1. Person Centered Care in Managed Care – Myth or Reality?
YAI Conference
Monday May 6th, 2013
Presentation by
Jerry Huber
Deputy Commissioner OPWDD

2. The Amazing Race

3. Coordinated Assessment System (CAS)
Care Coordination
Case Studies
RFA
Front Door
ICS
DISCO
Coordinated Assessment System (CAS)
RFI
People First Waiver
InterRAI
Pilots
CQL
Managed Care
Personal Outcome Measures

4. THEMES Equity Balance Person Centered Needs Based Outcomes Driven
Incentivized
THEMES

5. OFF TO THE RACES
Improving how we meet needs - expanding self direction and employment to provide opportunities for everyone, launching CAS
Improving quality of our care through workforce support and measuring individual outcomes
Participating in NYS Olmstead Plan – creating more housing opportunities & moving people out of institutions
Launching managed care through pilot DISCOs – moving toward integrated, holistic care
Continuing health and safety reforms –

6. AGENDA FOR TODAY
1. Discuss 4 Essential aspects of Person-Centered Practice as a Foundation for Managed Care
2. Discuss similarities and differences within managed care for people with ID/DD as compared with mainstream managed care
3. Outline milestones and time tables for the transition in managed care here in NY

7. Assessment Planning Access Evaluation Standardized Comprehensive
3/13/2013
Assessment
Standardized
Comprehensive
Planning
Person Centered
Assessment Based
Measurable Outcomes
Access
Access to Services “Front Door”
Consistency
Evaluation
Outcomes Based

8. Assessment
Planning
Access
Evaluation

9. Goals of Needs Assessment
Standardized needs assessment that identifies individual needs and strengths to inform
Person-centered care planning
An assessment tool that can inform acuity levels for resource allocation.
Ability to draw on individual or aggregate level data for
quality monitoring
purposes.

10. New York State-specific InterRAI DD
Items from Child and Youth ID and Mental Health tools
Items from Community Mental Health (CMH) tool
Items from the Correctional Facilities tool
New York State OPWDD Coordinated Assessment System (CAS)
interRAI Intellectual Disability (ID)

11. Coordinated Assessment System
CAS Core
Child and Adolescent Supplement
Mental Health Supplement
Forensic Supplement
Medical Management Supplement
Substance Use Supplement

12. CAS and the Case Study
18 Assessment Specialists hired to complete CAS for the case study
Assessment Specialists received extensive training specific to the CAS
CAS summary and CAPs will be used by agencies to inform care planning
Ongoing review of the CAS, protocols and manual will continue throughout the case study
Reliability and validity testing will be conducted

13. Long-Term Vision
New Coordinated Assessment System will be phased in thoughtfully over the next several years:
Beginning with year long case studies,
Moving next to DISCO pilot projects,
Next into use with all newcomers to the service system,
Eventually, over time, will be used with those currently receiving services.
We will be careful not to disrupt lives, but instead identify opportunities for greater integration and independence based on needs, strengths and desires.

14. For More Information…
InterRAI Integrated Assessment Suite:
CAS specific questions:

15. Assessment
Planning
Access
Evaluation

16. Essential Elements of Person Centered Care
3/13/2013
Essential Elements of Person Centered Care
Person-Directed
Person-Centered
Outcome-Based 
Information, Support and Accommodations
Wellness and Dignity of Risk
Participation of those that individual selects
Community Integrated

17. 3/13/2013
FUTURE
The DISCO will be responsible for ensuring that they have organizational characteristics that support person centered planning
Person centered planning is expected to be part of and integrated into the entire culture of an agency and managed care entity

18. Assessment
Planning
Access
Evaluation

19. What Is the Front Door Initiative?
3/13/2013
What Is the Front Door Initiative?
The Front Door Initiative is:
A person centered approach to developing plans of support for people - not a program or a service
Part of the fundamental process by which people access supports and services through OPWDD - providing a broader array of individualized service options to give individuals and families more flexibility and choice of supports and services that meet their needs

20. 3/13/2013
Why Now? – 3 Factors
The sustainability factor - how do we sustain appropriate service provision within fiscal realities?
The relevancy factor - are the services we currently offer those that families and individuals coming into our service system are seeking?
The compliance factor - in light of Olmstead and recent federal decisions on ADA, will the menu of service options we provide allow us to meet the goals of Olmstead and federal requirements?

