Transcription
www.The NationalCounc il.orgThe National Landscape: Health Homes,Accountable Care Organizations andIntegration and Its Impact on MassachusettsKathleen Reynolds, LMSW ACSWNational Council for Community Behavioral HealthcareJuly12, 2012
www.The NationalCounc il.orgOverview A changing landscapefor behavioral health Medicaid expansion andthe influx of newconsumers New approaches toorganizing care Demonstrating value andaccountability: Are youready?
www.The NationalCounc il.orgAffordable Care Act – Four Key Strategies
www.The NationalCounc il.orgDelivery SystemRedesign –Health Homes(Medical Homes)
www.The NationalCounc il.orgStatus 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
www.The NationalCounc il.orgPerson-Centered Healthcare Homes: Anew paradigm Picture a world where everyone has.– An Ongoing Relationship with a responsiblehealthcare provider– A Care Team that collectively takesresponsibility 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?
www.The NationalCounc il.orgDefining the Healthcare HomeSuperbAccess toCarePatientEngagement amCarePerson-Centered Healthcare HomePatientFeedbackPubliclyAvailableInformation
www.The NationalCounc il.orgDefining the Healthcare HomeSuperbAccess toCare Everyone has a health home practitionerand team Patients can easily make appointmentsand select the day and time. Waiting times are short. Email and telephone consultations areoffered. Off-hour service is available.
www.The NationalCounc il.orgOpen Scheduling Same Day Access Model –Consumer Engagement Standards1.2.3.4.Master’s Level assessment provided the same day ofcall or walk in for help (If the consumer calls after 3:00p.m. they will be asked to come in the next morningunless in crisis or urgent need)Initial diagnosis and assessed service needs determinedLevel of care and benefit design identified with consumerthat includes an estimate of time neededInitial treatment plan developed based on benefit designpackage– 2nd clinical appointment for TREATMENT within 8 days ofinitial intake– 1st medical appointment within 10 days of initial intake9
www.The NationalCounc il.orgDefining the Healthcare HomeClinicalInformationSystems Systems support high-quality care,practice-based learning, and qualityimprovement. Practices maintain patient registries;monitor adherence to treatment; haveeasy access to lab and test results; andreceive reminders, decision support,and information on recommendedtreatments. There is continuous learning andpractice improvement.
www.The NationalCounc il.orgDefining the Healthcare HomeCareCoordination The health home team engages in carecoordination & management within theteam The team also coordinates with otherhealthcare providers/organizations inthe community Systems are in place to prevent errorsthat occur when multiple physicians areinvolved. Follow-up and support is provided.
www.The NationalCounc il.orgCare Coordination The Care Coordination Standard: When I need tosee a specialist or get a test, including help formental health or substance use problems, help meget what I need at your clinic whenever possible andstay involved when I get care in other places. Services are supported by electronic health records,registries, and access to lab, x-ray, medical/surgicalspecialties and hospital care.
www.The NationalCounc il.orgAre you ready to be a healthcarehome? Do you Have a provider team with a range of expertise(including primary care)?Coordinate consumers’ care with their healthproviders 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 theseactivities?
