1 The National Landscape: Health Homes, Accountable Care Organizations and Integration and Its Impact on Massachusetts Kathleen Reynolds, LMSW ACSW National Council for Community Behavioral Healthcare July12, 2012
2 Overview A changing landscape for behavioral health Medicaid expansion and the influx of new consumers New approaches to organizing care Demonstrating value and accountability: Are you ready?
3 Affordable Care Act Four Key Strategies
4 Delivery System Redesign Health Homes (Medical Homes)
5 Status of Health Home Statewide Work 6 State Plans have been approved: Missouri (2) Behavioral Health and Primary Care Rhode Island (2) adults and children with SMI New York chronic behavioral and physical health Oregon 3 states have submitted State Plans and await approval: Iowa, North Carolina, Washington 15 States with Planning Grants: Alabama, Arizona, Arkansas, California, District of Columbia, Idaho, Maine, Michigan, Nevada, New Jersey, New Mexico, North Carolina, Washington, West Virginia, and Wisconsin
6 Person-Centered Healthcare Homes: A new paradigm Picture a world where everyone has... An Ongoing Relationship with a responsible healthcare provider A Care Team that collectively takes responsibility for ongoing care And where... Quality and Safety are hallmarks Enhanced Access to care is available Payment appropriately recognizes the Added Value What does this look like in practice?
7 Defining the Healthcare Home Superb Access to Care Patient Engagement in Care Clinical Information Systems Care Coordination Team Care Patient Feedback Publicly Available Information Person-Centered Healthcare Home
8 Defining the Healthcare Home Superb Access to Care Everyone has a health home practitioner and team Patients can easily make appointments and select the day and time. Waiting times are short. and telephone consultations are offered. Off-hour service is available.
9 Open Scheduling Same Day Access Model Consumer Engagement Standards 1. Master s Level assessment provided the same day of call or walk in for help (If the consumer calls after 3:00 p.m. they will be asked to come in the next morning unless in crisis or urgent need) 2. Initial diagnosis and assessed service needs determined 3. Level of care and benefit design identified with consumer that includes an estimate of time needed 4. Initial treatment plan developed based on benefit design package 2nd clinical appointment for TREATMENT within 8 days of initial intake 1st medical appointment within 10 days of initial intake 9
10 Defining the Healthcare Home Clinical Information Systems Systems support high-quality care, practice-based learning, and quality improvement. Practices maintain patient registries; monitor adherence to treatment; have easy access to lab and test results; and receive reminders, decision support, and information on recommended treatments. There is continuous learning and practice improvement.
11 Defining the Healthcare Home Care Coordination The health home team engages in care coordination & management within the team The team also coordinates with other healthcare providers/organizations in the community Systems are in place to prevent errors that occur when multiple physicians are involved. Follow-up and support is provided.
12 Care Coordination The Care Coordination Standard: When I need to see a specialist or get a test, including help for mental health or substance use problems, help me get what I need at your clinic whenever possible and stay involved when I get care in other places. Services are supported by electronic health records, registries, and access to lab, x-ray, medical/surgical specialties and hospital care.
13 Are you ready to be a healthcare home? Do you Have a provider team with a range of expertise (including primary care)? Coordinate consumers care with their health providers in other organizations? Engage patients in shared decision-making? Collect and use practice data? Analyze and report on a broad range of outcomes? Have a sustainable business model for these activities?
