Credentials: The New York Foundling (The Foundling) is recognized - - PowerPoint PPT Presentation

HOW DO YOU KNOW YOU

ARE READY FOR VBP?

EVIDENCE BASED PRACTICES AND NEW YORK FOUNDLING

THE FOUNDLING

Founded by the Sisters of Charity in 1869 as a home for abandoned children, The Foundling today offers an expansive array of preventive, behavioral health, foster care juvenile justice and educational services for underserved children, families, and adults with developmental disabilities. Whether it’s an abused child in need of a foster home, a young mother who lacks the skills to care for her child, or a young person lost in the juvenile justice system, The Foundling provides the resources necessary to rebuild lives and rebuild families. The Foundling reaches about 7,000 families/27,000 individuals each year in all five boroughs of New York City, surrounding counties, and Puerto Rico.

Credentials:

The New York Foundling (The Foundling) is recognized as the industry pioneer with the largest portfolio of evidence based public health interventions in the world.

2007

• Bluesky (FFT,

MST, MTFC) 2010

• Arrow (MST-

Psych)

• KEYS (FFT, MST,

MTFC)

• STEPS (FFT-CW)

2012

• Families Rising (FFT)
• Close to Home

(MTFC) 2013

• IFS (BSFT)
• Partners for Change

(FFT-CW)

• FAST (MST-CANS)
• Family Foster Care

(CSNYC) 2016

• Health Home Care

Mgmt.

• Satellite Clinic
• School Based

Mental Health

• Blues Program
• Incredible Years

Credentials cont’d:

Over the past 145 years, The Foundling has grown to an agency that provides effective, direct reimbursable services to over 7,000 families or 27,000 individuals.

79.5% 20.5%

Treatment Completion Rate

Case Completed Case Not Completed

Less than 1% of all government spending is based

• n impact

 what does impact look like?

NYC FOSTER CARE PLACEMENTS

REDUCED BY 53%

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000

Foster Care Placements

Foster Care Placement

MEDICAID SAVINGS FROM FOSTER CARE

PLACEMENT REDUCTION

50% FEDERAL/50% LOCAL *USING MIDRANGE MEDICAL/MENTAL HEALTH PER DIEM

Base Line year 2007 2008 ($51,428.50) 2009 $1,182,855.50 2010 $3,959,994.50 2011 $9,370,272.70 2012 $12,671,982.40 2013 $19,383,401.65 2014 $25,559,964.50 2015 $27,278,421.00 2016 $31,649,719.40 2017 $32,763,641.00

Data Analytics are a Modern Day Crystal Ball

▪ Making business decisions without properly utilizing and

analyzing data can impede a company from reaching its full potential.

▪ Clearly-Defined Problems Lead to Better Decisions ▪ Replication is possible with data ▪ Data is Neutral and That’s a Good Thing

PARTNERSHIP FOR IMPROVING COMMUNITY HEALTH OUTCOMES PROGRAM (PICHO)

Brad Witte, Ph.D. I Care Management Director I Anthem – Behavioral Health 108 Leigus Road, Wallingford CT 06492 I 203.677.8117

NY FOUNDLING IIBHS Discharges # of IP/RTC Admits # IP/RTC Days # ED Admits # PHP Days # IOP Days 1 year pre-IIBHS 38 348 47 15 During IIBHS 2 11 20 33 % Variance 94.74% 96.84% 57.45%

• 120.00%

#DIV/0! 0-180 Days Post IIBHS 1 8 9 % Variance 97.37% 97.70% 80.85% 100.00% #DIV/0! 181-365 Days Post IIBHS 6 30 13 % Variance 84.21% 91.38% 72.34% 100.00% #DIV/0!

RIGOR MATTERS

While the term evidence-based is commonly used, the actual level of scientific evidence supporting a given program varies widely, often lacking any credible research standards. To truly be “evidence-based,” programs must demonstrate evidence of a deterrent effect, sustained effect, multiple site replications, cost- benefit analysis, and other prescribed factors.

Evidence Continuum Type of Evidence Confidence Continuum Evidence-based Experimentally Proven Multiple RCT’s High RCT Quasi-Experimental (Control Groups) Moderate Research Informed Correlational Study Pre-Post Outcome Survey Post-Test Outcome Survey Low Opinion Informed Satisfaction Survey Personal Experience Testimonials Anecdote Very Low

Investing with Evidence and Confidence

VBP INVESTING

Investing limited resources where there is absolutely no proven ROI would be considered negligent in most areas of business and practice, so why do we allow it with taxpayer-funded programs for children and families? There exists in the world today “blue-chip” social investments with proven ROI. These investment

• pportunities have high-quality, well-designed,

experimentally proven prevention and intervention models that meet the highest standards of scientific scrutiny.

