CENTENNIAL CARE NEXT PHASE 1115 Waiver Renewal Subcommittee December 16, 2016 New Mexico Human Services Department
Introductions 8:30 – 8:40 Feedback from November meeting 8:40 – 8:45 LTSS 8:45 – 10:15 Break 10:15 – 10:20 PH-BH Integration 10:20 – 11:20 Public comment 11:20 – 11:40 Wrap up 11:40 – 11:45 2
Refine care coordination Address social determinants of health Opportunities to enhance long-term services and supports Continue efforts for BH and PH integration Expand value-based purchasing Provider adequacy Benefit alignment and member responsibility 3
Long-Term Services and Supports (LTSS) 4
LTSS SS Overv Ov rview iew Under Centennial Care all members who meet the NF LOC have access to the community benefit Increase in the number of unique members who LTSS Population have access to the community benefit: Setting of Care Enrollment Mix 24,013 users in CY2014 (Long Term Nursing Facility vs. 27,836 users in CY2015 Community) 27,593 users in 9 months of CY16 Community benefit is included in the Setting ng Nursin sing Communit ity y Facilit lity Benef efit it expansion benefit package Average monthly cost of a nursing home is 2011 18.7% 81.3% approximately 2.8 times as expensive as the average community benefit 2012 18.9% 81.1% Recent analysis conducted by the LFC indicated 2013 17.3% 82.7% that the overall occupancy rate at nursing facilities has been declining since 2011 2014 15.9% 84.1% NM ranked in the 2 nd best quartile overall in the 2014 national State Long Term Care Scorecard 1 2015 14.3% 85.7% 1 http://www.longtermscorecard.org/ 5
Agency ncy Based Community unity Self Directe ted Community unity Benef nefit it Benefi nefit t (ABCB) B) (SDCB) B) Community-based alternative to Community-based alternative to • • institutional care that maintains institutional care that facilitates members in the home or greater member choice, direction community and control over covered services Member chooses consumer Member receives annual budget • • delegated or directed model for based on need. personal care services (PCS) Member directs how to spend • the annual budget on services. Member (or representative) is • common-law employer of providers Benefits and services vary based on model 6
Needs ds Concepts Further her Discussio ussion Streamline NF LOC Automatic NF LOC renewal for 1. What other areas are important to renewals and certain members streamline for members? improve assistance to Align benefits for ABCB and 2. What other enhancements should be individuals SDCB considered for members to remain in the Improve Establish levels for ABCB and community? comparability of SDCB budget ranges based on 3. Nursing facility diversification service offerings need that may include between community provisions for one time benefit options and transition costs improve transition Implement new cohort for into SDCB members who use fewer PCS Continue successes hours of rebalancing effort Diversification of services between provided by nursing homes institutionalization Explore provider fees / taxes: and community care Legislative process Fiscal sustainability CMS approval of nursing homes NF LOC ADL change from 2 ADLs to 3 ADLs Value-based purchasing arrangements with LTSS providers 7
Physical Health-Behavioral Health Integration 8
Intent of Integration “Integration of services through the expansion of patient centered medical homes and health homes with intensive care management provided at the point of service to help recipients manage their health and their use of the health care system.” “What New Mexico now challenges its plans to do is manage care and deliver outcomes that can be measured in terms of a healthier population. In order to effectively drive the kind of system change New Mexico seeks, plans will have to think and behave differently and support the movement towards care integration and payment reform .” -from current 1115 Waiver 9
http://www.milbank.org/publications/evolving-models-of-behavioral-health-integration-evidence-update-2010-2015/ 10
Increase provider competency to serve members with More than mental co-morbid PH-BH conditions illness and addiction Early onset; early death (>8 million Improve screening for BH conditions, including each year) substance-use disorders Medicaid = largest payer Leverage the emergency department information Provider and Plan exchange to identify members who require linkage to Challenges: mental health and substance abuse treatment Workforce EHR capacity Continuity of Improve information sharing challenges due to varied care gaps interpretations of privacy rules 11
Needs ds Concepts Further her Discussio ussion Increase provider’s Provider education on PH-BH 1. Are all three practice models present in competency and integration models and best New Mexico? What is working well? capacity to manage practices 2. How can we support provider’s capacity both physical and 3 practice structures and 6 to manage co-morbid conditions? behavioral conditions levels of collaboration 3. How can MCOs encourage patient Increase behavioral Improve identification of engagement? Provider engagement? health screening behavioral health and substance 4. Can MCOs work with local and regional across the continuum use issues and linkage to leaders to create stronger forms of of care treatment integrated care that affect health Remove barriers to Substance abuse treatment outcomes? sharing information availability 5. Should HSD identify screening tools that between providers Improve physical health they recommend providers use? Value-based conditions and reduce in 6. What ways can HSD support better payment strategies morbidity and mortality information sharing? for integrated care Direct Care management: early 7. Can value-based payment models assessment; treatment address provider and plan challenges? engagement; active follow-up; What models are better suited for structured patient education; integrated providers? standardized psychotherapy Linkages to community resources and population health supports beyond health services 12
Increase the number of health homes to additional counties Submit an additional health home SPA or amendment to add substance use disorders as primary diagnoses Build capacity through additional tele-behavioral health clinical supervision and tele-psychiatry development Increase implementation of value-based purchasing or prospective payment methodologies Others? 13
Dece ecember ber 16, 2016 Febru bruary ry 10, 0, 2017 17 Octob tober r 14, , 2016 • BH-PH integration • Benefit and • Goals & objectives eligibility review • Long-term services • Waiver background and supports • Care coordination Octo tober r 2016 16 Novem ember r 2016 16 Decem ecember er 2016 January uary 2017 Febru ruary ry 2017 January uary 13, 3, 2017 017 Novem vembe ber r 18, , 2016 • Value-based • Care coordination purchasing • Population health • Personal responsibility 14
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