21. OPWDD’s Front Door Initial Contact Assessment of Skills
Eligibility Determination
Assessment of Skills
Support Needs Identified
Informed Decision Making and Individualized Plan Development
Service Authorization and Implementation

22. 3/13/2013
Front Door Goals
Facilitate OPWDD’s approach to the delivery of services based on:
A focus on the values of self determination and self-direction
Resources to individuals based on needs, rather than the programs currently available
More informed choice of supports and services
Holistic use of paid and community supports
Statewide consistency and availability of individualized and self-directed service options

23. 3 Approaches to Achieve Goals
Simplify Access to Self-Direction
Streamline Internal Processes
OPWDD & Provider Partnership Through Change

24. OPWDD & Provider Partnership Through Change

25. Areas for Increased Partnership
Reinvestment Planning and Implementation
Communication in Service Planning

26. Reinvestment
Reinvestment is one or more methods for individuals to maintain service dollars but change service type to be able to purchase services in a more integrated setting.

27. Steps to Achieve Reinvestment Models
Review and modify existing processes, procedures and templates or develop new ones that enable providers to reinvest dollars associated with existing services that support more choice and better outcomes for people while also serving more people
Develop consistent policies, procedures and reports that OPWDD Regional Offices can utilize to better manage base resources
Create policies that can be put in place that shift management of current resources away from vacancy management and toward capacity management and more integrated settings

28. Communication in Service Planning
OPWDD and partners must communicate about individual level of need and how that need impacts service planning. Services in traditional supervised IRA and day habilitation settings will not be authorized by OPWDD simply because a program opportunity is available. An individual must have a level of need significant to require the level of support offered in these services and must choose these options as opposed to an option in a more integrated setting

29. Assessment
Planning
Access
Evaluation

30. HCBS Quality Framework
3/13/2013
HCBS Quality Framework
Eligibility (Level of Care) is carried out in a valid, reliable, and equitable fashion
Individual Plans include services and supports that align with individual goals, strengths and needs
Provider qualifications are regularly checked and monitored
Individual health and well being is maintained
Financial accountability is maintained
The Medicaid agency maintains administrative authority

31. CMS Increasing Expectations
3/13/2013
CMS Increasing Expectations
Using Data to drive systems improvements
Evidence Based Performance Measures for Federal Waiver Assurances
Regulatory Compliance
CMS expects states to remediate individual situations but also to respond to trends in the data.
In reviewing evidence, CMS looks to see if continuing compliance issues are identified through quality improvement initiatives.
Must show how we review trends, develop and evaluate quality improvement strategies.
Health and Safety

32. How do we make this Shift?
3/13/2013
How do we make this Shift?
Evolving system
Historically – Compliance/QA focus
Shifting from site-based “bricks & mortar” inspections to reviews focused on individuals and achievement of outcomes
“The measure of Quality is not the delivery of a support or service, but the results that services or supports provide for each person”
Source: Designing Quality—Responsiveness to the Individual. CQL 1999
Outcome measures emphasize responsiveness to individual needs rather than compliance with organizational process or program requirements.
Supports and services are not the outcomes. The supports and services are the
practices, activities, and processes that enable people to achieve their prioritized
outcomes. As such, organizational systems, policies and procedures create
frameworks for enabling people to achieve outcomes. Systems, policies and
procedures are not ends in themselves. The measurement of quality is shifting
from a focus on compliance with organizational process to a focus on responsiveness
to personal outcomes.

33. What are CQL Personal Outcome Measures?
Valid and reliable personal outcome measures
that focus on what is meaningful to the person
served.
Provides a methodology to assess how well the
organization’s provision of supports and services
facilitate outcomes that are meaningful to each
individual.
Different than National Core Indicators (NCI)
which are system outcome measures.

