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The Managed Care Technical Assistance Center of New York Andrew Cleek, PsyD

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Page 1: Andrew Cleek, PsyD - CTACNYctacny.org/sites/default/files/trainings-pdf/readiness-tool... · The Managed Care Technical Assistance Center of New York Andrew Cleek, PsyD

The Managed Care Technical Assistance Center of New York

Andrew Cleek, PsyD

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The Managed Care Technical Assistance Center of New York

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I. Introduction II. Readiness Assessment Results III. Addendum Results IV. Agency Readiness Benchmark Report V. Next Steps

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The Managed Care Technical Assistance Center of New York

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The Community Technical Assistance Center of New York (CTAC) is a training, consultation, and educational resource center available to all child and adult-serving agencies in New York State. Our goal is simple: to provide programs with a set of technical assistance, training activities and tools that promote effective care through efficient practices.

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The Managed Care Technical Assistance Center of New York

What is MCTAC? MCTAC is a training, consultation, and educational resource center that offers resources to all mental health and substance use disorder providers in New York State.

MCTAC’s Goal

Provide training and intensive support on quality improvement strategies including business, organizational and clinical practices, to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.

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The Managed Care Technical Assistance Center of New York

Managed Care Readiness Assessment

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Data Collection and Analytics • Data collection: online survey • Focus of Analysis: Examine readiness and

preparedness for the transition to Managed Care and identify areas where additional support is needed

• Report: MCTAC presenting aggregated data to relevant stakeholders

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The Managed Care Technical Assistance Center of New York

• This MMC Readiness Tool is designed to provide organizations with 11 domains of processes, practices and change management activities needed to effectively prepare for and function during the early stages of a business relationship with a Managed Care organization.

• When completed, the self-assessment tool offers a snapshot of the organization’s current level of readiness as well as an assessment of the need for technical assistance. This tool may be helpful as a planning resource to guide organizations in their preparation and decision making activities.

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MMC Readiness Assessment

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The Managed Care Technical Assistance Center of New York

Readiness Assessment Results for Child-Serving Organizations

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The Managed Care Technical Assistance Center of New York

276 Child – Serving Agencies submitted Readiness Assessments

On average, 60% of reimbursement was from Medicaid Only.

30% of agencies reported that less than 10% of reimbursement was

from managed care.

There are statistically significant differences by Region.

There are statistically significant differences by Reimbursement.

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The Managed Care Technical Assistance Center of New York

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116 (42%)

36 (13%)

87 (32%)

43 (16%)

0

20

40

60

80

100

120

140

OMH OASAS OCFS Other

Num

ber o

f Age

ncie

s

Agency Type

Agency Type

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The Managed Care Technical Assistance Center of New York

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Domain Name Label in Graphs

1 Understanding MCO Priorities & Present Managed Care Involvement MCO Priorities

2 MCO Contracting Contracting

3 Communication /Reporting (Services authorization, etc.) Communication

4 IT System Requirements IT

5 Level of Care (LOC) Criteria / Utilization Management Practices Level of Care

6 Member Services/Grievance Procedures Member Services

7 Interface with Physical Health, Social Support and Health Homes Interface

8 Quality Management/Quality Studies/Incentive Opportunities Quality

9 Finance and Billing Finance 10 Access Requirements Access

11 Demonstrating Impact/Value (Data Management & Evaluation Capacity) Evaluation

Aggregate Total Score Total Score

MCTAC Readiness Assessment - Domains

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The Managed Care Technical Assistance Center of New York

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Domain Average Score 1. MCO Priorities 3.34 2. Contracting 3.20 3. Communication 2.67 4. IT 3.17 5. Level of Care 2.87 6. Member Services 2.85 7. Interface 3.83 8. Quality 2.82 9. Finance 3.21 10. Access 3.32 11. Evaluation 2.63 Total Score 3.08

*Domain score is below total average score

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The Managed Care Technical Assistance Center of New York

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The Managed Care Technical Assistance Center of New York

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3.29 3.09

2.56

3.11 3.44 3.47

3.07 3.40 3.49

3.00

2.38

2.98

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

1. MCOPriorities

2. Contracting 3.Communication

4. IT

Domain Scores by Agency's Region

NON NYC NYC Combined

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The Managed Care Technical Assistance Center of New York

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2.76 2.62

3.88

2.65

3.21 3.39

3.87

3.21

2.50* 2.40*

3.50

2.52*

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5. Level of Care 6. MemberServices

7. Interface 8. Quality

Domain Scores by Agency's Region

NYC NON NYC Combined

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The Managed Care Technical Assistance Center of New York

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3.06 3.19

2.45

2.97

3.57 3.83

3.09 3.41

2.96* 2.87*

2.40* 2.82*

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

9. Finance 10. Access 11. Evaluation Total Score

Domain Scores by Agency's Region

NYC NON NYC Combined

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The Managed Care Technical Assistance Center of New York

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3.02* 2.68*

1.90*

2.79*

3.64 3.65 3.38

3.64

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

1. MCOPriorities

2. Contracting 3.Communication

4. IT

Domain Scores by Agency's Managed Care Reimbursement

Less than 10% More than 10%

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The Managed Care Technical Assistance Center of New York

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2.38* 2.36*

3.77

2.44*

3.25 3.13

3.96

3.13

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5. Level ofCare

6. MemberServices

7. Interface 8. Quality

Domain Scores by Agency's Managed Care Reimbursement

Less than 10% More than 10%

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The Managed Care Technical Assistance Center of New York

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2.80* 2.81*

2.31* 2.66*

3.68 3.96

2.96

3.49

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

9. Finance 10. Access 11. Evaluation Total Score

Domain Scores by Agency's Managed Care Reimbursement

Less than 10% More than 10%

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The Managed Care Technical Assistance Center of New York

Number of Children – Serving Agencies Providing Specific Services 131 (66.8%) crisis intervention services

55 (28.6%) youth peer advocacy and training services.

