1. CBH Meeting- May 31, 2012 Jennifer Ternay JLS Advisory Group, Inc.

2. New York 2

3.  Regional Behavioral Health Organizations  Operational in Jan 2012 for 4 regions and fifth region live in Feb 2012  Joint contracts with Office of Mental Health and Office of Alcoholism and Substance Abuse Services  Phasing in over three years  Expanded scope moving to risk 3

4.  Concurrent review of inpatient stay  Reduce unnecessary readmissions  Improve rate of engagement after discharge  Gather information about clinical conditions of children with SED treated in OMH licensed specialty clinic  Provider profiling  Facilitate cross-system linkage 4

5.  Carved into MCO  Formulary problems  MCO can’t implement payment for APGs 5

6.  Ambulatory Patient Group (APG)  Referred to as “Government Rates”  Target date: 7/1/12  Limited number of codes  Blended and phased in  Allows for multiple services on the same day 6

7.  Provide or subcontract for all services  Responsible for services by subcontractor  Allows for administrative role as health home without providing any actual services  State plan amendment (SPA) effective Jan’12  Outcomes to be measured – see SPA at http://www.health.ny.gov/health_care/medicaid/program/me dicaid_health_homes/docs/nys_health_home_spa_draft.pdf http://www.health.ny.gov/health_care/medicaid/ program/medicaid_health_homes 7

8.  Describe relationship and communication between dedicated CM and treating clinicians  P&Ps and contracts to support collaboration and define roles and responsibilities  24/7 availability of care manager  System to track and share patient information and care needs; monitor outcomes and change care as needed  P&Ps to support transition and notification to/from higher levels of care 8

9.  P&Ps and contracts with community-based resources  Data through regional health information organization/qualified entity  Accountable for reducing avoidable health care costs (preventable hospital admission/readmission and avoidable ER)  Accountable for timely follow-up post discharge and improving patient outcomes 9

10. Initial standards  Plan of care for every patient  Follow-up on tests, treatments, services and referrals  Health record accessible to team for population management and identification of gaps in care  Use regional health information organization 10

11.  PMPM is risk-adjusted based on region, enrollment volume, case mix and eventually, patient functional status  Two rates ◦ Case finding group - outreach and engagement ◦ Active care management – paid in 2 installments with second paid once pre-set state quality metrics are met  Single SMI/SED rates - $148/$189/$385  Shared savings opportunities 11

12.  Implementation not going well  Other lobbying entities want to block community mental health agencies  New York is fast track but never on time  Children not allowed to be excluded by CMS but in reality the adults are the priority  Struggling to define options for children 12

13. Next Steps 13

14.  ASO vs. MBHO  Leveraging CMEs  Health homes  Data on substance abuse services  Non-Medicaid services  MH-SA integration  Bi-directional care (Herb’s 5/24 email) 14

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