34. My Focus: What is most important to me now.
3/13/2013
CQL The Council on Quality and Leadership
My Self My
Focus My
World
My Dreams
My Focus: What is most important to me now. 34

35. CQL The Council on Quality and Leadership
3/13/2013
CQL The Council on Quality and Leadership
My Self
1. People are connected to natural supports.
People have intimate relationships.
People are safe.
People have the best possible health.
People exercise rights.
People are treated fairly.
People are free from abuse and neglect.
People experience continuity and security.
People decide when to share personal information. 35

36. My World CQL The Council on Quality and Leadership
3/13/2013
CQL The Council on Quality and Leadership
My World
1. People choose where and with whom they live.
2. People choose where they work.
3. People use their environments.
4. People live in integrated environments.
5. People interact with other members of the community.
6. People perform different social roles.
7. People choose services. 36

37. People choose personal goals. People realize goals.
3/13/2013
CQL The Council on Quality and Leadership
My Dreams
People choose personal goals.
People realize goals.
People participate in the life of
the community.
4. People have friends.
5. People are respected. 37

38. Proposal for Operationalizing POMs in DISCO Pilots – Components
3/13/2013
Proposal for Operationalizing POMs in DISCO Pilots – Components
Care Coordination Framework Practice Guidelines
Communication and Learning throughout the OPWDD system
QI Plan—Use of CQL Data in Quality Improvement

39. CARE COORDINATION WHAT TIES IT ALL TOGETHER: ASSESSMENT BASED ON NEEDS
PERSON CENTERED IN THEORY AND IN PRACTICE
ACCESS – RIGHT SERVICES AND THE RIGHT TIME
EVALUATION – FOCUS ON REAL OUTCOMES FOR THOSE SERVED

40. CARE MANAGEMENT AND MANAGED CARE
Concepts of care management are rooted in the development of managed care principles
Care Management has a focus on the best outcomes for individuals served
Managed Care’s history has had a focus on cost containment
Each rely on concepts of health promotion and disease prevention

41. CMS’s “Triple Aim” Better Health for the Population Better Care
for Individuals
Lower Cost
Through
Improvement

42. Where does Person Centered Planning Fit In?
Since much of the Medicaid cost for those with long term care needs is outside of traditional health care, the emphasis needs to be on planning for all aspects of the individual needs for each person enrolled in a managed care plan

43. Variations in Managed Care Strategies for those with LTC Needs
1. Population already has complex medical and social needs
2. Due to these needs utilization of resources including specialty care is often quite extensive
3. Cost for services most often tied into daily living needs, including housing and day activities in addition to medical needs

44. Integrated Care is a Must
To really provide comprehensive Person Centered planning and care to the DD population, there is a need to integrate good care coordination that includes all aspects of medical, behavioral and social needs of the individual

45. Where Does Self Directed Care Fit In?
Different models of Self-Direction under Managed Care:
Carved Out Models (ex. WI)
Carved In Models (ex. Michigan)
With either model, MC organizations in NY will need to provide Self-Directed Options for those enrolled

46. Person Centered Care in Managed Care – Myth or Reality?
It will be what we make it
Concepts of good care coordination, Person Centered Planning and quality Managed Care are not mutually exclusive concepts
Managing one’s complete care is the requirement of the individual, his or her circle of support and the provider network
It Takes a Village but we need to create that Village

47. Enhancing Individualized Services in New York – A RECAP
The Need for Reforms of Financial and Service Platforms prior to going into Managed Care:
1. The Sustainability Factor
2. The Relevancy Factor
3. The Compliance Factor

48. OPWDD Transformation
As OPWDD pursued development of the People First Waiver, we worked with CMS to define priority elements of system transformation:
Expanding opportunities and supports for EMPLOYMENT
Expanding COMMUNITY SERVICE OPTIONS – supportive housing, community-based services
Expanding SELF DIRECTION options
OLMSTEAD PLAN- Creating opportunities for people to move from institutions to integrated settings