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Strengthening Behavioral Health care Presentation to : Health, Welfare and Institutions Committee Virginia House of Delegates July 30, 2007 Dr. Lawrence.

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Presentation on theme: "Strengthening Behavioral Health care Presentation to : Health, Welfare and Institutions Committee Virginia House of Delegates July 30, 2007 Dr. Lawrence."— Presentation transcript:

1 Strengthening Behavioral Health care Presentation to : Health, Welfare and Institutions Committee Virginia House of Delegates July 30, 2007 Dr. Lawrence Goldman VP, Strategic Planning

2 2 We Are the Industry Leader in Managed Behavioral Health, with a Focus on the Public Sector We understand the unique challenges of serving in the Public Sector. Programs designed to advance a public service agenda Populations with different behavioral health issues and social supports Real-time accountability to multiple stakeholders Need to balance administrative economies of scale and customization Programs must complement – rather than duplicate or disrupt – the existing delivery system Founded in 1986, with headquarters in Norfolk and Reston Privately held and physician-owned Committed to principles of recovery Diverse client base – over 24 million lives –Employer Solutions Division covering 21% of Fortune 100’s –Health Plan Division with 26 health plan clients –Federal Division (TRICARE) with 3 Million lives –Public Sector Division with Government clients covering over 4 million lives in 12 states

3 3 ValueOptions’ National Footprint Long Beach Phoenix Colorado Springs Topeka Irving Trafford Boston Trafford Phoenix Colorado Springs Topeka Irving Trafford New York City Trafford Phoenix Colorado Springs Dallas Tampa Jacksonville Detroit Hamilton Headquarters Service Centers Corporate Support Offices Norfolk Trafford > 1 million lives > 300,000 > 100,000 < 100, million covered lives Latham Topeka Reston Durham Troy Virginia Beach Santa Fe Hartford Total Locations - 20

4 4 Manage access and treatment for children and adolescents Transition of Medicaid behavioral health to recovery-based model Target broader issues like homelessness that are related to behavioral health Meet diverse needs of rural counties Provide statewide utilization management and review Support consumer-led initiatives, quality improvement, and integration of care Improve care and support for Medicaid- eligible children and families Bring technology and care management to bear for at-risk children Partner with providers to improve breadth and quality of care Coordinate and manage behavioral health care and an innovative pharmacy program Blend 17 funding streams to enable an integrated service delivery system Experience and innovation Increased access and quality leading to demonstrable improvements Cost-effective and operationally efficient programs Robust data management Customized programs to meet diverse needs Minimizing disruption and mitigating risks Responsiveness – providing access to our senior decision- makers We Are the Industry Leader in Managed Behavioral Health, with a Focus on the Public Sector

5 5 Scope of Mental Health Problem Headlines Washington Post, July 17, 2007 –“In addition to a call for more funding, the most immediate changes probably will address laws that oversee how those with mental illnesses are monitored after they receive community-based services. Such people often do not need to be in a hospital but need to stick to treatment, which could include medication, therapy or both. Many mental health experts and lawmakers have said the state's oversight of people in this category is lax and the law is not specific enough to address those who do not comply with court orders…” Roanoke Times, May 25, 2007 –EDITORIAL: Fix the fractured mental health system: Virginia mental health officials and the ill need unified standard procedures. The Virginia Pilot, March 2, 2006 –Virginia gets a D in mental health services

6 6 Scope of Mental Health Problem Kaiser Commission reported* Increased public cost when mental illness is not treated 20% of the US Population is some form of mental health disorder 5% have serious mental illness such as schizophrenia, major depression, etc. * Profiles of Medicaid's High Cost Population - December 2006

7 7 Untreated or poorly managed behavioral health problems have serious social repercussions. This a key strategy to –Improve broader health issues –Reduce the cost of other social services Source: World Health Organization, “Investing in Mental Health,” 2003 Improve broader social and public health

