ONONDAGA CASE MANAGEMENT SERVICES, INC.

Transcription

1 ONONDAGA CASE MANAGEMENT SERVICES, INC. in collaboration with New York Care Coordination Program, Inc. and Beacon Health Strategies, LLC Agenda Provide overview of the Provider Led Model Introduce Onondaga Case Management Services, Inc. Introduce New York Care Coordination Program Introduce Beacon and its work in NY and across the country Anticipated responsibilities by partner Underlying philosophy and approach to a successful Initiative Q and A 1

2 Provider Led Network Model Collaboration includes Onondaga Case Management Services Inc., NYCCP and Beacon Health Strategies application submitted by Provider Lead A Provider may function as Provider Lead in more than one county Collaboration to be structured through contracts Onondaga Case Management Services Onondaga Case Management Services (OCMS) provides comprehensive care management planning - coordinating care for adults, children and families so they can develop resources and supports to overcome obstacles and live a satisfying life. Our research-based processes are cost effective as they reduce unnecessary interventions and have demonstrated success in improving people s lives. We offer 16 different community-based programs, including transition planning from hospital to home - for people with complex physical and mental health needs. 2

3 Onondaga Case Management Services Case managers/care coordinators partner with people to support them as they select, prepare, and achieve their personal recovery goals. Goals are often related to mental health, physical health and substance use disorders with an emphasis on community involvement. Other goal areas include employment, education, housing, financial stability, and social life development. OCMS combines long established partnerships with critical human service agencies in the community with health information technology to provide integrated support to people efficiently and effectively. Partnerships with other care management entities AIDS Resources - ACR Onondaga Case Management Services Core Services Care Coordination Peer/Family Engagement and Support Intensive Services Systems Coordination Clinic Services 3

4 Care Coordination A process that engages individuals and families in defining their vision of wellness and developing a plan that will support them through the steps to sustainable progress toward their goals. Peer Engagement and Support Peer Mentors Individual Peer Support Groups Men s Group, Young Adult Group, Dual Recovery, Women s Group, Holder s of Hope, Social Events Parent Partners Partner with Care Coordinators (Wraparound Facilitators) to support families and the Wraparound process Provide support to families referred to the SPOA (Single Point of Access) 4

5 Intensive Services ACT Team (Assertive Treatment) Home Based Crisis Intervention (HBCI) Youth Emergency Services (YES) System Coordination Single Point of Access (SPOA) Care Coordination and Residential Services Dual Recovery Coordinator Vocational Coordinator 5

6 OCMS Behavioral Health Clinic Best Practice clinic serving adults and children & families. October 2011 Opened in response to community need for increased access to clinic services in Onondaga County. About New York Care Coordination Program, Inc. Formed in 2000, six western and central counties, with support from the NYS Office of Mental health Onondaga County founding member with peers, providers, and county commissioner serving on the Board and chairing key initiatives Multi-county, multi-stakeholder collaborative undertaking to improve outcomes for individuals with serious behavioral health issues Operational in mid-2002 with project management through Coordinated Care Services, Inc. Partnered with Beacon Health Strategies, LLC in 2009 for managed care readiness Expanded in 2010 to include Westchester County Incorporated in 2011; Western Region Behavioral Health Organization August BEACON HEALTH STRATEGIES 200 State Street Suite 302, Boston, MA t beaconhealthstrategies.com 6

7 13 NYCCP Transformation Timeline Structures for Change Practice and Regulatory Reform Finance Reform Managed Care s July July NYCCP in the context of NYS reform NYS Health Reform STRUCTURES Regional BHO s Phase 1 Full managed care Phase 2 s PRACTICES Integration Cultural Competence Peer Services NYCCP Western Region BHO Cross-regional, multistakeholder design of full managed care model s of Upstate New York Training for next phase of Care Coordination 7

