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© 2014 Community Care Behavioral Health Organization1.

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Presentation on theme: "© 2014 Community Care Behavioral Health Organization1."— Presentation transcript:

1 © 2014 Community Care Behavioral Health Organization1

2 2 Achieving Integrated Systems: How a Behavioral Health MCO Partners with Community and Medical Services Featuring: Dr. Jeffrey Brenner Dr. James Schuster Phil Keating Chris Minnich Carmine Picarelli

3 © 2014 Community Care Behavioral Health Organization3 3 Good Care Collaborative Steering Committee: Dr. Jeffrey Brenner, Camden Coalition of Healthcare Providers Dr. Ruth Perry, Trenton Health Team Michael Anne Kyle, Greater Newark Healthcare Coalition Ev Liebman, AARP NJ Linda Schwimmer, NJ Health Care Quality Institute Jeffrey Brown, Affiliated Accountable Care Organizations Joe Fleming, PICO NJ Ray Castro, New Jersey Policy Perspective

4 © 2014 Community Care Behavioral Health Organization4 4 4 About the Good Care Collaborative: The Good Care Collaborative is a coalition of providers and advocates from across the healthcare spectrum in New Jersey. We are committed to discussing sensible Medicaid reform and defining a collaborative vision of good care. Our goal is to improve the quality of Medicaid services while decreasing costs of the system. In an effort to do so, we will focus on a comprehensive legislative agenda that includes short-, mid- and long-range Medicaid reforms.

5 Behavioral Health Managed Care and Community Collaborations James Schuster, MD, MBA Phil Keating © 2014 Community Care Behavioral Health Organization

6 Community Care Quick Facts A nonprofit recovery-oriented behavioral health managed care company Provider-owned (UPMC) Incorporated in 1996 and headquartered in Pittsburgh, PA Federally tax exempt non-profit 501(c)(3) Major focus is publicly-funded behavioral health care © 2014 Community Care Behavioral Health Organization6

7 PA Managed BH Quick Facts Counties have right of “first opportunity” Counties have a variety of partnerships with Managed Care Organizations County direction facilitates close collaborations between MCO and: – County human services – Children and Youth – Forensic Services – State and county BH funding streams 7© 2014 Community Care Behavioral Health Organization

8 UPMC Operational Structure University of Pittsburgh Medical Center (UPMC) UPMC Insurance Services Division UPMC Health Plan Askesis Development Group, Inc. Medical Assistance Community Care 8 © 2014 Community Care Behavioral Health Organization

9 Membership Trend FY 2004FY 2005FY 2006FY 2007FY 2008 570,659562,436606,663954,9381,043,125 FY 2009FY 2010FY 2011FY 2012FY 2013 1,097,6451,297,4581,377,4191,528,0031,603,454 © 2014 Community Care Behavioral Health Organization9

10 Services in PA and NY 10© 2014 Community Care Behavioral Health Organization Southwest Region Lehigh-Capital Region Southeast Region Northeast Region North Central Region: County North Central Region: State North Central Region: County Community Care Office Hudson River Region Pike Erie Allegheny Blair Clarion Forest Warren McKean Potter Cameron Elk Jefferson Clearfield Centre Clinton Adams Mifflin Snyder Union Lycoming TiogaBradford Columbia Montour Northumberland York Chester Berks Schuylkill Juniata Sullivan Huntingdon Carbon Monroe Pike Luzerne Wyoming Lackawanna Susquehanna Wayne

11 Focus on Recovery Recovery Transformation Peer & Family Involvement Systems Integration (Children & Youth) Focused Care Management Model Respecting Individual Differences Physical & Behavioral Health Integration Person with Lived Experience © 2014 Community Care Behavioral Health Organization11

12 Examples of Recovery-Focused Initiatives 12© 2014 Community Care Behavioral Health Organization Children’s Accountable Clinical/Health Homes Adult (SPMI) Accountable Clinical/ Health Homes Addictions Expansion (Recovery Oriented System of Care) Physical Health/Behavioral Health Multiple Models

