Behavioral Health Services in 2015 Opportunities, Challenges & Implications

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1 Behavioral Health Services in 2015 Opportunities, Challenges & Implications Health Care Reform Stakeholders Working Group March 18, 2015 Toni Tullys, Director, Behavioral Health Services Elisa Koff Ginsborg, Executive Director, BHCA

2 Overview Context & Background Overview of Significant Changes & Issues ACA Expanded Population and Services Federal Waivers Growth in funding at State Level Payment Reform & EHR Workforce & Recruitment Emerging Unintended Consequences Discussion

3 The Changing Behavioral Health Field ACA & Parity Legislation recognition of the importance of behavioral health in whole health of individuals and populations Integration of mental health and substance use disorders at Federal, State and County levels = Behavioral Health Use of evidence based and best practices Focus on access, timeliness to service and quality of care through use of data

4 Health Reform & Behavioral Health Shift to specialty service across the broader health care system Expanded coverage and benefits Integrated primary care/behavioral health services New regulations/expectations and greater oversight (quality reviews and audits) New relationships with Managed Care Plans Santa Clara Family Health Plan (SCFHP) Anthem Blue Cross & Beacon Health Strategies Kaiser

5 The Triple Aim & Santa Clara County (SCC) 1. Improve the health of populations 2. Improve the experience of care 3. Bend the cost curve Santa Clara County Health and Hospital System Vision: Better Health for All Mission: Dedicated to the Health and Wellbeing of Communities in Santa Clara County

6 Behavioral Health System of Care Integration of Mental Health and DADS Departments into Behavioral Health Services (BHS) is underway BHS provides a continuum of services across the lifespan: Acute Care, Outpatient Services, Residential Services, Prevention In 2014, Mental Health served 24,000 individuals and DADS served 9,000 individuals

7 BHS Demand and Capacity Launching an analysis of existing capacity, by program and modality, across all levels of care Assessing increased provider capacity in 2014 Evaluating current demand for services through MH Call Center and DADS Gateway to determine specific capacity needs as well as other portals to BHS Assessing demand for integrated BH/Primary Care

8 Low Income Californians Behavioral Health Needs & Preferences Treatment Gap 3 in 10 low income Californians say in the past year they ve felt a need to talk with a healthcare professional about their behavioral health. Only half of those who felt such a need actually spoke with a professional about these issues, a nontreatment rate comparable to those found in other recent studies. Source: Blue Shield Foundation: exploring low income Californians needs and preferences for behavioral health care. 2015

9 Who are the Newly Eligible for Services? years of age and meet residency requirement Medi Cal Expansion (MCE) annual income is less than 138% of FPL ($32,913 for family of 4) SCC estimate: 65,000 Covered California annual income is % of FPL ($32,913 $95,000 for family of 4) SCC estimate: 70,000

10 Important Sub Population: Individuals with Mild to Moderate BH Needs This is a new population; local managed care plans are responsible for services Counties including SCC have developed phone screening tools to determine individual needs and placement in managed care vs. specialty MH SCFHP estimated # of mild moderate clients is 3,324

11 Expanded Eligible Populations: Implications Those previously covered by County now covered by MediCal Expansion are paid for 100% by Federal Funds Need to ensure that the newly eligible re enroll for Medi Cal Need to develop capacity (County operated and communitybased) for expanded populations seeking services Definition of Mild/Moderate mental health needs and decisions made with Health Plans have significant implications for the future

12 Cal Medi Connect State Medi Cal & Federal Medicare Demonstration Project 3 year project to promote coordinated health care delivery for dually eligible population Goal: keep seniors and individuals with disabilities at home and out of institutions and reduce overall costs 7 CA counties; SCC launched in January 1, 2015; 8,219 enrollees 45 receiving BH services BHS Collaboration with Managed Care Plans: SCFHP and Anthem Blue Cross/Beacon counties/santa clara county/

13 Expanded Eligible Services: DMC Waiver Amendment Bay Area Counties will be first to implement SCC is viewed as model for continuum of services required Substance Use Clients will be eligible for Case Management Services (similar to MH Rehab option) IMD change will allow Residential Services Providers to be paid by MediCal

14 DMC Waiver Amendment Implications Require increased capacity to provide new services Impact of new funds on penetration rates Timely Certification of providers essential Impact on rates how are they being set? Quality Management Aspect of Waiver: Drug MediCal services will fall under EQRO

15 Medi Cal 2020: Whole Person Focus Draft Plan Just Released 3/16/15 Recognition of non traditional MediCal eligible services: include tenancy supports like outreach and engagement, housing search assistance, stabilization, paying rent and bills on time, not disruptive to other tenants, maintaining SSI and other benefits.

16 Unprecedented $1.5 Billion growth State wide Source: Mike Geiss cited by CCCMHA

17 Unprecedented Growth: Opportunities How can County take full advantage of potential funding to expand services and increase penetration rate? Recent EQRO audits document SCC overall penetration rate of 5.5% Room for Growth

18 Electronic Health Record (EHR) EPIC Valley Medical Center & other hospitals CoCentrix BHS live in 2016 Provider Systems Currently 10 different systems BHS will create linkage through new EHR

19 EHR: Implications System must meet mandated EHR timelines. EHR will improve quality of services. What resources will be required at County level? What resources will be required at provider level?

20 Payment Reform More Questions than Answers Value & Lower Costs Risk Audit, documentation and utilization reform MediCal 2020 Integrated Care & Shared Savings

21 Payment Reform: Implications Despite many unknowns, we know it will be HUGE! Not addressing would result in reforms thrust upon us Risk and Change Requires Strong Partnerships

22 Workforce Issues Challenge: limited workforce in Safety Net behavioral health sector Competing with Private Sector and Corrections Large Pay differentials Different Expectations (Community Behavioral Health/Public Funding Requirements) Safety Net workforce values working in public sector Specific professions greater challenges Locally: SJSU MSW Program cuts Medi Cal 2020 highlights peer support specialists

23 Emerging Unintended Consequences Anecdotal evidence indicates some newly insured with Covered CA or other private insurance are losing access to County services, but not gaining access to services. County can only provide services (other than emergency care) if insured client has denial letter from their insurer. Court may order drug treatment or provider may assess need for services that County provides, but providers report that private insurance offering insufficient alternatives and is not issuing denial letter. Providers would like to see convening of Courts, State, County, Providers, Health Plans to allow for better understanding of scope and options to address issue.

24 Discussion Questions? Other issues? Recommendations?

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