WHAT WORKS AND WHAT DOES NOT:

WASHINGTON INSTITUTE PUBLIC POLICY, FEBRUARY 2015

What Does Not: Scared Straight programs deliver

• $13,491 total benefits (tax payer, victims, court

and police related costs) toward crime prevention. The benefits to cost ratio of Sacred Straight is

• $204.33 and there is a 1% chance that benefits will

exceed the costs. What Works: Functional Family Therapy for youth on probation delivers $29,944 total benefits (tax payer, victims, court and police related costs). The benefits to cost ratio of FFT is $8.94 and there is a 99% chance that benefits will exceed the costs.

LAYING THE FOUNDATION FOR THE EXPANSION OF WHAT WORKS IN NYC

LEGEND: JJI – JUVENILE JUSTICE INITIATIVE: FAP – FAMILY ASSESSMENT PROGRAM: PINS – PERSONS IN NEED OF SUPERVISION: JD – JUVENILE DELINQUENTS

NYC PLACEMENT RATES

NYC Placements

2003 2007 2014

Rate of youth in care ages 0- 18 (per 1000) 11.0 8.9 6.5 # of youth in placement (total) 21,554 16,911 11,511 Residential: 1,043 Foster Boarding Home: 6,694 Kinship: 3,746

As of July 2016 there were 9,134 children in foster care Medicaid Savings $63,874,197

Between 2007 and 2011, 223 youth were diverted from placement in NYC at an average placement cost of $210,000 (USD)* each, approximately $46,830,000 in placement costs were averted. After subtracting the program cost (program start-up and annual costs) the financial savings to NYC totaled more then $35,928,360.

*(Charting a New Course: A Blueprint for Transforming Juvenile Justice in New York State. (2009). Vera Institute)

FUNCTIONAL FAMILY THERAPY BENEFIT-COST

ESTIMATES

(UPDATED JULY 2015).

FUNCTIONAL FAMILY THERAPY (FFT) IS A STRUCTURED EXPERIMENTALLY PROVEN FAMILY-BASED INTERVENTION THAT USES A MULTI-STEP APPROACH TO

ENHANCE PROTECTIVE FACTORS AND REDUCE RISK FACTORS IN THE FAMILY. ANALYSIS ONLY INCLUDES EFFECT SIZES FROM PROGRAMS THAT WERE DELIVERED COMPETENTLY AND WITH FIDELITY TO THE PROGRAM MODEL.

Benefit –Cost Summary* Total $30,378 Costs ($3,405) Benefits minus cost $26,973 Summary Statistics: Benefit to cost ratio $8.92 Benefits minus costs $26,973 Probability of a positive net present value 99 %

*Washington State Institute for Public Policy, July 2015

MULTISYSTEMIC THERAPY FOR SUBSTANCE

ABUSING JUVENILE OFFENDERS BENEFIT-COST ESTIMATES

(UPDATED JULY 2015) MULTISYSTEMIC THERAPY FOR SUBSTANCE ABUSING (MST-SA) IS A FORM OF

THE EXPERIMENTALLY PROVEN MST THAT IS TARGETED TOWARD YOUTH WHO ARE ABUSING DRUGS AND ALCOHOL. THE ESTIMATES SHOWN ARE PRESENT VALUE, LIFE CYCLE BENEFITS AND COSTS.

Benefit-Cost Summary* Total $30,646 Costs ($7,689) Summary statistics: Benefit to cost ratio $3.99 Benefits minus costs $22,958 Probability of a positive net present value 70 %

*Washington State Institute for Public Policy, July 2015

ENGAGING MMCO

ENGAGING WITH MMCOS & PPS

 Know your data – 

Who is your number 1 and 2 payer



What is your cost per slot, encounter, individual, no show rates, high producers, low producers, number of non-billable hours/staff



What is your threshold for making money,



Are you confident with PYSCKES

 Know you processes 

Know your areas for potential efficiencies and savings

 Know your unique value in the field and to MMC  Know your peers value 

What separates you from the field



What is your model and what are mediators of sustained change

 Collaborate, collaborate, collaborate  Push, push, push

And then:

