1. WESTERN REGION BEHAVIORAL HEALTH ORGANIZATON WITH BEACON HEALTH STRATEGIES, LLC AND COORDINATED CARE SERVICES, INC.

2. QUARTERLY ALL-STAKEHOLDER MEETING FEBRUARY 29, 2012 NEW YORK CARE COORDINATION PROGRAM WITH BEACON HEALTH STRATEGIES, LLC AND COORDINATED CARE SERVICES, INC. Western Region Behavioral Health Organization

3. WRBHO All Stakeholder Meeting Welcome and Introductions Kathleen Plum, Ph.D., RN, NPP Director, Monroe County Office of Mental Health Chair, New York Care Coordination Program BHO Oversight and Implementation Committee.

4. New York Care Coordination Program, Inc. Kathleen Plum, Ph.D., RN, NPP, Director, Monroe County Office of Mental Health, Rochester, NY. Chair, NYCCP BHO Oversight and Implementation Committee. Treasurer, NYCCP Board of Directors. Patricia Brinkman, LMHC, MBA, Director, Chautauqua County Mental Health Services, Mayville, NY. Chair, NYCCP BHO County Directors Group. Member, NYCCP Board of Directors Joe Woodward, CASAC, Executive Director, Housing Options Made Easy Buffalo, NY. Chair, NYCCP Peer Service and Family Support Group. Member, NYCCP Board of Directors. Howard Hitzel, Psy.D. President, Lake Shore Behavioral Health, Buffalo, NY. Chair, NYCCP Provider Group. Co-chair, NYCCP Board of Directors Adele Gorges, Executive Director Valerie Way, LCSW-R, Senior Program Associate Robert Dempsey, Peer/Family Coordinator Kathy Berthod, Program Assistant

5. Beacon Health Strategies, LLC Mark Deasy, Director of Account Operations John Lee, Program Director for Western Region Behavioral Health Organization Christine Mangione, Manager for Clinical Operations for Western Region Behavioral Health Organization Coordinated Care Services, Inc. Anne Wilder, President, CCSI

6. Facilitators Clyde Comstock, Chief Operating Officer, Hillside Children’s Center Rochester, NY, Member NYCCP Board of Directors Don Kamin, Ph.D., Chief, Clinical & Forensic Services, Monroe County Office of Mental Health Neilia Kelly, Chief, Policy and Planning, Monroe County Office of Mental Health Paul McArthur, Administrator, Strong Behavioral Health, Rochester, NY; Member, NYCCP Board of Directors

7. Today’s Objectives Learn more about the WRBHO and what we are trying to accomplish together Provide feedback on your experience with the WRBHO to date Begin the work of creating effective inpatient/ outpatient transition processes for each region in support of High Need/ High Risks individuals Get to know others in the region across stakeholder groups- engage in new partnerships

8. Today’s Agenda All Stakeholder Meeting – 1:00 pm – 2:00 pm Updates from the State WRBHO  News and Updates  Review of program goals  Review of data being collected and reports to be created Sub-regional Meeting- 2:15 – 4:00 Breakout groups  Provide feedback on your experience with the WRBHO  Assess current inpatient /outpatient transition  Develop recommendations for improvement and next steps

9. News and Updates: New York State NYS Office of Mental Health Thomas Smith, M.D Director of Operations, NYS Behavioral Health Organizations; Associate Professor of Clinical Psychiatry, Columbia University New York State Psychiatric Institute NYS OASAS Steve Hanson Acting Associate Commissioner

10. News and Updates: Western Region Behavioral Health Organization Activity of WRBHO – As of Week Eight Task 1- Volumes, outreach, getting the kinks out Task 2- SED Data submission webinars this week Task 3- First round to be ready by April 30 Task 4 – Meetings and conference calls Complementary work of NYCCP Health Homes BHO Phase 2

11. Why Regional Behavioral Health Organizations? Opportunity to prepare for a redesigned Medicaid Program in Phase 2: A fully managed system of care.  Understand what the current system looks like.  Understand the critical success factors are related to a Phase 2.  Implement needed changes.

