1. JONAS WAIZER PhD Chief Operating Officer FEGS Health & Human Services System PAUL LEVINE LCSW Executive Vice President & CEO The Jewish Board Of Family And Children’s Services Sunday, April 22, 2012 IAJVS Conference Houston Texas National Health Reform, Medicaid Redesign and Behavioral Health Providers: A Report on Health Homes

2. TODAY’S OBJECTIVES 1. Health Care Reform: Trends and Projections  FEGS and JBFCS  National and New York City Trends 2. What are Health Homes?  Current National Focus on Health Homes  New York State Medicaid Redesign  Health Home – Key Elements 3. Strategies - How Can Providers Prepare?  New Directions  Next Steps Q & A

3. FOR-PROFIT  AllSector Technology Group, Inc.  HR Dynamics, Inc.  Staff Resources, Inc.  F∙E∙G∙S Home Attendant Services, Inc.  F∙E∙G∙S Home Care Services  Jewish Care Services of LI  NYSD Forsyth Housing Development Fund Co.  NYSD Housing Development Fund Co.  NYSD Rombouts Housing Development Fund Co.  F∙E∙G∙S Holding Corp.  Tanya Towers, Inc.  Waverly Residence, Inc. NOT-FOR-PROFIT:  Behavioral Health  Developmental Disabilities- Special Needs  Education and Youth  Employment, Workforce Development  Family Services  Haym Salomon Division of the Arts  Home Care  Residential and Housing  WeCARE  Work Services Subsidiary & Affiliate Corporations Overview of F·E·G·S Health and Human Services System Major Operating Divisions F·E·G·S HEALTH & HUMAN SERVICES SYSTEM F·E·G·S HEALTH & HUMAN SERVICES SYSTEM © F · E · G · S 2011

4. F·E·G·SF·E·G·S New York City and LI – 350 Sites $250 Million Budget ($110 Million Medicaid) 100,000+ Individuals/Year with 300+ Staff Behavioral Health Services to 25,000 Individuals/Year with 650 Staff Specialized Housing Nightly Supports 1200 Residential Clients 9 Clinics and 3 Recovery Programs serve 12,000 Persons with SMI Care Management to 5900 Individuals/Year by 160 Staff at $13 Million in Medicaid Specialized Employment to Persons with SMI

5. Major Operating Divisions:  Adults Living with Mental Illness  Children & Adolescent Services  Jewish Community Services  Counseling Services  Domestic Violence and Preventive Services  Early Childhood & Learning  People Living with Developmental Disabilities  Professional Learning and Development Affiliate Organization:  The Shield Institute, Inc. Overview: JBFCS JBFCS JBFCS

6. JBFCS $190 million combined total budget 175 programs in 77 locations across NYC & Westchester Serving 65,000 clients annually through mental health, social service, developmental disabilities, child welfare & Jewish community programs Over 2,300 employees, including 350 social workers, psychologists, MDs, and nurses Over 800 volunteers, providing $1 million of in- kind services 12,000 individuals served in clinics each year 1,100 children and adults call JBFCS “home” each night

7. Federal Medicaid Facts: Today Nationally: 5% of Patients use 45% of Dollars Number of Enrolled Clients from 1006-2006 Rose from 19 to 36 Million Same Period: Mental Health Spending Rose from $36 to $58 Billion Annually Over 50 Million Americans Still Have No Health Insurance Federal Affordable Care Act will Cover 30 Million More Americans with Same Level of Funding

8. New York State Medicaid Challenge Accounts for 40% of State Budget Covers 25% of State Population Contributes to Annual Budget Deficit New Governor Appoints Medicaid Redesign Team of All Stakeholders Highlights of Medicaid Reform: Managed Care for All Integrate Health, BH, SU Behavioral Health SNP IT Across Providers (RHIOs) Health Home – Care Coordination

9. Federal and State Medicaid Policies Deinstitutionalized State Psych Centers Encouraged More State Medicaid Expanded Community & Residential Services Offered Managed Care as Option Promoted Special Needs Plans Separated Disability Groups: BH/DD, Medical Promoted “Targeted” Case Management Behavioral Health: 1990-2005

10. Federal Medicaid: Deficit Reduction Act (2005) Slowed the Growth in Medicaid Costs Mandated Managed Health Care Offered Medicaid Diversion Programs Shift from Day Services to Recovery (PROS) Stricter Conformance to Federal Rules - OIG Behavioral Health: 2005 - 2011

11. Current Federal Medicaid Policies Shrink Medicaid Don’t Pay Hospitals for Readmits < 30 Days Integrate Health, Behavioral Health, SU Mandate Managed Care for All by 2014 “Health Homes” for Complex Cases, esp. MI Quality Measures, Outcomes and Incentives IT Revolution and RHIOs NYS Governor’s Medicaid Redesign Team National Medicaid Reform: 2011 - 2013

12. Which Clients are Eligible for a Health Home? People with Medicaid who have: One Serious And Persistent Mental Health Condition - OR - At Least Two Chronic Medical Conditions - OR – One Chronic Medical Condition and At-Risk For Another Chronic Conditions Include: Mental Illness Substance Use Disorder Asthma Diabetes Heart disease Obesity/ Overweight (BMI over 25) HIV/AIDS Hypertension

