North Country Behavioral Healthcare Network & Management Services LLC Annual Report

North Country Behavioral Healthcare Network & Management Services LLC Annual Report Year Ending June 30, 2015

2014-2015 Annual Report Barry Brogan, Network Director Executive Summary North Country Behavioral Healthcare Network System Redesign: Challenges and Opportunities for Behavioral Health The tidal wave that we predicted in this space over the past two Annual Reports made landfall in the summer of 2014. In late July the North County s two performing provider systems (PPS) Adirondack Health Institute (AHI), and the North Country Initiative (NCI) were collectively awarded nearly $2 million in planning grant funds and handed a mandate in late August that the first draft of both an organizational plan and up to 11 sanctioned projects (22 across the region) were due by the third week in December 2014. The efforts that ensued throughout the fall and early winter produced two regional plans which were graded as outstanding by independent and State reviewers and rewarded with up to over $264 million to implement the project over the next five years. Across the North Country new collaborative relationships between hospitals, doctors, behavioral health providers, Community Services Directors and other stakeholders were formed to meet the challenge and opportunity that the Delivery System Reform Incentive Payment program (DSRIP) presented. NCBHN members and the staff itself were heavily involved throughout the seven county network catchment area in assisting in the design of the projects which would be included in the December applications. AHI and NCI leadership seemed to work without rest during the months of November and December to bring the various parties to the table and to meet the aggressive time line that DOH established for the program. It appears that of the Networks 23 members at least 17 are specifically mentioned as either stakeholders or actually participating at some level in DSRIP projects. Not all of the projects are behavior health related, especially regarding the hospitals but most are. Our early analysis is that NCBHN members will be significantly engaged in the integration of behavioral health and primary care; establishment of two new detox programs; and with projects concerning population health. NCBHN staff participated in two regional planning groups in the Franklin, Essex & Clinton region of the AHI territory. We provided consultation as well to staff from Canton Potsdam Hospital who were working on the St. Lawrence AHI planning group. On the NCI western side we participated in several project specific planning groups involving the integration of behavioral health and primary care and the population health initiative. We continue to serve on the Project Advisory Committee for NCI, but have no formal role in the AHI plan. North Country DSRIP North Country Initiative ADK Health Institute Est. Attributed Lives 40,000 125,000 Est. 5 Yr Project Budget 78,062,821 $186,715,496 Capital Request $32 Million $64 Million 1 P age

Moving forward we are reviewing the implementation plans that were submitted to the state on June 1, 2015 and will be providing comments to the PPS on any issues identified. We continue to advocate for expanded representation from the behavioral heath provider community of each of the PPS governance structures. Where does DSRIP fit into the Network strategic plan which was adopted in 2013? We have known for several years that something like a DSRIP initiative would be coming out of the State s efforts to obtain the massive 1115 waiver amendment with the Federal government, though we certainly had no idea what form it would take or the enormous amount of pressure it would place on the entire health care system to move rapidly in the formation of important new partnerships and collaborations. We did know that Medicaid funded behavioral health services would be moving from a fee for service model to a managed care model with managed care organizations becoming the new payer. We knew that this would introduce a new competitive environment where MCOs can pick and choose with which agencies they seek to contract, and we engaged forward looking consultants to work with the Network members to ensure that our agencies had the knowledge they needed to position their agencies to succeed in the new managed care world. Also in 2013 Network members learned about the State Health Innovation Plan (SHIP) which called for the development of Advanced Primary Care Practices (APCP) that would be able to both assume risks and control referrals. DSRIP, we now know, is the funding mechanism which will fuel the development APCPs. Other potential risk bearing entities are also developing in the form of regional Accountable Care Organizations (ACOs). Ultimately these entities may be controlled by hospitals or groups of APCPs which band together thus creating greater critical mass and a more attractive environment in which to assume risk. In this context risk means engaging in financial arrangements where an attributed population will be assigned to an APCP or to an ACO for a set amount of money. If the cost of care for the population comes in under budget the risk bearing entity keeps a profit, if cost of care is greater than the budget then the entity loses money that year. Where do these massive system realignments leave the members of North Country Behavioral Healthcare Network, and is our strategic plan still relevant? It is clear that except for the most severely ill and most complex patients, referrals for most behavioral health services will be directed through some model of APCP as they develop throughout the DSRIP process. APCPs will have a choice in how to access behavioral health for the members (patients) they are charged with taking care of. They can develop the services internally. New regulatory models that are being tested in DSRIP may introduce flexibility in allowing primary care to bill for, or in some other way be paid, to cover the cost of behavioral health services. In this scenario the best and the brightest within behavioral health will certainly be enticed to join the staffs of the leading APCPs. 2 P age

