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Provider-Sponsored Networks “Building Partnerships” Presented by… Linda McKinnon, Chief Executive Officer, Central Florida Behavioral Health Network Bob.

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Presentation on theme: "Provider-Sponsored Networks “Building Partnerships” Presented by… Linda McKinnon, Chief Executive Officer, Central Florida Behavioral Health Network Bob."— Presentation transcript:

1 Provider-Sponsored Networks “Building Partnerships” Presented by… Linda McKinnon, Chief Executive Officer, Central Florida Behavioral Health Network Bob Holm, Regional Substance Abuse Director, Suncoast Region DCF Richard Brown, Chief Operating Officer, The Agency for Community Treatment Services Nancy Hamilton, Chief Executive Officer, Operation PAR

2 Central Florida Behavioral Health Network is a not-for-profit organization of community providers incorporated to ensure and enhance an array of behavioral health and other human services needs for the citizens of our communities. CFBHN Mission

3 CFBHN History Linda McKinnon Chief Executive Officer Central Florida Behavioral Health Network

4 CFBHN History “Not an overnight sensation!” 1995 No collaboration among providers or between disciplines 1996 Collaboration among mental health providers in Hillsborough and Manatee counties related to pre-paid Medicaid pilot 1997 Collaboration between ADM and substance abuse providers in Hillsborough and Manatee counties to create CFBHN No collaboration between mental health and substance abuse providers DCF contracts with CFBHN to manage funds targeted at SSD and SSI dis-enrolled and intervention services

5 CFBHN History 1998 Hillsborough County mental health providers join collaboration as vendors DCF contracts with CFBHN for TANF-funded services and children’s substance abuse services CFBHN assumes additional administrative responsibilities for outcomes and quality oversight for contracted services 1999 CFBHN joins Florida Behavioral Health Hillsborough County Workforce Board contracts with CFBHN to implement a three-year grant for supportive employment services targeted to the most difficult to employ TANF recipients

6 CFBHN History 2000 DCF regionalization pilot DCF expands contracts with CFBHN to include substance abuse services for heroin and cocaine abusers and family intervention services DCF contracts with CFBHN to provide services in collaboration with Hillsborough County children’s system of care development grant Sarasota County substance abuse provider and Hillsborough/ Manatee Public schools join collaborative as vendors 2001 G. Pierce Wood Hospital closes Substance abuse and mental health providers in Hillsborough County collaborate to address needs of substance abusing persons with serious mental illness

7 CFBHN History 2002 CFBHN Board membership expanded to include 19 substance abuse and mental health non-profit providers in 9 counties comprised of Suncoast Region and District 14 Family intervention services expanded to Pinellas, Pasco and Sarasota counties CFBHN contracts to operationalize COSIG Grant in Hillsborough County TANF-funded services expanded to Pasco County CFBHN contracts to provide substance abuse aftercare services in Suncoast Region

8 CFBHN History 2003 CFBHN contracts for TANF-funded services throughout Suncoast Region and District 14 (Polk, Highlands and Hardee counties) DCF contracts with CFBHN to provide TANF oversight functions in Suncoast Region and District 14 Family intervention services expanded to District 14 SAMH Program Office contracts with CFBHN to provide services targeted to persons with co-occurring disorders and operationalize COSIG Grant in Hillsborough County CBC contracts with CFBHN to provide children’s mental health services in Hillsborough, Manatee and Sarasota counties CFBHN awarded ASO development pilot for District 8 (Charlotte, Lee, Collier, Hendry and Glades counties)

9 CFBHN History 2004 DCF Suncoast Region contracts with CFBHN to provide substance abuse prevention for adults DCF District 14 contracts with CFBHN to develop service strategies for persons with co-occurring disorders CFBHN identified to operationalize Robert Wood Johnson Resources for Recovery Grant throughout Suncoast Region CFBHN operationalizes substance abuse elder care pilot CFBHN implements diversion services for CBC District 8 DCF initiates start up contract for SB1258 ASO pilot

10 CFBHN History Current FY2004-2005 Contract DCF Suncoast contracts with CFBHN to manage all substance abuse treatment services and funding DCF initiates single contract with CFBHN for contract administration, management and oversight functions for substance abuse treatment throughout Suncoast Region

