“healthcare reform” preparing for the change mental health association of new york state
DESCRIPTION
“Healthcare Reform” Preparing for the Change Mental Health Association of New York State October 26, 2011. Ps & Qs. “ To mind one's P's and Q's; to be attentive to the main chance .” The Dictionary of the Vulgar Tongue Francis Grose, 1785 ed. Ps & Qs. Pillars People - PowerPoint PPT PresentationTRANSCRIPT
“Healthcare Reform”Preparing for the Change
Mental Health Association of New York StateOctober 26, 2011
“To mind one's P's and Q's; to be attentive to the main chance.”
The Dictionary of the Vulgar Tongue
Francis Grose, 1785 ed.
Ps & Qs
Cost --Contain costsQuality -- focused on
outcomesAccess -- timely, right service
at the right time
Pillars of Healthcare
Spending on mental illness grew faster than for heart disease, cancer, trauma-linked disorders & asthma Americans seeking treatment for mental health conditions almost doubled, from 19M to 36M Treatment cost for mental disorders rose from $35B to nearly $58B between 1996 and 2006 Antidepressant use among U.S residents almost doubled from 1996 to 2005.
AHRQ data (HHS Agency for Healthcare Research and Quality-August 2009.
August 6, 2009 — Anne Ziegler (Fierce Health)
Cost
7
Cost of Health & Mental Health
Among the most expensive 1% of Medicaid beneficiaries (acute care only)
Almost 83% have three or more chronic conditions
Over 60% have five or more chronic conditions
And most of them are in unmanaged fee-for-service
Source: Kronick RG, Bella M, Gilmer TP, Somers SA, “The Faces of Medicaid II: Recognizing the Care Needs of People with Multiple Chronic Conditions.” Center for Health Care Strategies, Inc. October 2007
Purchasers (employers or government) seek value for health care expenditure & managed care companies to deliver: Member satisfaction Positive clinical outcomes and recovery Timely access to needed services Controlling the rate of cost increases Targeting scare health care dollars to the
High Risk/High Cost/High Need members.
Quality
“ …knowing which treatments work won’t matter unless we know how to target the interventions to the people who will benefit most….In the absence of such knowledge we risk treatment decisions guided by accessibility to resources rather than patient needs.”
Psychological scientists Varda Shoham, Ph.D., and Thomas R. Insel, M.D.Perspectives on Psychological Science.
Source: Association for Psychological Sciencehttp://psychcentral.com/news/2011/09/14/mental-health-care-reform-urged-by-top-
scientists/29412.html
Cost, Quality & Access
Practice Models: what types of interventions work — and for whom
1 in 4 Americans has a diagnosable mental disorder 6% of Americans have a serious mental illness, e.g. Bi-polar disorder or schizophrenia 50 million children and adults in this country are diagnosed every year with mental illness People with diabetes, heart disease, asthma & cancer are at greater risk of becoming depressed.
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_862051.html
Incidence of Mental Illness & Medical Conditions
If you are depressed & have asthma, diabetes, heart disease or cancer your are:
2X as likely to develop cardiovascular disease and stroke, 4X more likely to die within six months of a heart attack 3X more likely to be non-compliant with your treatment.
http://www.huffingtonpost.com/lloyd-i-sederer-md/mental-health-care_b_862051.html
The Case for Health Homes
DOB & DOH OMH & OASAS Managed Care Companies Providers Counties Peers/Recipients All are advocates
Who Are They
In challenging economic times States move more aggressively to manage costs. States have 3 ways to manage costs
Restrict eligibility, which is prohibited under the federal health care reform initiative
Cut benefits-vision, dental, pharmacy, etc. Cut provider payments
Managing State Medicaid Costs
The Economist-April 2011
CA & NY are moving the elderly and disabled into a managed care system
Second step in Managed Care - integrate the dual eligibles into MC
Dual eligibles account for 40% of Medicaid’s cost and just 15% of the population.
Future of Medicaid
The Economist-October 2012
If the managed care system works as designed, doctors (health care professionals) can monitor all aspects of care, in contrast to the fragmented fee for service system.
If states do not draft their contracts properly or fail to be vigilant in monitoring patient’s health, their experiment in managed care could be a disaster.
Future of Medicaid
The Economist-October 2012
To limit the financial exposure of the state Design and manage systems of care To bring together health care financing and health care service delivery into one operating system Manages data for quality monitoring, to track & trend utilization, etc. Use of clinical outcome measures and use of standardized measures to track progress
Why States Use Managed Care
Health Homes & ACOsNCCBH -http://www.thenationalcouncil.org/galleries/default-file/ACOs%20and%20Health%20Homes%20Exec%20Summary.pdf
Health Homes & ACOs are responsible for providing the full range of healthcare services needed by the populations they serve
Goals are to improve quality, patient experience, & reduce costs
MH/SU providers are urged to prepare for participation in the larger healthcare field
Ensure IT readiness of providers
ACOs
Final Federal Regulations published Oct 20 Decreased quality measures from 65 to33 Re: ACO regulations,
"But fundamentally, most health systems continue to struggle with the fact that their present operations are oriented toward billing per service, and not taking on risk and responsibility for quality."
Dan Mendelson, CEO Washington-based consulting firm Avalere Health
Oct 20, 2011
Life improvements, e.g. community tenure, education, jobs, housing, etc.
Services in least restrictive settings Decreased use of ER & avoidable
inpatient and residential stays Customer satisfaction with personal
goal achievement
Quality Outcomes
Components of Managed Care
Benefits designed by the purchaser, e.g. the state in Medicaid or the insurance company with approval by the employer group
Networks are built for Access & to: Meet geo-access requirements Provide timely access to ambulatory
services, e.g. medication management Provide the “right” level of care to
support recovery & build on strengths
27
Services not Programs
Services Individual Therapy Group Therapy Medication Therapy Detox Case Management Care Coordination Peer Support
Interventions Assessment Treatment Planning Discharge Planning Medication
Therapy/Education/Monitoring
Verbal Therapies Assistance with ADLs Safety Planning
Services & Interventions vary by: frequency, duration & location of care--in other words, the program
28
Members & Money in Managed Care
Members: Who is in Adults Adults with SMI Children Dual Eligibles
Who gets served
Money: What is in Medicaid Grant Dollars Other State & Local
Money
Preserve the base funding
Less about the Models: Carve In or Carve Out
People Pillars: Cost, Quality & Access Players & Plans
Services not Programs Evidence based practices Measurable outcomes Care coordination Recovery Follow the Money not the Model
Opportunities