127 (65.1%) community psychiatric treatment and support services.

53 (27.5%) crisis respite.

120 (63.5%) psychosocial rehabilitation services

68 (35.2%) planned respite.

116 (60.1%) family peer support services

75 (39.1%) prevocational services.

136 (70.5%) care coordination.

49 (25.7%) supported employment.

107 (56%) habilitative skill building. 54 (28.3%) non-medical transportation.

135 (71.1%) family caregiver supports and services.

20 (10.3%) day habilitation services.

113 (59.8%) community advocacy and support.

22 (11.5%) adaptive and assistive equipment. 23 (12%) accessibility modifications. 19 (9.9%) palliative care.

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The Managed Care Technical Assistance Center of New York

Screening and Evaluation Tools: 73% of agencies reported that they conduct at least some type of specific screening and evaluation tool including the CANS, SDQ, CBCL, BDI, UCLA PTSD

Specific Treatment Models: 83% of agencies reported that they use specific treatment models including CBT variations, MI, 12 Step, Family Therapy models

Measures Used to Track Outcomes: 86% of agencies reported specific outcome measures including treatment plans, number of ER/Hospital Visits, CANs, OASAS Client Data System, Pre/post or satisfaction surveys

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The Managed Care Technical Assistance Center of New York

Services offered by Agencies through Collaboration

N %

Crisis Intervention Services 78 80

Community Psychiatric Treatment and Support Services

75 86

Psychosocial Rehabilitation Services 58 65

Family Peer Support Services 68 70

Youth Peer Advocacy and Training Services 82 60

Care Coordination 71 88

Habilitative Skill Building 58 64

Family Caregiver Supports and Services 59 80

Crisis Respite 108 75

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The Managed Care Technical Assistance Center of New York

Services offered by Agencies through Collaboration

N %

Planned Respite 96 71

Prevocational Services 79 62

Supported Employment 90 62

Community Advocacy and Support 65 67

Non - Medical Transportation 75 55

Day Habilitation Services 85 53

Adaptive and Assistive Equipment 91 54

Accessibility Modifications 86 52

Palliative Care 79 48

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The Managed Care Technical Assistance Center of New York

Agencies… N % Have a system in place to orient families to the rules and expectations of the

program. 84 89

Train and supervise staff on trauma informed principles and practices. 71 75 Have a system in place to ensure that our physical environment is safe and

welcoming for consumers. 88 94

Develop rules and regulations that are sensitive to the needs of caregivers and children who have experienced trauma.

79 84 Have a system in place to ensure that the suggestions, needs, and perspective of

families, informs the decisions we make. 84 89

Have a clearly defined plan or protocol for management of crises with families that have been clearly communicated to all staff.

79 84

Services focus on ‘what happened to you’ rather than ‘what's wrong with you’. 82 87 (or collaborating agencies) are implementing at least one evidence-based trauma

treatment approach to help families heal from past traumatic experiences. 72 77

Routinely screen and assess for trauma in caregivers and children 69 73 Have a supervisory process to address the impact of our work on the staff’s

emotional and physical wellbeing. 74 80

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The Managed Care Technical Assistance Center of New York

Assessment / Work Plan

Development Tool –

Available Online

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The Managed Care Technical Assistance Center of New York

• Each agency submitted a survey based on self- report.

• The benchmarking tool is based on scores relative to agencies that completed the assessment. Agencies that have not submitted the assessment may differ in significant ways.

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Important Limitations of the Data

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The Managed Care Technical Assistance Center of New York

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• Using a work plan template, individualized results of the readiness assessment, and a menu of suggested activities in areas of greatest need, agencies can develop individual strategies to support the transition to managed care.

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The Managed Care Technical Assistance Center of New York

Domain Readiness Score

Improvement Tasks

Performance Measure

Resources Needed

Funding Source

Estimated Dated of Completion

MCO Priorities

Contracting

Communication

IT

Level of Care

Member Services

Interface

Quality

Finance

Access

Evaluation

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The Managed Care Technical Assistance Center of New York

Business Best Practices

Services Best Practices Professional Development Value Based Practices System Redesign

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The Managed Care Technical Assistance Center of New York

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The Managed Care Technical Assistance Center of New York

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Tools Timeline

Matrix

Completed Launched July 15, 2015

Billing/Claims Completed August 2015

Glossary of Terms Completed

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The Managed Care Technical Assistance Center of New York

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Tools Timeline

Credentialing September 2015

Chargemaster September 2015

Utilization Management September/October 2015

Outputs to Outcomes Fall 2015

Plan of Care Tool (Proposed) Proposed

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The Managed Care Technical Assistance Center of New York

A comprehensive and interactive online tool that provides agency staff with the information needed to successfully engage with MCOs. Launched July 15, 2015 – 3,772 Page views the first week 6,373 page total views, as of 8/11/15

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The Managed Care Technical Assistance Center of New York [email protected] @CTACNY