11 The Purchaser’s Role Bob Holm Regional Substance Abuse Director Suncoast Region DCF

12 DCF’s Strategy What the Purchaser Wants Evaluate, integrate and re-engineer system of care into a seamless and easily navigated system Ability to achieve uniform clinical policies and best practice throughout Network Uniform data collection used to drive quality improvement initiatives Resource maximization and cost effectiveness Increased access to care Simplification and non-duplication of contracting and oversight functions to allow for effective use of limited staff

13 The Purchaser’s Role Moving the System Forward State and District SAMH plan development  Needs assessment  Defining population eligibility  Utilization standards  Service allocation projection Financing strategies ASO and service system design Contract development ASO contract performance and oversight Regulation and licensing Review and approval of quality and systems improvement initiatives and plans Technical assistance to managing entity Review and approval of contracts with network providers

14 Reengineering Substance Abuse Treatment RWJ Resources for Recovery Grant Suncoast Region and CFBHN named as a pilot in Grant Medicaid Maximization: Contract requires 10% increase in Medicaid revenues earned for substance abuse treatment throughout CFBHN providers Testing of Flexible Payment Methodologies: Grant funds moved to CFBHN to allow greater flexibility for services to more adequately meet consumer needs and to test strategies for case rates and other prospective payment methodologies Increased Access to Care: Contract requires reduction of wait lists for residential services and increased access to detoxification services

15 Contracting with Networks Currently using a hybrid performance contracting mechanism designed to increase and move towards flexibility and accountability.  Contract used to define ASO functions and Network requirements and is defined differently by local districts/region  Administrative Services Organization: “An independent operating entity organized for the purpose of managing and assessing a network of human service providers and provider agencies, to include but not limited to, quality improvement, clinical management, network management, data management, revenue maximization and integration of systems.” (As described in District 8 ASO contract)

16 Suncoast-Specific Terms Managing Entity - An entity that manages the delivery of behavioral health services Network Provider - An entity that contracts with the Managing Entity to provide services to clients that are funded through the contract with the department (subcontractor) System of Care - Behavioral health services developed into an integrated network to provide services to substance abuse and mental health clients

17 Contract Requirements The ASO… Is responsible for the administration and provision of services Must ensure that network providers will provide services as specified in the system of care plans identified for each county in the Network Operational Plan Must ensure services described are provided throughout the contract period

18 Contract Requirements The ASO… Must ensure that the number of persons served, as required by contract, are served with outcomes Must establish a client grievance procedure that assures that all grievances not resolved at the provider level are referred to the managing entity

19 Contract Requirements The ASO is responsible for… All mandated outcomes,electronic data submissions and performance improvement initiatives Incident reporting Assuring emergency preparedness of its providers Provider financial and audit requirements Billing and invoice validation

20 ASO Contract Responsibilities Unique to Suncoast Region The ASO is responsible for… Management of wait lists for all substance abuse services Reduction of wait list for residential treatment services Evaluation of Region’s detoxification system Increase of Medicaid billing and reimbursement for substance abuse treatment services by 10% Implementation of substance abuse services to the elder care pilot Implementation of co-occurring service capability throughout provider network

21 Lessons Learned from Purchaser Communication is Key!! Need to clearly define what is being purchased Need to understand and articulate the role of the purchaser Requires partnership of all stakeholders Requires commitment of local SAMH Program Office and state SAMH Program Office Requires transfer of administrative responsibilities, dollars and staff Need to identify barriers and work toward resolving issues Requires ability to assess readiness of Network to assume responsibilities

22 Building the Network Governance Structure Richard Brown Chief Operating Officer The Agency for Community Treatment Services acts The Agency for Community Treatment Services

23 CFBHN Suncoast & District XIV 9 counties 19 members (providers) 4 Regional Councils District VIII 5 counties 8 members 5 providers 1 CBC 2 consumer representatives

24 Governance Structure All corporate generated documents need to reflect succinctly…. ”who you are and what you are to do”

25 CFBHN Descriptors Not-for-profit Provider sponsored network Administrative Service Organization Aspiring to become:  Single Managing Entity

26 Corporate Documents Articles of Incorporation Bylaws Business Plan Board Policies Member Agreements Vendor Agreements Etc.