12. Objectives for the Regional Behavioral Health Organizations Review BH inpatient length of stay for all Medicaid Fee-For Service admissions Reduce BH inpatient readmission rates Improve rates of engagement in outpatient treatment post discharge Better understand children diagnosed as SED Report on performance for the region as a whole and for providers individually in the region Encourage cross-systems linkages that will improve outcomes

13. WRBHO Data and Reports Data collected and reports to be generated link back to the goals Review data elements: inpatient stay info, discharge process info, transition to outpatient info Review of quarterly reports planned Sample reports

14. WRBHO Data and Reports Data collected tie directly to WRBHO goals Regular reports will describe our region in terms of strengths, service gaps and opportunities to improve Reporting and analysis will be done at the regional, sub-regional, county, and provider levels

15. What Data Are Being Collected? Patient and inpatient provider Identifiers: BHO Activity – Time frames for completion, etc. Episode of Care Characteristics Content of Discharge Plan Was an appointment for outpatient MH/SUD treatment part of the discharge plan? Indicator that physical health care needs requiring post hospital follow up were identified: Consumer Family Involvement Adult AOT SPOA Application

16. Quarterly Reports Designed to Answer Key Systems Questions Monitor, Review and Assess Use of Behavioral Health Inpatient Care  Who is receiving care at the highest level?  Are the individual’s needs being identified and addressed?  Are individuals being connected with care post-discharge?  Why are individuals being readmitted to inpatient care?  How many admissions are classified as “long stay” – and what resources are lacking in communities such that longer stays are required?

17. Quarterly Reports will be Designed to Answer Key Systems Questions Children’s Outpatient SED Tracking  Who is being diagnosed as SED?  Where are children/youth with SED receiving outpatient care? Cross-System Linkages  What types of cross-systems linkages are needed for individuals receiving inpatient behavioral health care?  What types of linkages are needed with physical health care services? Are they happening?

18. Quarterly Reports will be Designed to Answer Key Systems Questions Provider Profile Reports  Display data, at the provider level, on key descriptive and performance dimensions:  Demographic and clinical characteristics  Provider / WRBHO staff interaction  Length of stay  Connection to outpatient care  Reports will include comparisons to regional average and track changes over time

19. Sample Report – Inpatient Episode

20. Sample Report – Outpatient Engagement

21. Sample Report – Length of Stay

22. Charge for the Sub-Regional Meetings Work together via facilitated discussions to: Provide feedback concerning your experience with the WRBHO Begin the development of a cross-system plan to impact inpatient /outpatient transitions

23. ….As you have your sub-regional discussions, please consider the following information being provided by John and Chris…..

24. Practices that Support Effective Inpatient to Outpatient Transitions Some facts: Only 42% of initial appointments following psychiatric hospitalization are kept nationally. Missed appointments increase the likelihood of re-hospitalization and increase costs of outpatient care. (Kreyenbuhl, Nossel, & Dixon, 2009). Between 25% and 50% of patients who miss mental health appointments disengage from treatment entirely (Killaspy, 2007).

25. Practices that Support Effective Inpatient to Outpatient Transitions Some facts… Dropping out of treatment after a psychiatric hospitalization increases the likelihood of re- hospitalization from 1 in 10 to 1 in 4 (Mitchell & Selmes, 2007). Keeping one outpatient appointment reduces the risk of re-hospitalization (Nelson, Maruish, & Axler, 2000).

26. Practices that Support Effective Inpatient to Outpatient Transitions – What Works…. A pre-discharge transition interview with the patient to identify and address barriers to attendance. Patient telephone contact pre-discharge with the outpatient provider. Communication about the patient’s discharge plans between inpatient and outpatient clinicians.

27. Practices that Support Effective Inpatient to Outpatient Transitions – What Works…. Return to their previous outpatient provider… unless the individual prefers another provider or when specific clinical needs would suggest an alternative. Scheduling appointments within a few days of hospital discharge. Reminder letters or phone calls from the outpatient provider regarding scheduled appointments.

28. Sub-regional Meetings Four Sub-Regions: Chautauqua Region- Goes to Board Room Erie Region - Stays in Atrium Finger Lakes Region – Goes to Emerald room Monroe Region- Goes to Chrystal Room You decide the sub-region to join

29. Sub-regional Meetings What to Expect Breakout by region, with large regions splitting into smaller groups of approximately 15. Facilitator and scribe for each group. Each group will:  Provide feedback on their experience with the WRBHO  Discuss the current inpatient/outpatient transition process: what is working well?, What should work better?, What are the barriers to making it better?  Identify the three things most important things to change  Discuss what key stakeholder groups should be asked to do in order to achieve the desired change  Decide upon three steps to take between now and the next meeting

30. Sub-regional Meetings What to Expect Each group will report back to the sub- regional group prior to the end of the session. Each sub region will provide feedback on the usefulness of the sub-region structure for future meetings. Information collected will be transcribed and sent out to all participants after the meeting

31. Find your rooms! FYI.. Each sub-region has a lead facilitator. If there is confusion…. seek them out: Chautauqua: Christine Mangione Erie: John Lee Finger Lakes: Val Way Monroe: Anne Wilder