14 Health Homes Serving Individuals with SMI and Substance Use Disorders 1. Assure regular health status screening and registry tracking/outcome measurement 2. Locate medical nurse practitioners/primary care physicians in MH/SU facilities 3. Identify a primary care supervising physician 4. Embed nurse care managers 5. Use evidence-based practices developed to improve health status 6. Create wellness programs
15 New Paradigm Primary Care in Behavioral Health Organizations Funding starting to open up for embedding primary medical care into CBHOs, a critical component of meeting the needs of adults with serious mental illness Clinical Design for Adults with Low to Moderate and Youth with Low to High BH Risk and Complexity Primary Care Clinic with Behavioral Health Clinicians embedded, providing assessment, PCP consultation, care management and direct service Food CBHO Mart Partnership/ Linkage with Specialty CBHO for persons who need their care stepped up to address increased risk and complexity with ability to step back to Primary Care Clinical Design for Adults with Moderate to High BH Risk and Complexity Food CBHO Mart Community Behavioral Healthcare Organization with an embedded Primary Care Medical Clinic with ability to address the full range of primary healthcare needs of persons with moderate to high behavioral health risk and complexity
16 Accountable Care Organizations NationalCounc il.org
17 On Your Mark, Get Set, ACO Accountable Care Organizations bring together healthcare homes, specialty care, and ancillary services
18 Core Principles of an ACO Directed by a coordinated set of providers Provides a full continuum of care to patients and populations Healthcare homes, specialty care, hospital, case management, care coordination, transitions between levels of care and more Financial incentives aligned with clinical goals Cost containment Enhancement of care quality and the patient experience Improvement of overall health status
19 Getting to the ACO Table Are you in conversation with local integrated health systems and at the table of ACO development efforts in order to pitch the importance of MH/SUD services to improving quality and bending the cost curve and building a case for how you can help these organizations succeed in the new world of risk?
20 Initial Approved ACOs for Medicare -1.Allina Hospitals & Clinics Minnesota and Western Wisconsin 2. Atrius Health Services Eastern and Central Massachusetts 3. Banner Health Network Phoenix, Arizona Metropolitan Area (Maricopa and Pinal Counties) 4. Bellin-Thedacare Healthcare Partners Northeast Wisconsin 5. Beth Israel Deaconess Physician Eastern Massachusetts 6. Bronx Accountable Healthcare Network (BAHN) New York City (the Bronx) and lower Westchester County, NY 7. Brown & Toland Physicians San Francisco Bay Area, CA 8. Dartmouth-Hitchcock ACO New Hampshire and Eastern Vermont 9. Eastern Maine Healthcare System Central, Eastern, and Northern Maine 10. Fairview Health Systems Minneapolis, MN Metropolitan Area 11. Franciscan Health System Indianapolis and Central Indiana 12. Genesys PHO Southeastern Michigan 13. Healthcare Partners Medical Group Los Angeles and Orange Counties, CA 14. Healthcare Partners of Nevada Clark and Nye Counties, NV 15. Heritage California ACO Southern, Central, and Costal California 16. JSA Medical Group, a division of HealthCare Partners Orlando, Tampa Bay, and surrounding South Florida 17. Michigan Pioneer ACO Southeastern Michigan 18. Monarch Healthcare Orange County, CA 19. Mount Auburn Cambridge Independent Practice Association (MACIPA) Eastern Massachusetts 20. North Texas Specialty Physicians Tarrant, Johnson and Parker counties in North Texas 21. OSF Healthcare System Central Illinois 22. Park Nicollet Health Services Minneapolis, MN Metropolitan Area 23. Partners Healthcare Eastern Massachusetts 24. Physician Health Partners Denver, CO Metropolitan Area4 25. Presbyterian Healthcare Services -Central New Mexico Pioneer Accountable Care Organization Central New Mexico 26. Primecare Medical Network Southern California (San Bernardino and Riverside Counties) 27. Renaissance Medical Management Company Southeastern Pennsylvania 28. Seton Health Alliance Central Texas (11 county area including Austin) 29. Sharp Healthcare System San Diego County 30. Steward Health Care System Eastern Massachusetts 31. TriHealth, Inc. Northwest Central Iowa 32. University of Michigan Southeastern Michigan
21 Health IT at the Heart of the ACO Framework Builds patient-centric systems of care Improves quality and cost Coordinates care across participating providers Uses IT, data, and reimbursement to optimize results Builds payer partnerships and accepts accountability for the total cost of care Assesses and manages population health risk Reimbursed based on savings and quality value
22 Healthcare Reform Context Under an ACO model, the value of healthcare services will depend on our ability to: 1. Be accessible (fast access to all needed services) 2. Be efficient (provide high-quality services at lowest possible cost) 3. Connect with other providers (via electronic information exchange) 4. Focus on episodic care needs 5. Produce outcomes
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