27 Policy Content  Reflect commitment to community driven, consumer centered care: Increased accessibility Continuous care approaches Integration with other systems

28 Scope of Fund Administration Select substance abuse funds All substance abuse funds Select substance abuse & select mental health All substance abuse & select mental health All substance abuse & mental health Other (or) “Lines of Business”

29 Purchase Relationships ADM Substance Abuse ADM Mental Health AHCA Community Care Provider(s) Local / Governmental Community Care Provider(s)

30 Membership Most congruent structure for a Provider Sponsored Network would reflect major providers of the anticipated “Lines of Business”

31 Substance AbuseMental HealthInsurance Single Managing Entity

32 Eligibility (Factors for Membership Decisions) Accreditation Financial Buy-in to Membership Current Contractor for Anticipated “Lines of Business” Medicaid Provider Demonstrated ethics & conformance with requirements of Member / Vendor Agreements In good standing with current funders

33 Governance Decisions  Financing ASO Infrastructure Earn & Build Staffing Grants (OPS) FCO Grants Membership Fee(s) Member / Vendor Dues

34 Governance Decisions  Build & Buy Claims Management Human Resources / Personnel Call Center Information System & MIS Management Auditing / Monitoring Etc.

35 Governance Decisions Targeted Reserve Fund Development A. Capital Equipment B. Research & Development C. Financial Security D. Risk Management E. Insurance Licensure F. Innovations

36 Governance Sticking Points Large vs. Small Agencies Mental Health vs. Substance Abuse Comprehensive Providers vs. Niche Providers Local vs. Remote Headquarters Inclusiveness: Members, Vendors, Purchasers, Stakeholders & Consumers Right of First Refusal Market Share Protections

37 Sticking Points – cont. Non-compete vs. Notification of Intentions ASO vs. Provider Status

38 TOOLS Towards Focus of Effort & the Attainment of Inclusiveness Business Planning System of Care Planning Ah Right…It’s time for extreme makeover!!

39 “We will know that we have arrived when the ASO readily matches consumers benefit to provider payments & providers are free to focus on matching consumer needs to services consistent with their progress in recovery”

40 Building Administrative Capacity Linda McKinnon Chief Executive Officer Central Florida Behavioral Health Network

41 Building Administrative Capacity The Role of the ASO Provider network development and management Planning Customer service Quality management Utilization management Information management Financial management Training and education; best practice development Systems integration Resource development

42 Current Organizational Structure Defined by Functional Roles August 16, 2004 Collaborating for Excellence in Behavioral Health Services Linda McKinnon Chief Executive Officer Sue Webber Director Finance TBH Manager Information Systems (On Hold) Lisa Main Fiscal Supervisor Lisa Thomas Fiscal Assistant TBH IS Technician (On Hold) Ioan Fernandez Data Specialist Yenny Hernandez Data Specialist Mary Herkert Director Network Operations Jan Burton Manager Contracts TBH Accountant Kathy Way Manager Contracts Laura Gross Administrative Assistant Rebekah Bickling Executive Assistant/ Admin Supervisor/ HR Liaison TBH Admin Assistant (On Hold) Brandi Mason Administrative Assistant Jimmie Adams Admin Assistant/ Receptionist Paula Pressler-Tash Director Quality Management/ Utilization Management Ibelice Rivera Quality Specialist TBH Quality Specialist TBH Quality Specialist Laura Cronk Quality Manager/ Data Operations Analyst Marcia Monroe Director Provider Services Kay Doughty Manager Specialty Services TBH Manager Adult Services TBH Manager Children’s Services (On Hold) Tampa Office

43 Current Organizational Structure Defined by Functional Roles August 16, 2004 Collaborating for Excellence in Behavioral Health Services Linda McKinnon Chief Executive Officer Nancy Rossback Receptionist/Admin Asst Rick Sanefski QI Manager Brian Mogosky Director Jennifer Formica Data Specialist Susan Lang Consumer Affairs Manager District 8 Office

