1. Planning for the Integrated Complex Care Case Rate
Behavioral Health Integration Complex Care Initiative
Planning for the Integrated Complex Care Case Rate
Thursday, January 11, 2018
8:30am-9:30am

2. Objectives for Today’s Webinar
What does the case rate horizon look like?
What is our process for determining the case rate?
What is required to sustain the case rate?

3. Improve outcomes, reduce cost, impact experience

4. Case Rate Timeline February & March 2018 Site Visits
April 2018 Case Rates Awarded
June 2018 Last BHICCI Monthly Payment
July 2018 Case Rates Begin

5. Why Now?
To facilitate the transition between the BHICCI and the CA Health Homes Program.
To move towards value-based purchasing (paying for outcomes vs. fee-for-service).

6. May 2018 IEHP Case Rate Webinar #2
Case Rate Timeline
February & March 2018 Site Visits
April 2018 Case Rates Awarded
May 2018 IEHP Case Rate Webinar #2
June 2018 Last BHICCI Monthly Payment
July 2018 Case Rates Begin
January 2019 HHP Begins
April 2018 HHP Case Rates Finalized

7. The Case Rate Is…
A monthly payment made for each Member enrolled in integrated complex care.
The case rate amount is based on the recommended staffing model required to provide care for complex Members.

9. Relationship to Other Funding
Anticipated to be additional funding on top of the PPS rate for FQHCs and not subject to end of year reconciliation.
Also anticipated to be additional funding for the county-funded Behavioral Health clinics.

10. Clinical Effectiveness High Fidelity to the Approach
Positive Return on Investment

11. Critical Factors for Financial Sustainability
Targeting ”the right” high cost, complex patients for the target population is critical.
On average, a target population with high baseline costs (i.e. $900 PMPM) is needed to break even.

13. Questions?