A Sustainable Source for Services through Health Home Legislation: What it Means for Supportive Housing

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1 A Sustainable Source for Services through Health Home Legislation: What it Means for Supportive Housing The Source for Housing Solutions Sharon Rapport, CSH Lezlie Murch, Exodus Recovery Brenda Goldstein, LifeLong Medical Care Susan Lee, CSH

2 Our Mission Advancing housing solutions that: Improve lives of vulnerable people Maximize public resources Build strong, healthy communities

3 States can apply for 90% federal funding for 2 years, then FMAP rate To coordinate & integrate care for Medicaid benes with -2 chronic conditions -1 condition, risk of 2 nd 1 serious MI

4 Silos for Medi-Cal Beneficiaries with Complex Needs Silos: Medical Care Mental Health Housing Substance Use Treatment Social Services

5 Health Home = virtual Home for addressing health-related needs Health Home Services Outreach & Engagement Comprehensive Case Management Patient & Family Support Care Coordination Comprehensive Transitional Care from Inpatient to Other Settings Referral to Community and Social Support Services Use of Health Information Technology to Link Services (if appropriate)

6 AB What is AB 361 and what does it have to do with supportive housing?

7 AB 361 Can t Pay for Housing, But it Can be A Source for Services AB 361 can create a sustainable source of funding for services in supportive housing Medi-Cal Expansion Will Make Sustainable Funding More Viable

8 CA Assembly Bill 361 (Mitchell): The State must target People who are chronically homeless (including people now living in supportive housing), and People who are frequent hospital users.

9 Critical elements Services provided outside of walls of clinic... and tailored to promote housing stability

10 Critical components Health homes must partner with permanent housing... and other community-based organizations, and have demonstrated experience serving target populations

11 Who is Eligible? Diagnosis of co-occurring disorders prevalent among frequent hospital users HTN/heart disease Diabetes Liver disease/hepatitis Kidney disease Musculoskeletal degeneration Chronic pulmonary disease (i.e., COPD) TB HIV/AIDS Repeated skin infections, open wounds Bipolar disorder Substance abuse Mood disorders PTSD Schizophrenia Cognitive disorders/tbi Risk: Assessment using algorithms to identify high-cost or frequent hospital users (i.e., 10 th Decile or NYU predictive modeling) Level of severity in conditions based on one or more of Frequent inpatient hospital admissions for medical, psychiatric, or substance use related conditions. Excessive use of crisis or emergency services. Chronic homelessness (defined to include supportive housing residents if the resident was chronically homeless).

12 Health Home Roles Defined Housing Provider: Establish partnership with health home, works with case manager to ensure housing stability (no funding). Primary Care Provider: May be lead Lead: Identify eligible beneficiaries, maintain information systems/data, assure quality, ensure linkage to housing. Case Manager: Provide clientcentered wrap-around services to outreach to/engage clients, help clients achieve/ maintain housing and health stability, integrate into community.. Care coordinator: Assures client access to primary, behavioral, specialty care, plans discharge from hospitals, refers to social services * Behavioral Health Provider(s): May be lead *Referral/links to social services: With client, identify client needs and potential resources to meet the needs in the community; use warm hand-offs and follow-up to ensure clients are accessing services. 12

13 Implementation State Plan Amendment Implementation

14 Exodus Recovery, Inc. (Los Angeles County Department of Mental Health Provider) Integrated Mobile Health Team (IMHT) An Innovative Demonstration of the Health Home Services Option By Lezlie Murch, M.A., LPCC Sr. VP Programs, Exodus Recovery, Inc.

15 Exodus IMHT Model Provides an Operational Demonstration of the Health Home Services Option The Exodus Recovery Integrated Mobile Health Team (IMHT) is a mobile, clientcentered, holistic approach to providing integrated services to vulnerable, homeless individuals with a mental illness, chronic physical health conditions and substance use disorders who are high utilizers of the public healthcare system. These services are delivered by a multidisciplinary team of clinicians who provide comprehensive care management and care coordination in conjunction with community resources and supports. The elements of the IMHT Program are closely aligned with the Health Home Services Option

16 TARGET POPULATION HEALTH HOME SERVICES Frequent utilizers of hospitals and emergency departments Individuals who have two or more chronic conditions and/or a serious mental illness Physical conditions such as substance abuse, diabetes/obesity, cardiopulmonary illness, HIV/STD s qualify California must target the homeless for services Health Home Service intended for Medi-Cal beneficiaries IMHT PROGRAM Frequent utilizers of hospitals and emergency departments Individuals who have a serious mental illness and at least one chronic physical health condition Physical conditions such as substance abuse, diabetes/obesity, cardiopulmonary illness, HIV/STD s qualify Homelessness is a requirement for enrollment Due to the Affordable Care Act, 95% of IMHT participants have Medi-Cal (Medicaid) The IMHT team strives to identify and engage the most vulnerable individuals at high risk for mortality * represents a minor difference in design between the two models

17 PROGRAM BENEFITS HEALTH HOME SERVICES Projected Benefits: Promotes the integration of behavioral health and physical health care Reduction in fragmentation of healthcare resources Addresses disparities with improved access to services and resources Better quality communication between healthcare providers Improved efficacy of treatment objectives Promotes a client driven, holistic approach meeting the client where they are by addressing the most pertinent need first IMHT PROGRAM Proven Benefits: Allows the seamless delivery of mental health, physical health and substance abuse services by integrated team Reduction in fragmentation of healthcare resources Addresses disparities with improved access to services and resources Better quality communication between healthcare providers Improved efficacy of treatment objectives Promotes a client driven, holistic approach meeting the client where they are by addressing the most pertinent need first