13. Why Health Homes? CMS Gives States Incentives to Establish Health Homes that will: Create Special Plans for Medicaid “Heavy Users” Pay 90% of Care Coordination for this Group Integrate Medical and Behavioral Health Engage Consumers, Forge Joint Care Plans Identify Primary MDs, Specialists (MSWs) Reduce Healthcare Costs and Improve Outcomes

14. How Do Health Homes Reduce Cost and Improve Outcomes? Lower rates of emergency room admissions Reduce hospital re-admissions & admissions Reduce Polypharmacy Decrease reliance on long-term care facilities Improve wellness, access, quality of life Medicaid HEDIS indicators - Schizophrenia

15. What is a Health Home? Not a Place, Facility or Medical Home A Model of Care Coordination Across Providers Adds Payment for the Care Coordination A Formal Provider Network with Shared Responsibility that includes Medical, Mental Health and Substance Use Focuses on Essential Services Links Providers via Shared IT & Information Partners with Consumers and Families Develop a Shared Coordinated Care Plan Promote “Loyalty” to Service Providers

16. What Benefits Do Health Homes Provide to Clients? Assess Full Range of Health Needs Integrated Service Plans and Flow of Information by Multiple Providers Promote Health Literacy Learn to Manage Chronic Illnesses Like Diabetes, Asthma, Hypertension. Receive Same or Next Day Appointment Support For Weight Loss, Smoking Cessation, Exercise, Recovery Services. Provide 24/7 Access To “Help Line” Supported Employment (TBD)

17. Health Home Provider Networks Include: Mental Health and Substance Abuse Service Providers Other Community Based Organizations Primary MDs or Practice Groups, or.. Medical Health Clinics (FQHCs) Hospitals Managed Care Organizations Existing Management providers Social Service and Residential Agencies Supported Employment Agencies

18. How Does Care Coordination Work? A Care Coordinator : Documents a common care plan Negotiates the Plan with the member, family & providers Oversees access to all of the services an individual needs Tracks for Adherence to Plans, Prescriptions A Provider Network: Signs HIPAA agreements and contracts. Shares electronic health information for real time coordination Commits to shared outcomes: client wellness, fewer visits emergency rooms and hospitals.

19. What is the Provider Role? Fast Access - accept referrals immediately. Collaborate in CCP - integrated care plan. Look at and Upload IT data with prompt notification of clinic or ER visit, Hospital admission, discharge, etc. Participate in assertive transitional care planning, to ensure needed services/ supports are in place. Provide data for reporting clinical quality metrics to NYS. Use best practices and participate in Health Home QA activities.

20. How Can Providers Prepare The Best Way to Forecast The Future Is to Invent It George Bernard Shaw and Steve Jobs

22. How A Group of New York Providers Responded Built On Past Relationships Acquired Expertise through a Federal Pilot: The Chronic Illness Demonstration Project Political Advocacy Investment of Staff Time and Capital Funds

23. Coordinated Behavioral Care, Inc. Community Providers Transforming Behavioral Health Care Founding Agencies Comprising the CBC Board Catholic Charities Neighborhood* Center for Urban Community Services* Comunlife* FEGS Health and Human Services System* Fountain House* Institute for Community Living* *Founding member and serves on CBC Board Other Coordinated Behavioral Care Member Agencies Astor Services for Children & Families Brooklyn AIDS Task Force Brooklyn Community Services Community Access Community Health Action of Staten Island EAS-TASC Fifth Avenue Counseling Center Goodwill Industries Greenwich House International Center for Disabilities Hamilton Madison House Henry Street Settlement Jewish Child Care Association Lower East Side Service Center NADAP NAMI-NYC Metro New York Psychotherapy and Counseling Center Jewish Board of Family and Children's Services* Palladia* PSCH* Services for the Underserved* The Bridge* The Coalition of Behavioral Health Agencies* The Northside Center for Child Development* The Staten Island Mental Health Society* OHEL Postgraduate Center for Mental Health Project Renewal Project Hospitality Project Samaritan Health Center Riverdale Mental Health Association Samaritan Village Samuel Field Y Self-Help Community Services Service Programs for Older People Skylight Center Steinway Child and Family Services The Association for Rehabilitative Case Management The Child Center of New York The Epilepsy Institute The Floating Hospital University Consultation Center University Settlement House Upper Manhattan Mental Health Center Venture House Weston United Other Agencies and Hospitals

24. Provider Assets Client Loyalty Capacity to Impact Hospital Performance Metrics  Direct Outpatient Aftercare  Divert Re-hospitalization  Divert ER Overuse Residential Beds & Crisis Beds: ER Diversion Track Record in Case Management and Community Coordination Specialized Mental Health Clinics and Recovery Programs Intent to Build Medical Homes Shared Interest in Becoming a SNP

25. CBC Inc. Building Shared Infrastructure Central CBC Provides or Arranges for: Governance Applications, Licenses Contracts: MCO and Providers Provider Network Relations Marketing/PR Core Policies & Procedures, Best Practices Call Center: 24/7 Capacity Central IT Billing, Data Analytics Technical Assistance & Consulting Learning Collaborative: How to be an MCO

26. Next Steps Remain Providers during “Change” Integrate Health and BH, SU Accept MCO Capitation Contracts Learn Business of Managing Risk Link to IT Exchanges Retrain Staff to Think Outcomes Develop Data Analytics Work in Progress