Another choice that the APCPs could make is to partner with existing providers who can demonstrate both quality and value to the entities which need access to behavioral health for their members. What type of community providers will they be looking to partner with? APCPs will be looking to those agencies that can meet the same quality, value, efficiency, and data capabilities that the APCP itself must meet to be paid by the MCO. Behavioral health providers must be preparing strategic plans with their Boards which will identify the processes which must be put in place over the next 36 months to position the agency to be able to demonstrate quality, value, efficiency and data capability. Agencies will, at the very least, need to enter into seamless partnerships with sister agencies to add value for their APCP customers. In areas such as developing patient centered care, ensuring timely access to services, family engagement, workforce development and implementation of adequate data systems it may be more efficient to work collectively rather than as individual agencies. The Network s current strategic plan addresses these challenges in a broad sense in its first two priority areas: To promote the adoption of interoperable EHR by 2016; and, Continue progress toward positioning members for patient centered managed care. As well as in our 4 th priority: Identify the strategic business and program opportunities for designing and implementing integrated partnerships within the region that result in better outcomes for people served. The HRSA funded Shared Services Planning Project, which is described in more detail below, will identify key administrative, IT and quality initiatives which present opportunities for collaborative efficiencies among behavioral health providers. Agencies that engage in these network efforts will be better positioned to take strategic action as the changes now forming in the healthcare delivery system become clearer. Beyond System Redesign Regional Projects: Housing, Suicide Prevention, IT Technical Assistance, & Shared Services We have solidified our relationship with the two HUD Continuum of Care organizations (CoCs), and introduced standard business practices to the administration of the collaboratives. Financial policies and procedures have been adopted, and discrete bank accounts established for each organization. We continue to assist these two regional efforts to build the HUD mandated infrastructure required to draw down homeless prevention dollars. Combined, the five county region is eligible and applied for over $1.3 million to combat homelessness in the North Country. In February we were notified that the region was granted the full requested amount with some projects actually exceeding the funding request. For the first time Points North 3 P age

Housing Coalition was awarded planning funding which is a major step in moving toward sustainability. We will continue to seek planning dollars to support the work of the Franklin Essex group as well. At the end of June 2015 we will complete the fifth of our anti-bullying and suicide prevention projects. These projects have been made possible through grants provided by the New York State Senate and sponsored by Sen. Betty Little. As with the previous projects this year s effort is based on a public/private partnership between six county Directors of Community Services and NCBHN. Projects are submitted by community non-profit organizations to their community services director. Collectively the directors select the projects and then hand the administrative and compliance function to Network staff for implementation. Looking forward Network Staff met with Senator Little in December to brief her on project activities and outcomes. Senator Little continues to support these community based projects and successfully advocated for renewed funding for the 2015-16 school year. The Senator has been long recognized as a strong supporter for access to behavioral health preventive and treatment services. Thank you Senator Little. As part of the Population Health Improvement Plan (PHIP) award that Fort Drum Regional Health Planning Organization (FDRHPO) received, NCBHN is partnering with FDRHPO on a shared position which will assist members in the western region with HIT connectivity and quality data measurement. Specifically in the initial phase of the project our TA provider will assist nine agencies with qualified providers to attain meaningful use status. This will allow these agencies to draw down federal funds to support additional IT development and capacity building. As of mid-june the PHIP contract had not been released by the state but the project has begun with support from FDRHPO. Finally, as we move into the 2015-16 year, we begin a one year project with nine NCBHN members and three non-member agencies which will further our knowledge on the potential for both new collaborative and/or partnership opportunities within the behavioral health provider community. Working with the Advocates for Human Potential, a nationally renowned human service business consulting firm, we will gather in-depth data on each agency and identify the most value added administrative functions which could be either done more efficiently, done in collaboration with other regional partners or perhaps outsourced completely to a high volume state or national vendor. Public Policy and Advocacy NCBHN remains a recognized regional voice for policy matters involving behavioral health. Along these lines we work closely with state-wide advocacy groups such as NYAPRS, and NYS ASAP. We have well established lines of communication with OASAS and to a slightly lesser extent with OMH officials in Albany. Early in this year s legislative session we submitted testimony to key budget committees, and Bud and Barry participated in two Albany advocacy days. Barry also traveled to Washington DC to attend the National Rural Health Association annual Policy Institute. He met with new congresswoman Stefanik, as well as 4 P age