8 8 The Social Cost of Poor Treatment Is High Mental disorders are the leading disability in the US among those Mental illness results in more than 4 million lost work days and 20 million work cutback days each year in the US A third of those who are homeless have a mental disorder, and more than half suffer from substance abuse The majority of people who commit suicide have a mental disorder, with estimates above 80% In 1998, 16% of those in state prisons and local jails were mentally ill Alcohol was involved in 39% of fatal car crashes in 2004 Patients with depression are 3x more likely not to comply with medical regimens Untreated or poorly treated problems... Absenteeism Job loss School drop-out Injuries/Accidents Suicide Incarceration Gambling Poverty Homelessness Crime...Produce tremendous social costs. Note: Direct costs estimate from 1996; indirect from 1990 $ Billions Cost of Mental Health Cost of Alcohol Abuse (Source: U.S. Surgeon General) (Source: WHO)

9 9 Public Sector Programs Customized solutions Tailor program & administrative strategies Technological innovations Integrated IS to track/report across funding streams Web-enabled systems for real time decision support and inter-agency planning QM programs Flexibility Responsiveness to consumers and family members

10 10 Key strategies… Engage providers, consumers and family members Oversight, Design & implementation Use evidence based practices Facilitate inter-agency collaboration Monitor improvements and document outcomes Create provider incentives Accurate and timely claims processing

11 11 And some results are… Increased access to services Expanded roles of and relationships Involvement in program design Increased satisfaction Savings that have been reinvested in the behavioral healthcare system …and some examples are…

12 12 Integrate With and Improve Physical Health Care… Source:Study conducted by the Center for Health Policy Research (CHPR) at the University of Massachusetts Medical School Essential Care Medical Care Management Program Assigns each member a care manager who coordinates the services of the primary care clinician, behavioral health providers, state agencies, and community services, etc. Program has grown to serve over 740 members from July 2005 to present Situation: Some members in the Massachusetts program are too ill to seek needed care  Before Enrollment  After Enrollment Impact: Participant PMPM medical costs reduced from $798 to $648 A 2005 academic study found that enrolled members: Received more targeted, integrated medical and behavioral health care, with increased access to primary care Improved on both the mental- and physical-related physical functioning scores on a standardized tool Increased compliance with behavioral and physical care Required less acute and emergency care services

13 13 Integrate With and Improve Physical Health Care… Impact on Children Surveys show that PCPs participating in MCPAP report that they are now able to meet the mental health needs of children and adolescents in their practices Program was implemented in FY05; 34% of pediatric practices were enrolled by September Full statewide PCP participation is expected by end of FY06 Care Management Decreases Physical Health Costs Massachusetts Child Psychiatry Access Project (MCPAP) Teams of child psychiatrists, social workers, and care coordinators provide psychiatric telephone consultation to PCPs within 30 minutes Consultation guides PCP to the appropriate level of care based on the member’s needs Other MBHP Initiatives Regional staff visit PCC Plan offices bi-annually to ensure that primary care staff know how to access behavioral health services and have a good relationship with a behavioral health provider MBHP places care managers in primary care offices to serve members with depression Situation: Statewide in Massachusetts, many PCPs did not know how to treat, screen, and refer patients with behavioral health issues Care Management Period CC Jan 02-Mar 02 (n=50) ICM Jan 02-Mar 02 (n=183)CC Apr 02-Jun 02 (n=103) ICM Apr 02-Jun 02 (n=198) $400 $800 $1,200 Pre During Post $0 PMPM Cost

14 14 The More Inclusive the Program, the Wider Its Impact State policy decisions play a major role in determining the nature and breadth of programs the more opportunities they provide for social impact. Housing Jail Diversion Coordination with Physical Healthcare Support for the Child Welfare System Pharmacy Management...the more broadly they are conceived...

