3 Coordinated Assessment System (CAS) Care CoordinationCase StudiesRFAFront DoorICSDISCOCoordinated Assessment System (CAS)RFIPeople First WaiverInterRAIPilotsCQLManaged CarePersonal Outcome Measures
4 THEMES Equity Balance Person Centered Needs Based Outcomes Driven IncentivizedTHEMES
5 OFF TO THE RACESImproving how we meet needs - expanding self direction and employment to provide opportunities for everyone, launching CASImproving quality of our care through workforce support and measuring individual outcomesParticipating in NYS Olmstead Plan – creating more housing opportunities & moving people out of institutionsLaunching managed care through pilot DISCOs – moving toward integrated, holistic careContinuing health and safety reforms –
6 AGENDA FOR TODAY1. Discuss 4 Essential aspects of Person-Centered Practice as a Foundation for Managed Care2. Discuss similarities and differences within managed care for people with ID/DD as compared with mainstream managed care3. Outline milestones and time tables for the transition in managed care here in NY
7 Assessment Planning Access Evaluation Standardized Comprehensive 3/13/2013AssessmentStandardizedComprehensivePlanningPerson CenteredAssessment BasedMeasurable OutcomesAccessAccess to Services “Front Door”ConsistencyEvaluationOutcomes Based
9 Goals of Needs Assessment Standardized needs assessment that identifies individual needs and strengths to informPerson-centered care planningAn assessment tool that can inform acuity levels for resource allocation.Ability to draw on individual or aggregate level data forquality monitoringpurposes.
10 New York State-specific InterRAI DD Items from Child and Youth ID and Mental Health toolsItems from Community Mental Health (CMH) toolItems from the Correctional Facilities toolNew York State OPWDD Coordinated Assessment System (CAS)interRAI Intellectual Disability (ID)
11 Coordinated Assessment System CAS CoreChild and Adolescent SupplementMental Health SupplementForensic SupplementMedical Management SupplementSubstance Use Supplement
12 CAS and the Case Study18 Assessment Specialists hired to complete CAS for the case studyAssessment Specialists received extensive training specific to the CASCAS summary and CAPs will be used by agencies to inform care planningOngoing review of the CAS, protocols and manual will continue throughout the case studyReliability and validity testing will be conducted
13 Long-Term VisionNew Coordinated Assessment System will be phased in thoughtfully over the next several years:Beginning with year long case studies,Moving next to DISCO pilot projects,Next into use with all newcomers to the service system,Eventually, over time, will be used with those currently receiving services.We will be careful not to disrupt lives, but instead identify opportunities for greater integration and independence based on needs, strengths and desires.
14 For More Information…InterRAI Integrated Assessment Suite:CAS specific questions:
16 Essential Elements of Person Centered Care 3/13/2013Essential Elements of Person Centered CarePerson-DirectedPerson-CenteredOutcome-Based Information, Support and AccommodationsWellness and Dignity of RiskParticipation of those that individual selectsCommunity Integrated
17 3/13/2013FUTUREThe DISCO will be responsible for ensuring that they have organizational characteristics that support person centered planningPerson centered planning is expected to be part of and integrated into the entire culture of an agency and managed care entity
19 What Is the Front Door Initiative? 3/13/2013What Is the Front Door Initiative?The Front Door Initiative is:A person centered approach to developing plans of support for people - not a program or a servicePart of the fundamental process by which people access supports and services through OPWDD - providing a broader array of individualized service options to give individuals and families more flexibility and choice of supports and services that meet their needs
20 3/13/2013Why Now? – 3 FactorsThe sustainability factor - how do we sustain appropriate service provision within fiscal realities?The relevancy factor - are the services we currently offer those that families and individuals coming into our service system are seeking?The compliance factor - in light of Olmstead and recent federal decisions on ADA, will the menu of service options we provide allow us to meet the goals of Olmstead and federal requirements?
21 OPWDD’s Front Door Initial Contact Assessment of Skills Eligibility DeterminationAssessment of SkillsSupport Needs IdentifiedInformed Decision Making and Individualized Plan DevelopmentService Authorization and Implementation
22 3/13/2013Front Door GoalsFacilitate OPWDD’s approach to the delivery of services based on:A focus on the values of self determination and self-directionResources to individuals based on needs, rather than the programs currently availableMore informed choice of supports and servicesHolistic use of paid and community supportsStatewide consistency and availability of individualized and self-directed service options
23 3 Approaches to Achieve Goals Simplify Access to Self-DirectionStreamline Internal ProcessesOPWDD & Provider Partnership Through Change
25 Areas for Increased Partnership Reinvestment Planning and ImplementationCommunication in Service Planning
26 ReinvestmentReinvestment is one or more methods for individuals to maintain service dollars but change service type to be able to purchase services in a more integrated setting.
