1. So You Want to Keep Doing the Good Work of Saving Lives:
So You Want to Keep Doing the Good Work of Saving Lives: What it will take in the New Era of Healthcare Reform Presented by: Suzanne Rabideau, MA, LPC, MBA
National Association of Crisis organization Directors
Annual Conference
Phoenix, AZ
October 21, 2016

2. Today’s Conversation – Funding and Sustainability
1. National Perspective HealthCare– for context purposes
Trends in payment sources
Forces Driving Change
Solutions coming about to solve problems with the healthcare system
Business Capabilities needed by providers of crisis services in order to operate in new world of healthcare
What does this mean for your organization
My hopes for our conversation-
You have 1-2 actionable take-aways
Have some fun

3. Some info about the presenter Suzanne Rabideau, MA, LPC, MBA
25 + years of working in healthcare systems
Clinician
All populations, all treatment/community settings
Executive Leadership in State Government
Behavioral health managed care contracts (early 2000’s about 1 Billion in contracts / year)
Redesign of Medicaid system
Executive Leadership Crisis Services
Consulting firm
Supporting managed care, provider agencies, peer/family run
Process enhancement
Strategic positioning
Most recent endeavor launching Nov 2016
Invested in and launching a commercial financing firm
National Business Funding Solutions, LLC

4. Slide presentation available
- under Resource tab

5. Before we get to far into this …..
In the big scheme of things, where are we with implementation of healthcare reform? Does this topic pertain to your organization?
Middle
Beginning
End

6. Starting Point for Our Conversation
What are the sources of revenue for behavioral health services funding?

7. Starting Point for Our Conversation
What are the sources of revenue for behavioral health services funding?
Foundation and Donations
Private Grants
Other non-government community resources
County Funding
State Funding
Medicaid Funding
Medicare
Marketplace
Certified Community Behavioral Health Clinic (CCBHC)

8. Starting Point for Our Conversation
What do we know about the current trend in these funding?
Foundation and Donations
Private Grants
Other non-government community resources
County Funding
State Funding
Medicaid Funding
Medicare
Marketplace
Certified Community Behavioral Health Clinic (CCBHC)

9. Payors are not buyer the old business paradigm
We do good work
We are passionate about what we do
Payers (States / Managed Care Organizations) contract with providers with passion but it is so much more than that!
What does the new paradigm look like

10. Forces Driving Change in the US Healthcare System
The United States healthcare delivery system is undergoing the most significant changes since when Medicaid was enacted.
“Generational Change”
Let’s see why

11. US Healthcare System in Numbers

14. 30% Waste

19. Diligent study of the data
Government is focusing efforts to understand the cost data
Cost of co-morbid conditions
Coordination/Medicare-Medicaid-Coordination- Office/Downloads/Dual_Condition_Prevalence_Comorbidity_2014.pdf

20. Does any of this have anything to do with providing crisis services?

21. Solutions Coming About to Solve Problems – An Overview
Triple Aim
Integration of Care (doing away with the silos)
Government Working to Spur Innovations (CMS Innovations)
Payment Modernization
Other key ideas …..
Crisis providers must become experts in all these topics …..

22. Triple Aim Institute of HealthCare Improvement (IHI)
/default.aspx
Improving health outcomes
Reducing the per capita costs of health care
Improving the consumer’s healthcare experience
Think of these as the goals to strive towards –
The how (operationally) is what the industry
is trying to figure out – this is where the innovation and creativity is happening

23. Integration of Care
Changes in payment models – less BH carve outs for Medicaid managed care
Changes in delivery systems
Co-location
BH provider at PCP offices
PCPs at BH provider offices
Virtual integration – services in multiple places with cohesion through technology
Resources
SAMHSA – HRSA Center for Integrated Health Care
Levels of Integrated Care
d-care- models/A_Standard_Framework_for_Levels_o f_Integrated_Healthcare.pdf

24. Government Working to Spur Innovations (CMS Innovations)
CMS is testing various models for payment and delivery systems to help improve access, improve outcomes and reduce costs.
CMS has an Innovation Center established under Section A of the Social Security Act to develop new payment and delivery models.

25. CMS Categories of innovation
Accountable Care
designed to incentivize health care providers to become accountable for a patient population; and, in turn, to invest in infrastructure and redesigned care processes that provide coordinated, high quality and efficiently delivered services.
Bundled Payments for Care Improvement
Initiatives to Speed the Adoption of Best Practices
Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

26. New payment models Also use of sanctions
Historically, medical reimbursement was on a fee-for-service model – deliver care and submit a claim to be reimbursed – incentivized volume
Move from volume to value
Some new approaches
Bundled Payments
Pay for Performance
Capitation
Also use of sanctions
Medicare – hospital readmission penalty

29. A few more concepts to cover
National trends –
Mergers and Acquisitions
Consolidation to:
Maximize infrastructure
Acquire competencies
Expand into new markets
Open Minds Conference – Centerstone CEO $ million annual revenue is the magic # for the future (11 mergers)
Unfamiliar competitors in the behavioral Health services market
Managed care companies purchasing provider organizations
Social service organizations entering market

30. A few more buzz words to cover
Medical Homes or Health Homes -
A comprehensive system of care coordination for individuals with chronic conditions. Health home providers will integrate and coordinate all primary, acute, behavioral health and long term services and supports to treat the “whole-person” across the lifespan.
Population Health Management – managing the health of a targeted population
Populations health determinants – how individual behavioral, social environments, physical environments impacts health
Hot spotting – data mining for individuals who have high cost, poor outcomes (5% population uses 50% of the resources, aggressively engaging these individuals in treatment
Business Intelligence, Predicative or Suggestive analytics
Tech solutions
Excellence in Mental Health Services Act – creating CCBHCs – Certified Community Based Health Centers – 2 year state planning grants to change delivery system, following there will be 8 (maybe 24) states selected to participate in demonstration grants
National Council resources

31. Recap National Healthcare Perspective
What is driving need for change in the US healthcare system?
What are some solutions that are coming about to support the change?
What might all this have to do with crisis services

32. So…..
Question 1 - What are you and/or your organization currently doing to make a difference in solving these national healthcare issues?

33. So…..
Question 1 - What are you and/or your organization currently doing to make a difference in solving these national healthcare issues?
Questions 2 - What are you and/or your organization currently doing that continues to contribute to the national healthcare issues?

34. Business Capabilities needed by providers of crisis services in order to operate in new world of healthcare
Understanding and navigating local care delivery systems and reimbursement systems
Use of electronic systems and demonstrating outcomes
Developing sustainable budgets
Negotiating contracts
Mission and values considerations
Adapting to sustainable business structures - Silos be gone

35. Write down one or more action(s) you will take in the next five days to enhance your organization’s sustainability.

36. Thank you and Onward!!!!!! suzanne@rabideauconsulting.com 602-501-3838