 Collaborate, collaborate, collaborate

Hours per Day

Work Days PY Discount

8 260 40.0%

Non-Supervisor

BH Standard No Show %

Supervisor of 1 – 3

20%

65.0% 23%

Supervisor of 4 – 6

30%

2,080

304

38.00

Supervisor 10+

50%

0.00

Unit Managers

60%

80

10.00

Unit Coordinators

70%

0.00

Program Directors

80%

540.80 67.60

Medical Directors

25%

344 43.01

Management Team

95%

1269 158.60 7.32 811 101.40 4.68

Salary FB% Salary + FB Base Cost PH Overhead % Cost Per Hour with Discount

• Avg. Revenue

Margin

$44,066.72 25% $55,083.40 $67.90 30% $88.27 $75.00

($13.27)

Salary FB% Salary + FB Base Cost PH Overhead % Cost Per Hour Without Discount

• Avg. Revenue

Margin

$44,066.72 25% $55,083.40 $40.74 30% $52.96 $75.00

$22.04 Difference in the Cost per/total for all hours to offer Supervision - ($35.31) ($14,321.68) Staff FTE %:

All Days Minus PTO All Days Minus PTO

100% 811 202.8 67.6 3.1 3.7 4.1 4.7 15.6 18.3 20.3 23.7

Suggested Prod. Discount

Supervisor of 7 – 9

40% Available Hours Per Year

Annual Leave / PTO

Days Per Year

Personal / Holidays / Sick Training/Staffings Travel Supervision

Hours Weekly No Show Percentage Driven Scheduling Rate

Charting/Paperwork Non-Billable Hours: Non-Billable Days Non-Billable Months Billable Months Billable Hours: Billable Days

Daily BH Production Yearly BH Production Quarterly BH Production Monthly BH Production Change Only The Blue Cells Supervisor's BH Capacity Worksheet

CAN YOU BUILD YOUR VALUE PROPOSITION?

Brad Witte, Ph.D. I Care Management Director I Anthem – Behavioral Health 108 Leigus Road, Wallingford CT 06492 I 203.677.8117

NY FOUNDLING IIBHS Discharges # of IP/RTC Admits # IP/RTC Days # ED Admits # PHP Days # IOP Days 1 year pre-IIBHS 38 348 47 15 During IIBHS 2 11 20 33 % Variance 94.74% 96.84% 57.45%

• 120.00%

#DIV/0! 0-180 Days Post IIBHS 1 8 9 % Variance 97.37% 97.70% 80.85% 100.00% #DIV/0! 181-365 Days Post IIBHS 6 30 13 % Variance 84.21% 91.38% 72.34% 100.00% #DIV/0!

VBP TRANSFORMATION TEAM

✓ CEO and President, Bill Baccaglini ✓ CFO, Michael Kurtz ✓ Sr. VP and Medical Director, Dr. Joe Saccoccio ✓ Sr. VP of Evidence Based Programs, Dr. Sylvia Rowlands ✓ Sr. Associate Implementation Support Center, Shannon

Ghramm-Smith, LMHC

✓ VP of Prevention Services, Marta Anderson, LCSW ✓ Director of Health Homes Care Management, Pradine

Content, LMSW

✓ AVP of Program Quality Analytics, Rosemary Collazo, MPA

ICL VBP Pilot

Chris Copeland COO March, 2018

How did ICL get started?

• Behavioral health as part of Healthcare
• Relationship with MCO – members
• Outcomes related to MCO goals
• Relationship with healthcare provider – patients
• DSRIP/PPS
• Value proposition – Leverage HCBS services to engage high

cost/low health outcome members/patients/consumers/people in effective healthcare

VBP Pilot

• VBP Pilot – HARP total cost of care
• Level I – upside only
• Payments based on:
• Potential savings
• Performance metrics
• Long term, detailed collaboration with MCO, healthcare provider,

health home and HCBS team – now 2 years in the making

VBP Metrics

Measure Type Classification Diabetes screening – schizophrenia/bipolar using antipsychotic medication Medical P4P Follow up after ER visit for alcohol or drug dependence Behavioral P4P Follow up in 7 days for MI hospitalization Behavioral P4P Follow up in 30 days for MI hospitalization Behavioral P4P Diabetes care - A1c testing Medical P4P Diabetes care – medical attention for Nephropathy Medical P4P Percentage enrolled in Health Home Behavioral P4P Percentage enrolled in PROS or HCBS for >3 months Behavioral P4P Influenza immunization Medical P4P