13 Systems Redesign © 2014 Community Care Behavioral Health Organization

14 Identifying and Coordinating Physical Health Concerns © 2014 Community Care Behavioral Health Organization14

15 Two Complementary Approaches Insurance collaboration supporting member engagement and enhanced provider coordination (Connected Care) Creation of behavioral health home model in mental health and drug and alcohol settings (Behavioral Health Home Plus) 15© 2014 Community Care Behavioral Health Organization

16 Connected Care Initiative to improve the connection and coordination of care for those with Serious Mental Illness among health plans, PCPs, and behavioral health providers in outpatient, inpatient, and ED care settings Based on Patient Centered Medical Home model with integrated care team and care plan to address all medical, behavioral and social needs Partnership between: – Center for Health Care Strategies (CHCS) – Department for Public Welfare (DPW) – UPMC for You – Community Care Behavioral Health – Allegheny County Department of Human Services 16© 2014 Community Care Behavioral Health Organization

17 Reduction in MH Hospitalizations 17© 2014 Community Care Behavioral Health Organization All MembersLate Cohort StudyComparisonStudyComparison Pre-Intervention Rate per 1,000 Member Mos. 41.133.825.816.2 Intervention Rate per 1,000 Member Mos. 39.637.243.345.1 Difference -1.6+3.4+17.6+29.0 Average Enrollment (months) -4.9-11.4 Percent Enrolled 18-24 months 0.041<0.01 Rates for all members dropped 4% in the study group, and increased 10% in the comparison group Rates for the late cohort increased 68% in the study group and increased 179% in the comparison group

18 Reduction in All-Cause Readmissions 18© 2014 Community Care Behavioral Health Organization All MembersLate Cohort StudyComparisonStudyComparison 30-Day Readmissions, Pre- Intervention 43.139.544.739.2 30-Day Readmissions, Intervention Period 38.939.735.740.0 Difference -4.2+0.2-9.0+0.8 Dif. in Differences -4.4-9.8 p-Value <0.01 Readmissions dropped 10% in the study group (all members), and increased 1% in the comparison group Readmissions dropped 20% in the late cohort and increased 2% in the comparison group

19 Reduction in ED Use 19© 2014 Community Care Behavioral Health Organization Full Two- Year Period By Six-Month Calendar Period July-Dec 2009 Jan-Jun 2009 July-Dec 2010 Jan-Jun 2011 Pre-Intervention Rate, Study 184.4206.6190.2182.5 Intervention Rate, Study 190.0250.4195.3188.7169.3 Pre-Intervention, Comparison 167.1182.4176.6171.1162.3 Intervention, Comparison 195.6232.6216.1184.8184.9 Dif. in Differences -22.9-6.3-34.4-7.7-35.8 p-Value 0.0520.8080.0340.583<0.01 ED visits increased 3% in this study group, and increased 17% in the comparison group

20 Behavioral Health Home Plus Services must be: – person/family centered – adhere to recovery principles – promote self-management skills – integrate into the individual’s recovery plan Individuals do not have to change existing providers or supports, but rather should enhance and build upon the individual’s provider and support network Integrating Mental health and drug and alcohol care with physical health care creates good health outcomes 20© 2014 Community Care Behavioral Health Organization

21 Behavioral Health Home Plus Wellness Coach Training by Peggy Swarbrick for Health Navigators to address Physical Wellness domain and Lifestyle Changes Health Navigator: Case Manager, Peer Specialist, RN Self-Management Strategies Used Focus on ways to integrate and collaborate for best whole person health 21© 2014 Community Care Behavioral Health Organization

22 Behavioral Health Home Plus Progress to date: – 4 demonstration sites, including CMSU – 11 additional sites initiated last year with support of federal research funding (PCORI) – 11 additional sites starting later in 2014 22© 2014 Community Care Behavioral Health Organization

23 23© 2013 Community Care Behavioral Health Organization

24 To learn more about the Good Care Collaborative: Visit our NEW website at www.goodcarecollaborative.orgwww.goodcarecollaborative.org Our next Site Visit will be May 21 st, 10:00 am-12:00 pm at Henry J. Austin’s Ryan White Clinic, Trenton, NJ. RSVP to shabnam@camdenhealth.org to reserve your place.shabnam@camdenhealth.org


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