NEW YORK CARE COORDINATION PROGRAM:

A VIEW OF CURRENT INITIATIVES IN THE ERA OF MBHO’S AND HEALTH HOMES

Bob LongCo-chair, NYCCP Steering CommitteeCommissioner of Mental Health – Onondaga County

What is the NYCCP? A multi stakeholder learning

collaborative (counties, peers and families, providers)

Focused on behavioral health system improvement

Data and outcomes driven Covers about 3.5 million people in seven

NY counties (Westchester, Erie, Monroe, Onondaga, Chautauqua, Genesee, Wyoming)

What can be learned from over 20 years of health care cost control?

Those who cannot remember the past are condemned to repeat it. ~ George Santayana

Lessons Learned: If You Focus on Costs (Managed Cost)

Restricts access to services & recovery, e.g.: Limited or no behavioral health care benefits Laborious pre/re-certification processes Rigidly applied ‘medical necessity’ criteria Arbitrary service limits (thresholds or caps) Limited covered services (rehabilitation, peer

support, etc) Inadequate provider panel (no choice,

delayed access) Results in short term savings (‘this fiscal year’

is all that matters), which leads to… Prolonged suffering, higher long term costs &

cost shifting (social services, homeless shelters, police, jails).www.carecoordination.org

Lessons Learned: If YouFocus on People (Managed Care) Person centered/Family Driven: every plan is

centered on the person’s goals, strengths & preferences, not just the available services; service and reimbursement systems are flexible

The goal is quality of life, not stabilization and maintenance and not just cost containment

Recognizes stages of change: supports and promotes the person’s ability to make

positive changes in his or her life Uses motivational interviewing concepts

Attends to longer term costs and benefits

NYCCP Results:Focusing on People

Quality of life results: Days in hospital down 53% Emergency room visits down

46% Gainful activity up 31%,

including a 51% increase in completive employment

Self harm down 54% Arrests down 25%

NYCCP Results(under Fee for Service System – i.e. no

binding utilization management)

Financial Results Comparing Case Management and ACT

recipients in NYCCP counties to 6 comparable counties - cost per recipient in NYCCP Counties is: 92% lower costs for inpatient 42% lower costs for outpatient 13% lower costs for community support 41% lower costs overall.

The moral of the story: helping people live more healthy and productive lives saves money.

How do Clinic Reform, PROS and Ambulatory Reform Move us Forward? Improved access to service & greater

recovery focus, e.g.: Broader covered services (e.g.

Rehabilitation Services, Outreach & Engagement, Crisis Intervention)

Greater integration and flexibility allows the system to be more person centered: More integrated services (e.g. PROS) More flexible services (e.g. >1 clinic

service in a day) Family driven services (ambulatory

reform)

The future ain’t what it used to be. ~ Yogi Berra

What’s next?

State: Regional Behavioral Health Organizations (RBHO’s) For recipients who are not enrolled in

managed care (“carve outs”) - all ages, mental health and alcohol and substance abuse

Charged with (for two years): Coordinating care and managing utilization

for Medicaid behavioral health services Approving, coordinating & facilitating

continuity and integration of behavioral health/physical health services

Goal: prepare the behavioral health system for full managed care

Federal: Health Homes Designed to:

be person-centered systems of care for people with at least two chronic conditions; one chronic condition and be at risk for another; or one serious and persistent mental health condition

facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care, and long-term community-based services and supports.

States can offer health home services in a different amount, duration, and scope than services provided to individuals not in the defined health home population

Health Homes (cont) Health home services include:

comprehensive care management - care coordination and health promotion

comprehensive transitional care from inpatient to other settings, including appropriate follow-up;

individual and family support; referral to community and social support

services, if relevant; and Meaningful use of health information

technology to integrate service provision

NYCCP RBHO/Health Home Vision

RBHO regions that respect established affinities - i.e. geographic preferences for where people receive their care

RBHO as ‘superstructure’ for Health Homes

RBHO as ‘superstructure’ Develops/coordinates health homes throughout

the designated region Coordinates care and manages utilization for

Medicaid behavioral health services delivered throughout the region

Coordinate & facilitate continuity and integration of behavioral health/physical health services

Efficiently provide functions (e.g. outreach to underserved people, education & training, interface with HMO’s for physical health, information technology, data analysis/ performance monitoring/CQI) to health homes

Possible Health Home Structures within the RBHO Health Homes include multiple provider

arrangements Single Provider – large provider with a full

array of physical and behavioral health services.

Provider Network – formal network of providers, who, in total, provide a full array of physical and behavioral health services.

Health home coverage may include: Multiple health homes in a single county One health home serving multiple counties

NYCCP RBHO/Health Home Vision

BHOHH1

HH2HH3

HH4

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Provider A

Provider B

Provider C

Provider D

Provider E

Provider F

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QUESTIONS?