CBH Meeting- May 31, 2012

Jennifer TernayJLS Advisory Group, Inc.

New York

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Regional Behavioral Health Organizations Operational in Jan 2012 for 4 regions and

fifth region live in Feb 2012 Joint contracts with Office of Mental Health

and Office of Alcoholism and Substance Abuse Services

Phasing in over three years Expanded scope moving to risk

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Concurrent review of inpatient stay Reduce unnecessary readmissions Improve rate of engagement after discharge Gather information about clinical conditions

of children with SED treated in OMH licensed specialty clinic

Provider profiling Facilitate cross-system linkage

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Carved into MCO Formulary problems MCO can’t implement payment for APGs

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Ambulatory Patient Group (APG) Referred to as “Government Rates” Target date: 7/1/12 Limited number of codes Blended and phased in Allows for multiple services on the same

day

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Provide or subcontract for all services Responsible for services by subcontractor Allows for administrative role as health

home without providing any actual services State plan amendment (SPA) effective

Jan’12 Outcomes to be measured – see SPA at

http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/nys_health_home_spa_draft.pdf

http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes

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Describe relationship and communication between dedicated CM and treating clinicians

P&Ps and contracts to support collaboration and define roles and responsibilities

24/7 availability of care manager System to track and share patient information

and care needs; monitor outcomes and change care as needed

P&Ps to support transition and notification to/from higher levels of care

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P&Ps and contracts with community-based resources

Data through regional health information organization/qualified entity

Accountable for reducing avoidable health care costs (preventable hospital admission/readmission and avoidable ER)

Accountable for timely follow-up post discharge and improving patient outcomes

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Initial standardsPlan of care for every patientFollow-up on tests, treatments, services and referralsHealth record accessible to team for population management and identification of gaps in careUse regional health information organization

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PMPM is risk-adjusted based on region, enrollment volume, case mix and eventually, patient functional status

Two rates◦ Case finding group - outreach and engagement◦ Active care management – paid in 2 installments

with second paid once pre-set state quality metrics are met

Single SMI/SED rates - $148/$189/$385 Shared savings opportunities

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Implementation not going well Other lobbying entities want to block

community mental health agencies New York is fast track but never on time Children not allowed to be excluded by CMS

but in reality the adults are the priority Struggling to define options for children

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Next Steps

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ASO vs. MBHO Leveraging CMEs Health homes Data on substance abuse services Non-Medicaid services MH-SA integration Bi-directional care (Herb’s 5/24 email)

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