44 Building Administrative Capacity Quality Management Performance Improvement Program Evaluation – Specialized reports, outcomes improvement, best practice identification, outlier review, customer satisfaction Performance Compliance - Corporate service validation, regulatory compliance and oversight, clinical pathway compliance Utilization Management - Clinical UM development and oversight Outcome/Data Management - Data and outcome validation, tracking and reporting Technical Assistance and Training Accreditation

45 Building Administrative Capacity Provider Services Credentialing and profiling Clinical systems development Best practice implementation Technical assistance Product development Service development Provider information and orientation Management of training resources Consumer, stakeholder, purchaser and provider satisfaction Complaints and grievance

46 Building Administrative Capacity Financial Management Financial reporting and forecasting requires tracking, analysis and reporting of the following:  Rate Setting and development methodologies  Provider allocations  Cost accounting system  Revenue maximization strategies/ internal resource management  Funding utilization and cash flow analysis  Agency reconciliation  Accounts payable and receivable  Budget development and management  Insurance  Board communication

47 Building Administrative Capacity Administrative Services  Information systems and data management  Information system development and technical assistance  Management reporting support  Contract development, negotiation on and compliance  Revenue maximization  Provider resource management  Medicaid maximization  Grant development  Risk mangment  Facility management

48 Building Administrative Capacity IS Capabilities - Lessons Learned Identify information system needs early on and be willing to invest in them!! Requires identification of software functional needs for: - Network management functions - Claims processing functions - GL linkage and financial functions - Member services functions - Care access functions - Care management and utilization management

49 Building Administrative Capacity Executive Services Board development Regional council development Purchaser relations Advocacy Legal Marketing Human resources Oversight of all Network and ASO operations

50 Building Administrative Capacity Lessons Learned Identify potential conflicts of interest (an ASO is not a provider) Be prepared to perform once you have got what you asked for – greater flexibility has its own set of requirements Don’t over-commit Be prepared to act on opportunism quickly Understand the implications on providers Develop a strong relationship with the Board This is a partnership with all stakeholders and requires open communication and trust ASOs are not “one size fits all”

51 Nancy Hamilton Chief Executive Officer Operation PAR

52 Provider/Member’s View Two-Hatters in Provider Sponsored Networks PAR CFBHN

53 “We have met the enemy & he is us” Pogo Keep this in mind…..ALWAYS!!

54 Holy Cow…What will become of us…will we survive??? I’m so confused…what to do…get on the bus…or find my self hitchhiking later??

55 Contracting thru The ASO Opportunities Flexibility Flexibility Sharing expertise Sharing expertise Sustainability Sustainability Giving up control to gain some control over the unpredictability of politics Giving up control to gain some control over the unpredictability of politics Respond to the needs of the community Respond to the needs of the community Improve quality of services Improve quality of servicesChallenges Our invoices will now be matched to the information in the data warehouse. The network is not going to hold up invoices for the first couple of months (good) but could be problematic in the future Our invoices will now be matched to the information in the data warehouse. The network is not going to hold up invoices for the first couple of months (good) but could be problematic in the future Investing in the network meant reduction in revenues – invest today for potential higher returns later – scary, hard to explain to Board & staff Investing in the network meant reduction in revenues – invest today for potential higher returns later – scary, hard to explain to Board & staff

56 Testimony – the CFO Renegotiating contract – reduced tedious financial reports required in the past. Renegotiating contract – reduced tedious financial reports required in the past. At negotiation, all reimbursement rates were increased to the model rate, less the admin. rate, which resulted in increased rates for most of our services At negotiation, all reimbursement rates were increased to the model rate, less the admin. rate, which resulted in increased rates for most of our services Contract was restructured to allow us more flexibility to spend dollars among cost centers. Don’t have to go through contract amendments to move dollars around Contract was restructured to allow us more flexibility to spend dollars among cost centers. Don’t have to go through contract amendments to move dollars around End of the year, the network was able to re- allocate funds due to lapse dollars. Since PAR was over-producing units in some of the cost centers, we were able to share in this reallocation – Next year who knows End of the year, the network was able to re- allocate funds due to lapse dollars. Since PAR was over-producing units in some of the cost centers, we were able to share in this reallocation – Next year who knows

