pre housing ER spending $43,600.29 and 181 ER visits. Post housing ER spending $325.50 and 9 ER visits.
October 2017
Social Determinants of Health (SDH) & Community Based Organizations (CBOs)
March 21, 2018
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Key Insights to Keep In Mind
➢ Performing Providers Systems (PPS) ➢ Managed Care Organizations (MCOs) ➢ Large Provider Systems ➢ CBOs
➢ TCGP, IPC, Maternity, HIV/AIDS, HARP, MLTC
➢ e.g. Housing, Nutrition, Health-based Housing Design
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SDH Interventions can be less costly than traditional medical interventions___ Addressing social determinants can have a significant impact on health outcomes
What Are Social Determinants of Health and Why Are They Important?
Social determinants of health are the structural conditions in which people are born, grow, live, work and age Under VBP, VBP contractors aim to realize cost savings while achieving high quality
➢ The VBP program design incentivizes VBP contractors to focus on the core underlying drivers of poor health outcomes—the Social Determinants of Health
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Standard: Implementation of SDH Intervention
“To stimulate VBP contractors to venture into this crucial domain, VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health
expected to solely take on the responsibilities and risk.” (VBP Roadmap, p. 41) Description: VBP contractors in Level 2 or 3 arrangement must implement at least one social determinant of health intervention. Language fulfilling this standard must be included in the MCO contract submission to count as an “on-menu” VBP arrangement.
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Guideline: SDH Intervention Selection
“The contractors will have the flexibility to decide on the type of intervention (from size to level of investment) that they implement…The guidelines recommend that selection be based on information including (but not limited to): SDH screening of individual members, member health goals, impact
and resources.” (VBP Roadmap, p. 42) Description:
VBP contractors may decide on their own SDH intervention. Interventions should be measurable and able to be tracked and reported to the State. SDH Interventions must align with the five key areas of SDH outlined in the SDH Intervention Menu Tool, which includes: 1) Education, 2) Social, Family and Community Context, 3) Health and Healthcare 4) Neighborhood & Environment and 5) Economic Stability
The SDH Intervention Menu Tool was developed through the NYS VBP SDH Subcommittee and is available here: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/
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Housing Security: Outcomes of MRT Supportive Housing
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Food Security: Outcomes of Medically Tailored Meals (MTM)
for half a year by saving one night in a hospital
diagnoses compared to similar patients not on MTM)
diagnoses compared to similar patients not on MTM)
post MTM intervention)
meals will be discharged to their home, rather than a long term facility (23%) (all diagnoses compared to similar patients not on MTM)
MTM intervention)
God’s Love We Deliver Nutrition Intervention Outcomes
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Standard: Inclusion of Tier 1 CBOs
“Though addressing SDH needs at a member and community level will have a significant impact on the success of VBP in New York State, it is also critical that community based organizations be supported and included in the
Level 2 and 3 VBP arrangements include a minimum of one Tier 1 CBO.” (VBP Roadmap, p. 42) Description:
Starting January 2018, VBP contractors in a Level 2 or 3 arrangement MUST contract with at least one Tier 1
VBP arrangement. This requirement does not preclude VBP contractors from including Tier 2 and 3 CBOs in an arrangement to address one or more social determinants of health. In fact, VBP Contractors and Payers are encouraged to include Tier 2 and 3 CBOs in their arrangements.
October 2017 32 01 02 03
Tier 1 CBO
➢ e.g. housing, social services, religious organizations, food banks
component that bills Medicaid and one component that does not and still meet the Tier 1 definition
Tier 2 CBO
➢ e.g. transportation provider, care coordination provider
Tier 3 CBO
Developmental Disabilities, or NYS Office of Alcoholism and Substance Abuse Services.
Tier 1, Tier 2, and Tier 3 CBO Definitions
Use the CBO list on DOH’s VBP website to find CBOs in your area
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The Role of Tier 2 and 3 CBOs in VBP
Tier 2 and Tier 3 CBOs can and will play an important role in VBP!
The more the merrier
(including Tier 2 & 3 CBOs) in an arrangement
Make a friend
VBP Contractors are incentivized to include multiple CBOs
which may result in more shared savings for a VBP Contractor
Align with a VBP arrangement
with the arrangement a lead VBP contractor is implementing
Cover a larger geographic area
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CBO Engagement and Integration
CBO Survey was released earlier this year. The survey is used to understand CBO integration with the NYS VBP program and use information provided to build a public inventory of Tier 1, 2 and 3 CBOs that can be used to facilitate VBP contracting.
➢ 441 Respondents to date
➢ Tier 1: 33% ➢ Tier 2: 12% ➢ Tier 3: 45%
➢ 43%- Have met with an MCO and VBP Contractor ➢ 12%- Currently participating in an SDH Intervention to support a VBP arrangement
Community Based Organizations. Directory is updated bi-weekly.