8 Beacon is a National Behavioral Health Care Company 6.6 million covered lives in 17 states 3.4 million Medicaid 12 Medicaid programs: CA, DC, FL, KY, MA, MI, NC, NY, RI, TX, WI, WV In partnership with NYCCP for the Western Region BHO initiative Clinical operations are in local markets Clinical integration Every relationship built on physical, behavioral and social care coordination and information sharing Staffing model, clinical location, IT, analytics, financial models Beacon led the Nation s first BH managed care initiative in the early 1990s. Our focus then is our focus now... Better care for individuals with complex medical, behavioral and social needs. ABD/Disability Medicaid Foster children Homeless populations Dually eligible Integrated case management Children and adults with autism Preparing for health care reform Focus Today Seriously mentally ill PACE programs Children with special healthcare needs HIV special needs plans Severely emotionally disturbed Developmental disability Health homes Beacon provides community-based Care Management in New York Beacon works with over 650k Medicaid members in NY BEACON S NEW YORK FOOTPRINT KEY NEW YORK BUSINESS HIGHLIGHTS Working in New York K 7 Health Plan Partners Medicare SNP SMI/Duals 7,000 Contracted Providers in New York State Case Management and Quality Improvement partnerships with 7 County systems: Chautauqua, Erie, Genesee, Monroe, Onondaga, Westchester, and Wyoming Medicaid >30 New York Clinicians Based Locally in NY: UR, CM and Physician Advisors January 12, BEACON HEALTH STRATEGIES 200 State Street Suite 302, Boston, MA t beaconhealthstrategies.com 8

9 Member Flow Chart Members Identified - DOH Health Plan Assigned Members Health Plan Assigned Members Health Plan Assigned Members FFS Members Assigned to a Assignment to Certified Lead Assignment to Certified Lead Assignment to Certified Lead Assignment Assignment Assignment Based CM Based CM Based CM Governing Partner Responsibilities Provider Lead Beacon Partner Participation in Governance Participation in policy and procedure NYCCP Partner Participation in oversight of business Service delivery consistent with org mission Enrollee Assignment Low-touch CM Low Tier Acuity Use of billing number Other roles to be determined RBHO Contract Liaison Stakeholder Governance Billing and claims payment QI analysis and Reporting Performance Incentive Dvlpmt/Mgmt Person Ctrd Philosophy Promotion Call Center Web Based CM Tool for all Treaters QI Implementation LGU Liaison TCM Slots 9

10 Provider Led Network Model Role of Provider Lead Participates in governance of Network: Setting policies and procedures, Using its billing number Participating in oversight of the conduct of business In Monroe County, Huther Doyle will be the lead In Erie County Alcohol and Drug Dependency Services will be the lead Provider Led Network Model Role of NYCCP Organizes the collaboration Contracts with both Provider Lead and Beacon Health Strategies, identifying the roles of each Assesses capacity and establishes networks including: providers of HH care management services providers of behavioral health and physical health services community support services Housing managed care plans county governments and others needed to bring together the key resources Assure person centered approach in all care management services 10

11 Provider Led Network Model Role of Beacon Health Strategies Billing and claims payments Care management practice competencies Well designed information technology and support systems to assure effective communication and knowledge sharing Care Management application (assessment and treatment planning tools) to be shared electronically by all providers FlexCare. Linkage to RHIO s. Enrollee assignment Call Center ( triage, etc) Level 1-Care Coordination Telephonic Service Quality Improvement analysis and reporting Provider Led Network Model Network Roles Care Management Services Multi-pronged: Outreach and engagement Telephonic services for low touch, low acuity services based care management providers delivering intermediate and high levels of support Development of a single, person centered care plan Linkage to behavioral health, physical health and community support services Mental Health, Chemical Dependency, Physical Health Services Support Services County Regional Health Information Exchange And more. 11

12 Contact information: Deborah Donahue Executive Director Onondaga Case Management Services, Inc. 220 Herald Place Syracuse, NY x104 Adele Gorges Executive Director New York Care Coordination Program, Inc Jay Street, Building J Rochester, New York agorges@ccsi.org 12