www.The NationalCounc il.orgHealth Homes Serving Individuals withSMI and Substance Use Disorders1. Assure regular health status screening and registrytracking/outcome measurement2. Locate medical nurse practitioners/primary carephysicians in MH/SU facilities3. Identify a primary care supervising physician4. Embed nurse care managers5. Use evidence-based practices developed to improvehealth status6. Create wellness programs
www.The NationalCounc il.orgNew Paradigm – Primary Care inBehavioral Health OrganizationsFunding starting toopen up forembedding primarymedical care intoCBHOs, a criticalcomponent ofmeeting the needs ofadults with seriousmental illnessClinical Design for Adults with Lowto Moderate and Youth with Low toHigh BH Risk and ComplexityFoodCBHOMartClinical Design for Adults withModerate to High BH Risk andComplexityFoodCBHOMartPrimary CareClinic sessment,PCPconsultation,caremanagementand directservicePartnership/Linkage withSpecialty CBHOfor persons whoneed their carestepped up toaddressincreased riskand complexitywith ability tostep back toPrimary CareCommunity Behavioral HealthcareOrganization with an embeddedPrimary Care Medical Clinic withability to address the full range ofprimary healthcare needs ofpersons with moderate to highbehavioral health risk andcomplexity
www.The NationalCounc il.orgAccountable CareOrganizations
www.The NationalCounc il.orgOn Your Mark, Get Set, ACO Accountable CareOrganizations bringtogether healthcarehomes, specialty care,and ancillary services
www.The NationalCounc il.orgCore Principles of an ACO Directed by a coordinated set of providers Provides a full continuum of care to patients andpopulations– Healthcare homes, specialty care, hospital, casemanagement, care coordination, transitions betweenlevels of care and more Financial incentives aligned with clinical goals Cost containment Enhancement of care quality and the patientexperience Improvement of overall health status
www.The NationalCounc il.orgGetting to the ACO TableAre you in conversation with local integrated healthsystems and at the table of ACO developmentefforts in order to “pitch” theimportance of MH/SUD servicesto improving quality and bendingthe cost curve and building acase for how you can help theseorganizations succeed in the newworld of risk?
www.The NationalCounc il.orgInitial 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 MetropolitanArea (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 YorkCity (the Bronx) and lower Westchester County, NY 7. Brown & Toland Physicians San Francisco Bay Area, CA 8. Dartmouth-Hitchcock ACO New Hampshire and EasternVermont 9. Eastern Maine Healthcare System Central, Eastern, andNorthern Maine 10. Fairview Health Systems Minneapolis, MN MetropolitanArea 11. Franciscan Health System Indianapolis and Central Indiana 12. Genesys PHO Southeastern Michigan 13. Healthcare Partners Medical Group Los Angeles andOrange Counties, CA 14. Healthcare Partners of Nevada Clark and Nye Counties, NV 15. Heritage California ACO Southern, Central, and CostalCalifornia 16. JSA Medical Group, a division of HealthCare PartnersOrlando, 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 andParker counties in North Texas 21. OSF Healthcare System Central Illinois 22. Park Nicollet Health Services Minneapolis, MN MetropolitanArea 23. Partners Healthcare Eastern Massachusetts 24. Physician Health Partners Denver, CO Metropolitan Area4 25. Presbyterian Healthcare Services -Central New MexicoPioneer Accountable Care Organization Central New Mexico 26. Primecare Medical Network Southern California (SanBernardino and Riverside Counties) 27. Renaissance Medical Management Company SoutheasternPennsylvania 28. Seton Health Alliance Central Texas (11 county areaincluding 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
www.The NationalCounc il.orgHealth IT at the Heart of the ACOFramework Builds patient-centric systems of careImproves quality and costCoordinates care across participating providersUses IT, data, and reimbursement to optimize resultsBuilds payer partnerships and accepts accountabilityfor the total cost of care Assesses and manages population health risk Reimbursed based on savings and quality value
www.The NationalCounc il.orgHealthcare Reform ContextUnder an ACO model, the value of healthcare serviceswill depend on our ability to:1. Be accessible (fast access to all needed services)2. Be efficient (provide high-quality services at lowestpossible cost)3. Connect with other providers (via electronicinformation exchange)4. Focus on episodic care needs5. Produce outcomes
www.The NationalCounc il.orgPartnering with Health Homes andAccountable Care Organizations National Council reporthttp://www.thenationalcouncil.org/cs/acos and health homes Webinar with Dale Jarvis &Laurie rdings presentations Live hat/
www.The NationalCounc il.org
www.The NationalCounc il.orgQuestions?Kathleen Reynolds LMSW ACSWkathyr@thenationalcouncil.org734.476.9879
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