18 TREATMENT TEAM STRUCTURE/PROVIDERS HEALTH HOME SERVICES IMHT PROGRAM A Health Home Service may be organized from a free standing facility, a hospital, community mental health center or virtual team but must include a designated lead provider. Exodus Recovery is the lead provider. The IMHT Team structure is that of an ACT team of generalists including: Psychiatric and physical health NP s LVN Service Provider and Care Coordination Team should be comprised of health professionals: Substance Abuse Specialist Team Lead/ Lead Care Coordinator Benefits Specialist Physicians, NP s, Nurses Housing Specialist Therapists, Social Workers Driver/Case Managers Behavioral Health providers Therapists Pharmacists Administrative Support Licensed complementary and alternative practitioners Housing Developer Partner Federally Qualified Health Center Partner with Pharmacist

19 REQUIRED SERVICES HEALTH HOME SERVICES Health Home providers are expected to integrate and coordinate all primary, acute, behavioral health and long term services and supports, either directly or through linkage and referral Required Services Outreach and engagement Care management Care coordination Health promotion Comprehensive transitional care/follow-up Family and client support Referral and linkage to community and social services must include connection to housing IMHT PROGRAM The IMHT team is expected to integrate and coordinate all primary, acute, behavioral health and long term services and supports, either directly or through linkage and referral Required Services provided with description Outreach and engagement - utilizes a vulnerability index to identify most vulnerable, at risk population Care management assessment, treatment planning, med support, individual and group therapy, targeted case management, rehabilitative activities Care coordination navigation to and from appointments and services, warm hand-offs to community providers Health promotion - physical and mental health providers offer preventative and ongoing care for chronic conditions. Providers have access to and work closely with specialty care, pharmacists, alternative practitioners Comprehensive transitional care/follow up discharge planning and coordination with hospital/facility staff, social services Family and client support groups, collateral contact, community resources Referral and linkage to community and social support services DPSS, 12-step support, faith based organizations, food banks, child care Housing All IMHT participant must be housed in crisis, transitional or permanent housing

20 FUNDING HEALTH HOME SERVICES The Affordable Care Act established a new Medicaid state plan option for Health Home services. This option provides states with 100% federal funding for Health Home services for the first eight quarters. Funding to be decreased after the initial period to the state s federal matching rate. Services must be for Medicaid beneficiaries CA AB361 allows CA the flexibility to design payment options IMHT PROGRAM The Integrated Mobile Health Team program is funded through Medi-Cal and the CA Mental Health Services Act. It is a contracted program within the Los Angeles County Department of Mental health Physical health services initially paid for through client supportive services (CSS) money an MHSA fund set aside to support a client in their recovery through housing, employment, education and integrated treatment of co-occurring physical health and SUD FQHC partner can ensure program sustainability through Medi-Cal billing for physical health services Client housing funded through CSS dollars and voucher based permanent supported housing

21 IMHT PROGRAM OUTCOMES Evaluation of data and client satisfaction demonstrates this integrated and collaborative coordinated care model works Exodus IMHT program has successfully housed 100% of enrolled clients (n=129) 80% of IMHT clients report no homeless days in 12 months 89% of IMHT clients report no hospital days in the past 12 months 88% of IMHT clients report no ER visits in the past 12 months Physical health indicators (BMI, hypertension, diabetes markers) have shown improvement Substance abuse indicators have shown improvement Client satisfaction over ten indicators is at 91% favorable

22 A Health Home for Me Patient Centered Health Homes for the Homeless Housing California April 2014 Brenda Goldstein, MPH

23 Life Expectancy USA 78 Japan 83 Mongolia 67 Ethiopia 53 USA Homeless 46

24 Key Components Flexible service models Who (staffing = mix of licensed/non-licensed staff) Where (home, streets, office) What care is (housing, medical and social case management, flexible funds for transportation, food, benefits advocacy) Integrated medical, behavioral health and case management

25 LifeLong Model #1: Services In Housing Health home in housing for 300 adults Physical and mental health services on site Link to full scope clinic Team = medical providers, LCSWs and case managers Individual and group services Dedicated time for team meetings

26 LifeLong Model #2: Current Clinic Based Services Serves clients living on streets and in scattered site housing Medical and mental health services provided by FQHC at a clinic site Case managers coordinate care, accompany clients to visits, advocate for clients

27 LifeLong Model #3: Proposal: A Model Clinic More case managers and wellness coaches PCP/Behavioral Health staff ratio = 1:1 Primary care panels half of normal size Longer appointments More drop in and same day access appointments Co-location with benefits advocates and specialty mental health clinic Extensive on-going training for staff

28 Partnerships and Funding Community Health Centers/FQHC MediCal Hospitals MHSA Managed Care Plans County Behavioral Health Funds Housing Developers Private Foundations

29 The Source for Housing Solutions Questions??

30 Questions for Discussion services How should health home lead providers be partnering with housing and services organizations? How should health home lead providers be partnering with housing and What are barriers to your organization becoming a health home or joining a health home? organizations? What are barriers to your organization becoming a health home or joining a health home?

31 Help Us Make Health Homes Meaningful for Supportive Housing Residents! The Source for Housing Solutions For more information, Sharon Rapport, CSH (213) , x18 (323)