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Primary Care and Behavioral Health 2/4/2011 CIBHA.

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Presentation on theme: "Primary Care and Behavioral Health 2/4/2011 CIBHA."— Presentation transcript:


2 Primary Care and Behavioral Health 2/4/2011 CIBHA

3 Promising Provisions Affordable Care Act – Prevention and Public Health Trust FUND--PCBHI – Section 2703 Health Homes for Individuals with Chronic Conditions – Medicare Accountable Care Organizations Shared Savings Program – Dual Eligible Demonstration Projects

4 Health Homes States can currently amend Medicaid State Plan 90% match for 8 quarters for following health homes services: – Comprehensive Care Management – Care Coordination and Health Promotion – Patient and Family Support – Comprehensive Transitional Care – Referral to Community and Social Support Services

5 SAMHSA’S PCBHI PROGRAM Focus on coordination between primary care and specialty care: – Significant enhancements to primary care Workforce enhancements Increased funding to SAMHSA, HRSA and IHS Bi-directional – MH/SUD in primary care – Primary care in MH/SUD settings – Services and technical assistance – Pharmacy opportunities through partnering (340b program)

6 SAMHSA’S PCHBI PROGRAM 2009—Grant award to 9 sites 2010—Expanded to another 44 sites 2010—Developed the Training and Technical Assistance Center in cooperation with HRSA Worked with ASPE to develop specific outcome measures for participants

7 Health Homes For Medicaid enrollees with – two or more chronic conditions, – one condition and the risk of developing another, or – at least one serious and persistent mental health condition Conditions include: – a mental health condition, – a substance use disorder, – asthma, diabetes, – heart disease, and – being overweight* *as evidenced by a body mass index over 25.

8 Health Homes Providers: – Team of health care professionals physicians nurse care coordinator nutritionist, social worker, behavioral health professional – Can operate in a variety of settings Free standing teams, Virtual teams Hospital-based Community health center Community behavioral health centers Rural clinics Group practice Academic health center

9 Health Homes Flexibility in defining the service Flexibility in reimbursement strategies Outcomes are defined by state:

10 Medicare ACOs Organizations that may become an ACO – Physicians and other professionals in group practices – Physicians and other professionals in networks of practices – Partnerships or joint venture arrangements between hospitals and physicians/professionals – Hospitals employing physicians/professionals – Other approved by Secty.

11 Medicare ACOs Requirements of ACOs – Have a formal legal structure to receive and distribute shared savings – Have a sufficient number of primary care professionals for the number of assigned beneficiaries (to be 5,000 at a minimum) – Agree to participate in the program for not less than a 3-year period – Can match physicians and patients – Have a leadership and management structure – Have defined processes to (a) promote evidenced-based medicine, (b) report the necessary data to evaluate quality and cost measures (c) coordinate care – Demonstrate it meets patient-centeredness criteria, as determined by the Secretary

12 Dual Eligibles Why focus on dual eligibles? – Approaching $300 B in expenditures in 2010 – Most have 2-5 chronic conditions – More likely to be institutionalized/hospitalized – States have incentives, but no plausible strategies to connect information or payment – 60% of all duals have a ID/BH condition

13 Dual Eligible Demos Two Current Initiatives: – Sharing Medicare Part A, B and D data with states—get a composite look at what persons gets/gaps – $15 million in design grants to States (2/1). Goal—identify and validate service delivery and payment integration models Models can be rapidly tested Spread to other states


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