From the Balcony and On the GroundThe Louisiana Balcony View
March 4, 2014
Coordinated System of Care (CSoC)
• 1915c/b(3) Waiver• Implemented in five of state’s 9 regions (1200
youth)• Wraparound Agencies• Family Support Organization• State Plan services + specialized services• Statewide expansion (2400 youth) planned for
this FY
2Louisiana Department of Health and Hospitals – Office of Behavioral Health
Louisiana CSoC Regions
Louisiana Department of Health and Hospitals 3
IMPLEMENTATIONEssential Community/System Supports
Essential Community/System Supports
• Community partnership• Collaborative action• Fiscal policies & sustainability• Access to needed services & supports• Human resource development & support• Accountability
Bruns, E. J. & Walker, J. S. (2010). The wraparound process: An overview of implementation essentials. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative.
Louisiana Department of Health and Hospitals – Office of Behavioral Health 5
Community Partnership
Strengths• Cabinet level state leadership engaged in
development• Broad-based inclusive planning processChallenges• Family/youth engagement• Geography
6Louisiana Department of Health and Hospitals – Office of Behavioral Health
Collaborative Action
Louisiana Department of Health and Hospitals 7
Strengths• Policy development led by national experts• Lead agency identified with expectation for
collaboration (Executive Order)Challenges• Concurrent move to statewide managed
behavioral healthcare• Lack of knowledge base and experience
Fiscal Policies & Sustainability
Louisiana Department of Health and Hospitals 8
Strengths• 1915b/c waivers• Braided fundingChallenges• Lack of flexibility of leveraged dollars• Family Support organization model
Access to Needed Services & Supports
Louisiana Department of Health and Hospitals 9
Strengths• Regionally based Wraparound Agencies (WAA)
in all implementing areas• Waivers and State Plan Amendments with
expanded/enhanced allowable servicesChallenges• Limited children’s service capacity in state• Provider understanding/buy-in
Human Resource Development & Support
Louisiana Department of Health and Hospitals 10
Strengths• Consistent workforce development approach• Reimbursement for Child & Family Team
participationChallenges• Role of Family Support Organization in the
wraparound process• Information sharing
Accountability
Louisiana Department of Health and Hospitals – Office of Behavioral Health 11
Strengths• Goals established in Executive Order• Performance measures within WaiversChallenges• Undeveloped data collection methodology• Lack of CQI focus
Contact Information
Jody Levison-JohnsonDeputy Assistant SecretaryOffice of Behavioral [email protected]
Louisiana Department of Health and Hospitals 12
From the Balcony and On the GroundThe Louisiana Ground View
March 4, 2014
Choices Care Management
• Indiana Choices – Since 1997
• Maryland Choices – Since 2005
• DC Choices – Since 2008• Louisiana Choices – 2012• Illinois Choices – Since 2014
Choices Care Management
• More than 240 employees• $60 million annual budget• More than 1600 youth
served daily• Working across ALL child
serving systems – 60% child welfare
Coordinated System of Care
Choices Operating System
• Systems of Care Principles (clinical)– Family Centered Involvement– Wraparound Process– Multi-system Coordinated Care
• Care Management technologies (fiscal)– Capitated or Case Rates– Outcome Based – Flexible Funding
• Technology blending clinical & fiscal– Real Time Data – Data driven decision making
Wraparound Facilitation
PLAN
Case ManagerSchool
FamilyJuv Probation
Child Welfare Mental Health/Substance Abuse
WraparoundFacilitator Flex FundsProvider Network
Community Partnership
• Strengths– Choices previous experience building relationships– State vision, support, and engagement
• Challenges– Newness of wraparound concepts in community– Lack of understanding/buy-in at the local level
Collaborative Action
• Strengths– Focus on quality improvement– Ongoing dialogue and conference calls
• Challenges– Frequent operational changes from SMO– Decisions made without WAA input
Fiscal Policies & Sustainability
• Strengths– Start-up funding provided by state– Braided funding
• Challenges– Lack of control and passed on risk– Limited flex funds
Access to Needed Services & Supports
• Strengths– Expanded service array for waiver enrollees– Establishment of local natural supports
• Challenges– Need more service providers– Adequate availability of FSO in all areas
Human Resource Development & Support
• Strengths– Training provided by Institute for Innovation &
Implementation– Phased roll out and hiring
• Challenges– Turnover– Lack of familiarity with SOC & Wraparound in
workforce
Accountability
• Strengths– Information management system– Real-time data analysis
• Challenges– Labor intensive data collection process– Making changes retroactive
Contact InformationShannon Van DemanChief Financial OfficerChoices, [email protected]
317.205.8311