Decreasing Emergency Room Visits: A New Collaboration Primary Care and Care Management Mary DeVivo, LCSW Cristina Victoria, BSW Human Development Services of Westchester, Inc.
Who is CBHS? Coordinated Behavioral Health Services Coalition of Non-Profit Community Behavioral Health Providers serving nine counties in the Hudson Valley region. www.cbhsinc.org
Who Are the Partners? Which Counties Do they Serve? Access: Supports for Living- Dutchess, Orange, Ulster Hudson Valley Mental Health- Dutchess, Ulster Human Development Services of Westchester (HDSW) – Westchester Mental Health America of Dutchess- Dutchess Mental Health Association of Rockland- Rockland Mental Health Association of Westchester – Westchester Putnam Family & Community Services – Putnam Rehabilitation Support Services (RSS) – Westchester, Orange, Sullivan, Dutchess, Ulster (In addition to other Counties in NYS) Westchester Jewish Community Services (WJCS) - Westchester
HRHCARE HRHCare provides the highest quality of comprehensive primary, preventative, and behavioral and oral health care and care coordination services to all who seek it, regardless of insurance status or ability to pay. AFFORDABLE services for all patients ACCESSIBLE services designed to be available where and when the patient is PROFESSIONAL and caring treatment of all patients HIGHEST QUALITY and COMPASSIONATE care based on the HRHCare Multidisciplinary Planned Care Model 26 Health Centers Over 350 Practitioners
CBHCARE CBHS and HRHCare formed a partnership to better meet the needs of clients and patients CBHCare is an Independent Practice Association (IPA) Contracting vehicle for value-based payment Integrating physical health and behavioral health services Developing cutting edge programs utilizing the individual and collective strength
Establishment of CBHCare IPA Collaborative of 9 (grown from 7) behavioral health providers Primary care Spent a little over 1 year establishing the legal and governance structure
MVP HEALTH CARE Nationally- recognized, regional, not for profit health plan committed to having a positive impact on the health and wellness of all members Over 700,000 members in the NY/Vermont area Educate clients to improve care and outcomes
Taking First Steps toward Value-Based Contracting First arrangement focused on reduction of ER visits Care Managers were deployed at HRHC facilities to meet with clients to discuss ER visits and to link them to services in the community and to Health Home Care Managers if already assigned.
HRHCare Site Locations Park Care, Yonkers- Westchester County Valentine Lane, Yonkers- Westchester County Peekskill – Westchester County Haverstraw- Rockland County Spring Valley- Rockland County Walden- Orange County Monticello- Sullivan County Beacon- Dutchess County Poughkeepsie- Dutchess County Amenia- Dutchess County Dover- Dutchess County Pine Plains- Dutchess County
Who we are reaching out to Individuals who are using the Emergency Room as the source for primary care. Not necessarily individuals with a behavioral health diagnosis. Individuals living with issues related to the social determinants of health. Some are using the Emergency Room due to substance abuse issues.
MVP CONTRACT CBHCare and MVP are contracting for: July 1-December 31, 2016: PMPM Care Management Fee Quality- Bonus for improvement on a set of 8 quality measures Utilization- Incentive for reduction in rate of unnecessary ED utilization For 2017/2018: Move to a Total Cost of Care Model Quality measures will be revised (still in progress)
Training Motivational Interviewing Trauma Informed Care eCW GSI Development of Person Centered Care Plan
Outcomes Decrease in Emergency Room visits Individuals had better access to primary care Primary Care physicians had the support of a behavioral health Care Manager Individuals had better coordination of care through on-site Care Management
Barriers Difficulty locating clients using data from 2015 Part-time status in primary care setting Integration as full team member Care Manager leaving host facility Limited caseloads
Moving Forward in 2017 Care Manager will be full-time in primary care setting Rosters will increase to 50 clients per Care Manager including other MCO’s besides MVP. Team huddles each morning Enrollment of clients into HRHCare Health Home Clinical supervision provided by a Licensed professional at the host agency Administrative supervision provided by the nurse manager Ongoing meetings with all of CBHS providers in the project
Strategies for 2017 HRHCare and MVP will determine HEDIS measures that need to be attained Value based payments will be determined based on the HEDIS measures decided upon Savings for both CBHS and HRHCare for achieving goals above the set rates
Director of Care Management Mary DeVivo, LCSW Director of Care Management Human Development Services of Westchester, Inc. (914) 835-8906 Ext 1030 madb@hdsw.org Cristina Victoria, BSW Care Manager (914) 835-8906 Ext 1044 cvictoria@hdsw.org