15 15 …And a Range of Program Designs Single Funding Stream (e.g., Medicaid) People enrolled and services covered are those funded through a single funding source Colorado, Florida, North Carolina, Pennsylvania Dual Funding Streams (e.g., Medicaid, MH, Child Welfare) Two or more agencies jointly contract for services or create inter-agency agreements to coordinate service delivery through single vendor Massachusetts, Connecticut, New Jersey Integrated Systems of Care Multiple agencies braid or blend programs and funding streams with a vision of reducing barriers, reducing admin costs, and creating a unified delivery system New Mexico, Arizona, Texas NorthSTAR

16 16 Meet your Specific Objectives… Examples of State-Specific GoalsValueOptions Program Approach New Mexico Create a unified behavioral healthcare system to improve quality and simplify administration Provide access to care and cultural sensitivity in rural and Native American communities Braided funding across 17 state agencies Regional offices with local staff and decision-making authority Massachusetts Adapt focus over time to ensure continuous improvement of the care delivery system Improve provider care quality Performance incentives defined annually by the state Quality improvement and pay-for-performance program for providers New Jersey Improve the child welfare system Leave medical risk in the hands of the state Improve care management and monitoring Focus on all at-risk children and their families ASO arrangement focused on care management Technology and reporting infrastructure used to improve access and quality of care and inform policy decisions Florida Build on the existing provider network Share risk and care management to encourage mutual accountability and financial feasibility Improve integration of physical and behavioral healthcare 50/50% partnership with major BH providers Fully capitated system from the state, with sub-capitation arrangement with providers for OP services Pharmacy management and PCP integration programs

17 17 Reinvest Savings to Improve the Delivery System State PriorityReinvestment Approach Improve quality and breadth of care Support development and payment for new services Management and innovations in our Massachusetts program yield some $12M each year to reinvest in community-based mental health and substance abuse services Our Colorado program has consistently leveraged Medicaid capitation to reinvest approximately 5% of annual revenue dollars toward recovery-based programs, community based programs and other innovative services In Pennsylvania, we have used reinvestment dollars to fund “bricks & mortar,” start-ups, and ongoing overhead costs for a consumer-driven Drop-In Center Increase access to services Expand eligibility In Florida, we have reduced the administrative rate from 22% in 1996 to a current rate of 12% through operational efficiencies, economies of scale, and a a new provider contracting/funding model. The net effect is an annual increase in the plan’s medical budget - $1.2M in 2005 In New Jersey, we introduced data mining technology that has helped produce an annual $64M in incremental Medicaid reimbursement for the state, which has been invested in care Ensure provider sustainability Increase reimbursement rates Operational efficiencies in Pennsylvania enabled us to keep administrative costs flat as the covered population grew. Through dialogue with the state, we identified opportunities to shift resulting surplus funds back to providers in rate increases for targeted services The Florida program implemented a 2% Risk and Reinvestment Pool to be funded from managed care administrative savings. Part of this pool is used to offset any financial losses that providers may incur due to expanded requirements with the same capitation rates Minimize related expenditures Return funds to the state In Colorado, our provider partnership has met the needs of the State’s growing Medicaid population while receiving just 81.5 % of the amount the State’s actuaries predicted these services would cost, saving more than $10M per year

18 18 VIRGINIA Community Service Board System Right reasons, right mandate Community based services Provides emergent, residential and preventative Needs (as reported to this committee) More trained professionals Increased training opportunities Quality improvement and data analytics Increased connectivity

19 19 The Virginia Solution States have turned to the private sector Need cohesion in the system with all stakeholders Private sector partnerships in other states have been effective Tools to consider are: Bed Tracking (especially residential) Primary Physician Outreach Outcomes measurement and Quality improvement Jail Diversion

20 20 The Virginia Solution System Integrator Linkage between CSB and DMHMRSAS Maintain CSB gateway Tracking entry into the system Analyze resources needs and allocation Expand outreach based on determined need Outcomes, quality Expanded IT capabilities Expanded toolset For the delivery system For the Department

21 21 Collaboration Along all stakeholders Increased system communication Efficiency, allows maximizing Federal matching funds Savings generated create re-investment opportunities

22 22 Conclusion The enemy - status quo The challenge - embrace change The solutions engage the private sector build a bridge between the system and the government amplify stakeholder involvement bring new technology create a reinvestment opportunity and strategy

23 23 Thank you Thank you for your time and interest….ValueOptions looks forward to working with you to build the new future for Virginia…. Dr. Lawrence Goldman


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