representatives of senators Schumer and Gillibrand. Issues regarding rural safety net programs, rural hospitals, FQHCs and HRSA grant programs were discussed. In November we brought the McSilver Institute (MCTAC) leadership and managed care organization representatives to Lake Placid to present the North Country s only briefing on the State s transition to Medicaid managed care. As part of our Annual meeting we will provide direct comments to OMH and OASAS staff who will attend a listening session on the proposed consolidation of OMH and OASAS. Prevention Agenda: Promote Mental Health and Prevent Substance Abuse As part of the DSRIP project development process NCBHN facilitated a meeting of four of its OASAS prevention provider agencies. Ultimately the recommendations from this group were incorporated into one of the FDRHPO PHIP population health projects. On March 11 th, 2015 NCBHN in collaboration with the Northern Tier Providers Coalition, Seaway Valley Prevention Council and Citizen Advocates, presented a very well received North Country Opiate Summit also in Lake Placid. Over 100 attendees heard officials from OASAS, OMH, the provider community, families of addicts, and law enforcement in eight sessions throughout the day. The OASAS Combat Heroine web site videos and resources were featured throughout the day. Network Operations: The State of the Network: Finances As mentioned in the Board Chair s welcoming comments the state of the Network is strong. Our funding situation is stronger as we come into the 2015-16 year then it has been in many years. Our base funding from the NYS DOH Office of Rural Health will extend another 32 months. The USDA housing grant has another 26 months of support and the new PHIP HIT contract could stretch for up to 5 years. The Senator Little Suicide prevention funding has historically been renewable either every year or every other year depending on current priorities. We are also starting our one year non-renewable HRSA grant July 1. Collectively these funding sources amount to a 28% increase in operating budget for the coming year. As always with a grant funded agency it will be important that the Network leverage the robust year ahead to position the organization to attract new members, new business opportunities and new program funding to sustain the organization and continue to provide member value into the future. The State of the Network: Personnel We have worked hard over this past year to balance the programming and administrative staffing requirements of the Network with the available budget. We have restructured a couple of positions, and for the time being are outsourcing our higher level accounting functions. On July 1 we anticipate bringing on our project specific HIT Technical Assistance Specialist through a special contract arrangement with the Fort Drum Regional Health Planning Organization. Our 2015-16 staffing line-up includes: Barry Brogan, Executive Director Samantha Dashnaw, Housing Coordinator & Sr. Office Manager Bud Ziolkowski, System Redesign Sr. Project Specialist Robin Calkins, Office Manager Tracy Hart, HIT Project Specialist 5 P age

The Network s Personnel Committee has been very active this past year and has identified a number of recommended goals that they will pass along to the 2015-16 committee. These include: 1. Transition the staff health insurance benefit from a heath reimbursement account model to a health savings account model. This initiative, which included consideration of input from staff, has been approved by the Board and is anticipated in the budget proposal we are submitting to the Network. Significant tax advantages and additional flexibility in health related spending will be realized by staff, as well as potential retirement age benefits. The HSA model appears to be popular with new and younger employees and may provide an important recruiting advantage as we move forward. We are planning on a January 1, 2016 start date. The Personnel Committee will oversee the HSA implementation plan. 2. Complete a CEO compensation survey of like-structured Rural Health Networks throughout New York State. 3. Review and make more consistent all core and ancillary position descriptions and update or confirm attendant wage structures. The committee also completed their annual review of the Network Personnel Policies and Procedures. Adjustments were made in the areas of Employer termination procedure; Time worked recording procedure; Health Insurance buy-out policy; and, Employee paid leave policy. Strategic Plan Affirmation As part of the Annual meeting program we will ask Network members to again review the current Strategic Plan as we head into the third year of its implementation. There will be an opportunity for members to assist staff in prioritizing our efforts moving forward. 6 P age