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October 2017 36 Hypothetical Example
contracting directly with an MCO to support a VBP arrangement A
GreenLeaf Managed Care Forestland Hospital
Total Care for General Population (TCGP) VBP arrangement with GreenLeaf Managed Care
under the arrangement have lack of access to affordable housing
Hazelcrest Housing CBO to implement a Housing Intervention for the highest utilizers covered under Forestland’s VBP arrangement Hazelcrest Housing CBO
TCGP Level 2
October 2017 37 Hypothetical Example
contracting directly with an MCO to support a VBP arrangement contracting directly with an MCO to support multiple VBP arrangements A B
EverGreen Managed Care Forestland Hospital
HARP Level 2
Chestnut Clinic
HIV/AIDS Level 3
Applewood CBO
arrangements targeted at the Special Needs Subpopulations (HIV/AIDs & HARP)
has revealed that a large challenge facing the local Special Needs Subpopulation is food insecurity
with Applewood CBO to implement a Nutrition Intervention for the local Special Needs Subpopulation served by the multiple VBP arrangements
October 2017 38 Hypothetical Example
contracting directly with an MCO to support a VBP arrangement contracting directly with an MCO to support multiple VBP arrangements subcontract with a VBP Contractor
(Hospital, IPA, ACO, etc.)
A B C
GreenLeaf Managed Care Hickory IPA
Integrated Primary Care (IPC) VBP arrangement with GreenLeaf Managed Care
chronic care episode included in the IPC arrangement, and is exploring innovative ways to prevent complications associated with asthmatics
that is known regionally for home environment-based interventions
Mountainside Healthy Homes to implement home-based interventions targeted at improving air quality in the homes
Mountainside Healthy Homes
IPC Level 2
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Payment for services rendered
Contracts without a risk- based component
Upside only
No downside risk If savings are achieved, CBO receives a portion of shared savings If losses are incurred, CBO would not take on any losses
Upside and Downside risk
Risk sharing contract If savings are achieved, CBO receives a portion of shared savings If losses are incurred, CBO would take on some degree
Contractor or MCO) in order for contracting to continue
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I. Community Based Organization (CBO) Planning Grants
I. Grants support CBOs with contracting and administrative resources II. Grantees:
➢ Arthur Ashe Institute for Urban Health (New York City) ➢ The Health and Welfare Council of Long Island (Long Island/Mid-Hudson Region) ➢ RFA released for rest of State
2. New York Performing Provider Systems (PPS)
I. Innovation Fund:
➢ Funding opportunity to support the efforts of CBOs and other partners to Implement innovative approach to achieve DSRIP and VBP performance goals
II. Transformation Fund:
➢ Funding opportunity to focus on addressing gaps in the IDS
III. Workforce Fund:
➢ Assistance relating to staff recruiting and training SDH
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➢ Managed Care Organizations (MCOs) receive, in aggregate, $85 million in guaranteed VBP stimulus funding for State Fiscal Years (SFYs) 2016-17 and 2017-18 ➢ CBOs can negotiate with MCOs to receive a share of these dollars to facilitate investment in SDH Interventions ➢ Since providers (including CBOs) who successfully address SDH at both member and community levels may not see savings in the short term, they will be incentivized by MCOs upfront to identify one (or multiple) social determinant(s) and be financially rewarded for addressing them (VBP Roadmap, p. 42)
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Implement the VBP Roadmap Requirements Related to SDH and CBOs
care providers
Begin CBO SDH Regional Meetings
QARR
Improve SDH Measures in Population Health and Payment Reform
Systems
Days
Create a New Housing Referral Process
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“The State will monitor progress on the Prevention Agenda targets, including how VBP contractors (aim to) impact these targets. The State intends to introduce a dedicated value based payment arrangement for pilot purposes in 2018 to focus specifically on achieving potentially trailing Prevention Agenda targets through CBO-led community-wide efforts.”(VBP Roadmap, p. 43)
Description: DOH is working on the development of a VBP pilot program aimed at the
prevention agenda.
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population
0-4 years
diabetes per 10,000 - Aged 6-17 years
diabetes per 10,000 - Aged 18+ years
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Key Takeaways
The NYS VBP Roadmap is clear in the importance of social determinants of health interventions and the role of CBOs.
The VBP Roadmap allows flexibility in the types of SDH interventions that may be implemented.
education, etc.) CBOs may provide a number of services and functions within a provider’s network.
Tier 2 and 3 CBOs play a vital role in strengthening a provider network.
October 2017 For Additional Information: Value Based Payment (VBP) Resource Library Contact Us: Bureau of Social Determinants of Health SDH@health.ny.gov