57 ASO must have an excellent data system & provide “value added” or this is just an extra expense to providers/partners within the ASO. I don’t think I can emphasize this enough. The data system MUST be easy to use & not place additional demands on the providers; one thing providers do NOT need is additional demands or requirements. ASO must have an excellent data system & provide “value added” or this is just an extra expense to providers/partners within the ASO. I don’t think I can emphasize this enough. The data system MUST be easy to use & not place additional demands on the providers; one thing providers do NOT need is additional demands or requirements. Offer an IS system for those smaller agencies & providers that do not have any IS system at all. This could be just client services & state reporting or it could be for other functions as well like HR, etc. Offer an IS system for those smaller agencies & providers that do not have any IS system at all. This could be just client services & state reporting or it could be for other functions as well like HR, etc. IS should be involved strategically (like at CFBHN) & involved in the process assuming there is the appropriate staff to do so. This will produce better IS systems and processes & since ASOs move great amounts of data, it is so important that we have IS systems that minimize paper movement & increase automation. IS should be involved strategically (like at CFBHN) & involved in the process assuming there is the appropriate staff to do so. This will produce better IS systems and processes & since ASOs move great amounts of data, it is so important that we have IS systems that minimize paper movement & increase automation. Testimony – VP of IS

58 Re-engineering (infrastructure, conceptually, & philosophically) Budgeting Budgeting Data Management Data Management Q.I. Q.I. HR / Credentialing HR / Credentialing Billing / Reporting Billing / Reporting Business / Strategic Planning Business / Strategic Planning System of Care Planning System of Care Planning

59 ASO Expectation  Reflect commitment to community driven, consumer centered care: Increased accessibility Increased accessibility Continuous care approaches Continuous care approaches Integration with other systems Integration with other systems

60 Clinical Client Centered - Assessment & Treatment Client Centered - Assessment & Treatment Consumer Satisfaction Consumer Satisfaction Matching & Prioritization Matching & Prioritization Waiting List Management Waiting List Management

61 Sticking Points Large vs. Small Agencies Large vs. Small Agencies Mental Health vs. Substance Abuse Mental Health vs. Substance Abuse Comprehensive Providers vs. Niche Providers Comprehensive Providers vs. Niche Providers Local vs. Remote Headquarters Local vs. Remote Headquarters Inclusiveness: Members, Vendors, Purchasers, Stakeholders & Consumers Inclusiveness: Members, Vendors, Purchasers, Stakeholders & Consumers Right of First Refusal Right of First Refusal Market Share Protections Market Share Protections

62 Eligibility (Factors for Membership Decisions) Accreditation Accreditation Financial Buy-in to Membership Financial Buy-in to Membership Current Contractor for Anticipated Current Contractor for Anticipated “Lines of Business” Medicaid Provider Medicaid Provider Demonstrated ethics & conformance with requirements of Member / Vendor Agreements Demonstrated ethics & conformance with requirements of Member / Vendor Agreements In good standing with current funders In good standing with current funders

63 One Big Happy Family??? Young & Old – Big & Small Young & Old – Big & Small Naive & Jaded Naive & Jaded Quiet & Noisy Quiet & Noisy Unique Personalities Unique Personalities Conflict / Resolutions Conflict / Resolutions In it for the long haul / Recommitment In it for the long haul / Recommitment Agree to Disagree Agree to Disagree Safety in numbers / One for all – all for one Safety in numbers / One for all – all for one Sometimes the needs of the many outweigh the needs of the few or the one…other times? Mr. Spock

64 For more information… Contact: Richard Brown The Agency for Community Treatment Services 4612 North 56 th Street Tampa, FL 33610 813-246-4899 phone <> 813-621-6899 fax rbrown@actsfl.org Nancy Hamilton Operation PAR 6655 66 th Street North Pinellas Park, FL 33782 727-545-7564 phone <> 727-545-7584 fax nhamilton@operpar.org Bob Holm Department of Children and Families SAMH Program Office 11351 Ulmerton Road, Suite 329 Largo, FL 33778 727-518-3271 phone <> 727-588-3618 fax bob_holm@dcf.state.fl.us Linda McKinnon 719 US Highway 301 South Tampa, FL 33619 813-740-4811 phone <> 813-740-4824 fax <> 813-389-8179 cell lmckinnon@cfbhn.org Thank you for your attendance and participation!!


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