Behavioral Health Integration in Centennial Care Presentation to the National Association of Medicaid Directors Nancy Smith-Leslie, Director, Medical Assistance Division November 14, 2018

Behavioral Health Integration In 2014, New Mexico launched its fully- integrated managed care program, Centennial Care through a Section 1115 waiver Integrates physical, behavioral and long-term care services delivered by three managed care organizations (MCOs) Includes robust care coordination requirements for the MCOs with specific member touch points MCOs required to conduct a health risk assessment with every member and a more comprehensive needs assessment for members identified as needing a higher level of care coordination

Comprehensive Delivery System Centennial Care Comprehensive Delivery System Established a care coordination infrastructure for members with more complex needs that coordinates the full array of services in an integrated, person-centered model of care Care coordination 850 care coordinators 37,013 in care coordination L2 and L3 Focus on high cost/high need members Health risk assessment Standardized HRA across MCOs 753,564 HRAs conducted Increasing number of members served by Patient Centered Medical Homes Approximately 400,000 members receiving services through a PCMH Expanding Health Homes—adults and children with co-occurring behavioral health diagnoses Expanding home and community based services 30,000 members receiving HCBS

Centennial Care Contract Contractual Requirements MCOs must have designated care coordinators with relevant expertise to meet the needs of specific populations, including members with complex behavioral health needs, members with housing insecurity needs and justice-involved members Defined care coordination requirements for specific populations, including members with complex behavioral health needs Populations to receive care coordination include: Individuals with a behavioral health diagnosis including substance abuse disorders; Members experiencing transitions of care including from residential or institutional facility to community placement; and Members transitioning from incarceration to community

Centennial Care Contract Delivery System Improvement Targets Sets targets for the MCOs to achieve improvements in specific areas of the delivery system Must increase use of community health workers Today, 100 employed or contracted by MCOs Must increase telemedicine office visits in rural areas by 15% annually for behavioral health

Centennial Care Contract Contract also requires the MCOs to employ a justice-involved liaison to facilitate care coordination Benefits are systematically suspended for individuals after 30 days of incarceration Benefits are automatically reactivated when the inmate is released from prison/jail upon receipt of release data from the facility Pursuing an interface with APRISS for real-time booking/release data at facilities

Participating Counties/Agencies:

Health Homes Launched in 2016 and expanded in 2018 for: Adults with serious mental illness (SMI) Children/adolescents with severe emotional disturbance (SED) Serving 2,000 members in 10 counties with seven providers, including one Tribal 638 provider Mandates Six Core Services: Comprehensive care management Intensive care coordination Prevention, health promotion, disease management Comprehensive transitional care Individual and family support services Referral to community and social support services

Pre-Tenancy and Tenancy Services New supportive housing services for members with Serious Mental Illness (SMI) to assist with acquiring, retaining and maintaining stable housing; Plan to use existing infrastructure and network of provider agencies associated with the Linkages Supportive Housing Program to deliver services; and Linkages will be expected to utilize peers for service delivery.

Substance Use Disorder Continuum of Care Services Extend Screening, Brief Intervention, and Referral to Treatment (SBIRT) services through primary care, community health centers and urgent care facilities Provide SUD treatment in accredited residential treatment centers for adults who require an enhanced level of care New inpatient services as part of our 1115 waiver renewal in Institutes for Mental Disease (IMDs)for members with an SUD diagnosis

Super Utilizer Intervention Began July 2015 Followed 35 top ED utilizers from each MCO Tracked each member’s ED visits, participation in care coordination, comprehensive needs assessment, and other social determinants of health on a monthly basis MCOs required to implement specific interventions to reduce ED visits, including

Assign to Community Health Worker; Pilot programs with Emergency Medical Technicians to visit members in their homes; Purchase EDIE software that provides instant notification when a member is in the ER; Patient Navigator program—hospital staff contacts the MCO’s navigator to help triage the member (directing to more appropriate setting such as Urgent Care facility and/or scheduling an appointment with the member’s PCP); Launch of “Video Visits” with physicians— members access through an app on smart phone

Average Monthly ED Visits Per Super Utilizer on a Quarterly Basis Data include members who were active during each reporting period