27 Steps to Achieve Reinvestment Models Review and modify existing processes, procedures and templates or develop new ones that enable providers to reinvest dollars associated with existing services that support more choice and better outcomes for people while also serving more peopleDevelop consistent policies, procedures and reports that OPWDD Regional Offices can utilize to better manage base resourcesCreate policies that can be put in place that shift management of current resources away from vacancy management and toward capacity management and more integrated settings
28 Communication in Service Planning OPWDD and partners must communicate about individual level of need and how that need impacts service planning. Services in traditional supervised IRA and day habilitation settings will not be authorized by OPWDD simply because a program opportunity is available. An individual must have a level of need significant to require the level of support offered in these services and must choose these options as opposed to an option in a more integrated setting
30 HCBS Quality Framework 3/13/2013HCBS Quality FrameworkEligibility (Level of Care) is carried out in a valid, reliable, and equitable fashionIndividual Plans include services and supports that align with individual goals, strengths and needsProvider qualifications are regularly checked and monitoredIndividual health and well being is maintainedFinancial accountability is maintainedThe Medicaid agency maintains administrative authority
31 CMS Increasing Expectations 3/13/2013CMS Increasing ExpectationsUsing Data to drive systems improvementsEvidence Based Performance Measures for Federal Waiver AssurancesRegulatory ComplianceCMS expects states to remediate individual situations but also to respond to trends in the data.In reviewing evidence, CMS looks to see if continuing compliance issues are identified through quality improvement initiatives.Must show how we review trends, develop and evaluate quality improvement strategies.Health and Safety
32 How do we make this Shift? 3/13/2013How do we make this Shift?Evolving systemHistorically – Compliance/QA focusShifting from site-based “bricks & mortar” inspections to reviews focused on individuals and achievement of outcomes“The measure of Quality is not the delivery of a support or service, but the results that services or supports provide for each person”Source: Designing Quality—Responsiveness to the Individual. CQL 1999Outcome measures emphasize responsiveness to individual needs rather than compliance with organizational process or program requirements.Supports and services are not the outcomes. The supports and services are thepractices, activities, and processes that enable people to achieve their prioritizedoutcomes. As such, organizational systems, policies and procedures createframeworks for enabling people to achieve outcomes. Systems, policies andprocedures are not ends in themselves. The measurement of quality is shiftingfrom a focus on compliance with organizational process to a focus on responsivenessto personal outcomes.
33 What are CQL Personal Outcome Measures? Valid and reliable personal outcome measuresthat focus on what is meaningful to the personserved.Provides a methodology to assess how well theorganization’s provision of supports and servicesfacilitate outcomes that are meaningful to eachindividual.Different than National Core Indicators (NCI)which are system outcome measures.
34 My Focus: What is most important to me now. 3/13/2013CQL The Council on Quality and LeadershipMy SelfMyFocusMyWorldMy DreamsMy Focus: What is most important to me now.34
35 CQL The Council on Quality and Leadership 3/13/2013CQL The Council on Quality and LeadershipMy Self1. People are connected to natural supports.People have intimate relationships.People are safe.People have the best possible health.People exercise rights.People are treated fairly.People are free from abuse and neglect.People experience continuity and security.People decide when to share personal information.35
36 My World CQL The Council on Quality and Leadership 3/13/2013CQL The Council on Quality and LeadershipMy World1. People choose where and with whom they live.2. People choose where they work.3. People use their environments.4. People live in integrated environments.5. People interact with other members of the community.6. People perform different social roles.7. People choose services.36
37 People choose personal goals. People realize goals. 3/13/2013CQL The Council on Quality and LeadershipMy DreamsPeople choose personal goals.People realize goals.People participate in the life ofthe community.4. People have friends.5. People are respected.37
38 Proposal for Operationalizing POMs in DISCO Pilots – Components 3/13/2013Proposal for Operationalizing POMs in DISCO Pilots – ComponentsCare Coordination Framework Practice GuidelinesCommunication and Learning throughout the OPWDD systemQI Plan—Use of CQL Data in Quality Improvement
39 CARE COORDINATION WHAT TIES IT ALL TOGETHER: ASSESSMENT BASED ON NEEDS PERSON CENTERED IN THEORY AND IN PRACTICEACCESS – RIGHT SERVICES AND THE RIGHT TIMEEVALUATION – FOCUS ON REAL OUTCOMES FOR THOSE SERVED
40 CARE MANAGEMENT AND MANAGED CARE Concepts of care management are rooted in the development of managed care principlesCare Management has a focus on the best outcomes for individuals servedManaged Care’s history has had a focus on cost containmentEach rely on concepts of health promotion and disease prevention
41 CMS’s “Triple Aim” Better Health for the Population Better Care for IndividualsLower CostThroughImprovement
42 Where does Person Centered Planning Fit In? Since much of the Medicaid cost for those with long term care needs is outside of traditional health care, the emphasis needs to be on planning for all aspects of the individual needs for each person enrolled in a managed care plan
43 Variations in Managed Care Strategies for those with LTC Needs 1. Population already has complex medical and social needs2. Due to these needs utilization of resources including specialty care is often quite extensive3. Cost for services most often tied into daily living needs, including housing and day activities in addition to medical needs
44 Integrated Care is a Must To really provide comprehensive Person Centered planning and care to the DD population, there is a need to integrate good care coordination that includes all aspects of medical, behavioral and social needs of the individual
45 Where Does Self Directed Care Fit In? Different models of Self-Direction under Managed Care:Carved Out Models (ex. WI)Carved In Models (ex. Michigan)With either model, MC organizations in NY will need to provide Self-Directed Options for those enrolled
46 Person Centered Care in Managed Care – Myth or Reality? It will be what we make itConcepts of good care coordination, Person Centered Planning and quality Managed Care are not mutually exclusive conceptsManaging one’s complete care is the requirement of the individual, his or her circle of support and the provider networkIt Takes a Village but we need to create that Village
47 Enhancing Individualized Services in New York – A RECAP The Need for Reforms of Financial and Service Platforms prior to going into Managed Care:1. The Sustainability Factor2. The Relevancy Factor3. The Compliance Factor
48 OPWDD TransformationAs OPWDD pursued development of the People First Waiver, we worked with CMS to define priority elements of system transformation:Expanding opportunities and supports for EMPLOYMENTExpanding COMMUNITY SERVICE OPTIONS – supportive housing, community-based servicesExpanding SELF DIRECTION optionsOLMSTEAD PLAN- Creating opportunities for people to move from institutions to integrated settings