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THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga.

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Presentation on theme: "THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga."— Presentation transcript:

1 THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga Springs, NY Monday September 16 th, Jonas Waizer, PhD, Chief for Healthcare Policy FEGS Health and Human Services

2 Change Is Constant: Who Moved My Cheese Personal Journey State Medicaid Redesign Provider Actions Challenges Models Actions Next Steps T ODAY S T HEMES 2

3 1968 –Autism: Parental Upbringing vs. Neurobiology 1980s – Deinstitutionalization vs. Trans-institutionalization 1990s – Programs vs. Consumer Centered Today – F-F-S vs. Managed Care, Service Integration, Risk Sharing CHANGE IS CONSTANT: A PERSONAL JOURNEY 3

4 All Other Chronic Conditions 306,087 Recipients $698 PMPM Mental Health and/or Substance Abuse 408,529 Recipients $1,370 PMPM Long Term Care 209,622 Recipients $4509 PMPM Developmental Disabilities 52,118 Recipients $10,429 PMPM $6.5 Billion 50% Dual 10% MMC $10.7 Billion 77% Dual 18% MMC $2.4 Billion 20% Dual 69% MMC $6.3 Billion 16% Dual 61% MMC $25.9 Billion Total Complex N=976,356 $2,338 PMPM 32% Dual 51% MMC NYSDOH: S PECIAL P LANS FOR H IGH -N EED M EDICAID P OPULATIONS 4

5 5 Strategic FactorOld WorldNew World (Federal ACA, MRT) Change NYS Fiscal Environment Fee-for-Service (FFS) – Session, Day Rates Set by Each State Agency Managed Care (MCOs) PMPM, Case Rates; Capitation Consolidate and Shift Public Funding Mechanisms Medicaid, Medicare, State/City Contracts Legislative Member Items Medicaid/Medicare, FIDA Consolidate Government Authority - Medicaid/Medicare NYS OMH, OPWDD, OASAS DOH NYC DOHMH NCDMH SCDMH Medicaid Redesign NYSDOH as Lead Agency Redesign Public Health Service Structures General Healthcare Clinic (A-28) Behavioral Health Clinic (A-31) Substance Abuse Clinic(A-22) Developmental Disabilities Clinic(A-16) Specialized Residences – Similarly Specialized Under MCOs Integrated Health Care: Co-location Care Coordination: Health Homes Affordable & Mixed Use Housing Service Sector Success Measures Hospitals – Fewer Days Outpatient - Day Hab & Clinics - Sessions Residences – Stability and Tenure Work Centers – Subsidized Employment Hospital – Reduced Readmissions Aftercare - 100% of Discharges Residences – Upward Mobility Employment – Mainstream FT or PT Report Cards (Across Agencies) Technology Billing, Client Registry Specialized EHRs (DD, MI, Psychiatry) Paper Medical/Clinical Charts Full EHR – Clinical Record and Billing Statewide Connectivity (Local RHIOs) Customer Access to Personal Health Record Provider StrategyDiversification, Growth Medicaid Revenue Maximization Partnerships, Networks, IPAs Risk-sharing w/MCOs Technology for Client Tracking w/in and w/RHIOs STRATEGIC CHANGES IN NYS HEALTH CARE

6 Maintain Services to Disability Groups - Shifting from FFS to MC Partnerships and Networks - Forming New Business Models Risk-Sharing Arrangements – Contracting with MCOs New Models of Care Coordination - DISCO, HARP, FIDA Integrating Services - Health, Behavioral Health, SA, Habilitation, etc. Focus on Outcomes – e.g. Recidivism, Employment, Housing Stability Focus on Measures - Performance, Health and Quality Metrics Upgrade EHR - Tracking, Reporting, RHIOs, Customer Centered Services SOME PROVIDER CHALLENGES 6

7 7 The Best Way To Predict the Future Is to Invent It Abraham Lincoln Peter Drucker Steve Jobs

8 One of the Nations Largest and Most Diversified Nonprofit Health and Human Services Organizations. FEGS by the numbers: 100,000+ New Yorkers Served Annually $300 Million Annual Budget 5,000 Staff 3,000 Interns, Volunteers and Consultants 350 program locations across New York City, Long Island and Westchester County 14 Subsidiaries 1.6 Million Square Feet FEGS H EALTH & H UMAN S ERVICES 2 Mission: To help each person served achieve greater success, independence and dignity at work, at school, at home and in the community. FEGS H EALTH & H UMAN S ERVICES P RESENTATION TO : H EALTH P LUS A MERIGROUP Operating Areas: Health Disabilities Homecare Housing Employment Education Youth and Families 8

9 NYS Medicaid MRT Program (NYS DOH) IPAs Service Provider Payment for Care Management Services Service Provider Medical Payment Risk Arrangements Continue as Service Providers M ANAGED S PECIAL N EEDS (S IMPLIFIED V IEW ) HEALTH HOMES (LIBA and CBC Partnership) DD- DISCO (ACA Partnership) MLTC (SinglePoint Care Network w/SelfHelp) Managed Care Organizations FEGS - N EW H EALTHCARE P ARTNERSHIPS Behavioral Health Developmental Disabilities Homecare 9 FEGS H EALTH & H UMAN S ERVICES Risk Sharing Partnerships Under MRT

10 Advance Care Alliance, LLC EmblemHealth (MCO) State Alliance Care Network, LLC Advance of Greater NY, LLC LI Alliance, LLC ACA Structure Providers ACA IPA owners Care management contract $ Contract for risk sharing, claims payment, IT, back office services 10

11 PROVIDER ACTIONS FOR THE 21 st CENTURY Focus on Engagement, Outreach, Adherence (esp. Rx) Care Coordination for Complex Cases – Keep People at Home Prepare for Variable Payment Systems: FFS, Case Rates, PMPM Pilot Innovative Services - e.g. Health Coordination, Employment Support, Residential and Crisis Beds, Self-Directed, etc.) Partnerships* IT Upgrades* 11

12 PARTNERSHIPS AND NETWORK DEVELOPMENT Acute Care Partners: Local Hospitals, Urgi-centers Primary Care Community Partners: FQHCs, Medical IPAs Specialized IPA: With Other Licensed Providers Families and Consumers: Promote Governance and Choice Managed Care Companies for Shared Savings, Shared Risk 12

13 IT REQUIREMENTS Track/Monitor Consumers Inside and Outside the Agency Import & Export Data (Network Providers, Hospitals, RHIOs) Link to MCOs for Referral Stream Collect and Process Standardized Measures, Metrics Process Data Analytics, Report Cards 13

14 NEXT STEPS: FOR PROVIDERS (& GOVERNMENT) Capitalize IT Upgrades (Inside and Outside) Train Provider Management and Staff in Risk–Sharing Models Simplify /Centralize Credentialing Standardize Measures, Data Analytics, Report Cards Simplify State Regulations (vis-a-vis MCO Requirements) Re-invest Resources 14


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