NYC AIDS Fund Learning Lab: Session 1 The Emerging Managed Care Environment … Choosing a Survival Path Doug Wirth, President/CEO

Today’s Discussion:  Review State Goals -- MRT, MMC & DSRIP  Explore Key Questions:  What do plans want now (need in the future)?  How to position the missions/services of smaller HIV/AIDS CBOs?  Survey Options for Meaningful Participation in the emerging environment

 Founded in 1999 by 7 CBOs that offered HIV/AIDS Services (+)  Started serving HIV+ members in 2003 & HIV- homeless in 2014  6,100 Members (w/ multiple & complex needs)  Key Outcomes:  Expansions: MLTC & Medicare (2014) ; BH HARP (2015) Measure Emergency Room Use Decreased 63% AdmissionsDecreased 74% Hospital Length of StayDecreased 35% (Voluntary) Member RetentionBtw 97% - 98% Inpatient Medical ExpenseDecreased 35% Retention in Outpt Care94% (2012)

Managed Care Models Serving Medicaid/M-care Recipients Current Models*  Medicaid Managed Care – 8 General Plans  HIV SNP – 3 Plans  MLTC – 23 Plans (and expanding) * NCQA found that NYS ranked 2 nd only to MA in Medicaid Managed Care quality. Emerging Models  FIDA/NYS Duals Demo – 23 Plans; Oct 2014 (v); Jan 2015 (p); 120,000 eligible  BH HARPs – Jan 2015 (NYC); 80,000 eligible

Populations 2005 SSI 2010 HIV/AIDS 2012 Homeless * Services ** 2011 Pharmacy Personal Care 2012 Health Homes 2013 AADHC 2014 Long Term Care 2015 Behavioral Health Key NYS Medicaid Managed Care Population & Service Expansions * The State allowed HIV- homeless individuals to join HSNPs in ** The State Budget gave authority to SDOH Commission and Medicaid Director, by 2015, to eliminate all Medicaid FFS carve-outs and any population exemptions.

Key Reasons for NYS Medicaid Redesign, MMC & DSRIP  Medicaid Spending Increases  Overall Quality of Care – “Average”  20% Enrollees (1 million) w/ High Need/High Cost  Reduce Avoidable Admissions  Desired “Care Management for All”  Hospital System Collapses & Consolidations  System Transformation  Clinical Improvements (Evidence-based)  Integrated Care Delivery  Shift to Quality Based Payments & Other Reforms Sources: Medicaid Redesign Team Update and Next Steps Presentation: Jason Helgerson, SDOH, July 2013; NYS BHO 2012 Reviews and Implementing Medicaid BH Reform in New York: Bob Meyers, SOMH, Sept NYS Health Home SPA for Individuals w/ Chronic Behavioral & Medical Health Conditions - SPA #

If managed care is the content for the future … What do Plans need to demonstrate/do:  Improved Quality  Reduce Health Disparities  Create models to serve High Need/Cost Individuals  Increase Outpatient Connectivity (PC, MH & SUD)  Reduce Costs (e.g. ERs, Admits, LTC)  Find/contract with Providers that:  Provide integrated care (PC, MH & SUD)  Can take risk  Can share data Q: What do you have to offer to achieve these goals … and can you prove/show it (outcomes)?

Things needed by MMC & PPS/DSRIPs: Evidence-based Interventions for Chronic Conditions  HIV/AIDS  Serious Mental Illness  Substance Use/Addictions Long-term Care Alternatives Social Determinants of Health Housing Stability & Food Security Job Training/Supported Employment Integrated Care (PC, MH & SA) Crisis Beds (hospital diversion) Proactive management of patients w/ higher risk scores Care transition models C-B Navigation Services C-B Ambulatory Detox/Rehab

Strategic Opportunities for CBOs: NICHE” PROVIDER (go it alone)  “NICHE” PROVIDER (go it alone) e.g. Case Findings or Housing Placements or Training/Supported Employment  STRATEGIC PARTNERSHIPS (collaborate) e.g. Health Homes or IPAs  MERGER/ASSET Consolidation (build integration) Vertical – Integrated Service Delivery System Horizontal – Expanded Service Capacity