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1Navigating the Transition to ManagedCare for Individuals with Intellectual andDevelopmental Disabilities (I/DD)August 30, 2018HCBS Conference
2DisclaimersThe New York Office for People with Developmental Disabilities and MediSked arenot engaged in a contractual relationship. OPWDD is the entity driving thetransformation in New York State and MediSked, LLC holds contracts with each ofthe seven CCO/HHs in New YorkThe opinions expressed in this presentation should not be construed as advice tocare for specific individualsAllison McCarthyAssistant Director, NYS Office for PeopleWith Developmental Disabilities Divisionof Person Centered ServicesDoug GolubPresident, MediSked
3The Office for People WithDevelopmental Disabilities’(OPWDD’s) Commitment Ensure that people withdevelopmental disabilities receivesupports that are person-centered,flexible, easy to access andresponsive to individual needs &preferences. Advance system to provide highquality outcomes-based supportsthat include health and wellness;and prepare for transition toManaged Care.
4MediSked Care Coordination SolutionsThe leading brand in holistic solutions that improveslives, drives efficiencies and generates innovationsfor human service organizations that support ourcommunityMediSked Solutions Support: Individuals & their Circles ofSupport Provider Agencies State & Administrative Oversight Care Coordination OrganizationsOut-of-the-box Solution include: 1115 Waiver Transformation in NY Meets all Health Home requirements MCO Readiness
5 Overview of NYS’ transition plan toachieve more integrated, holistic,and flexible service planning;AGENDA Attributes of the IT system adoptedby CCO/HHs, and how elementscan be used for planning,communication, and monitoring; Best practices and lessons learnedfrom Phase One, including how tosuccessfully introduce IT to caremanagement and habilitationsupports, both in New York andother states.
6NYS IDD Transformation2014Phase 0:The first FIDA-IDDcare managementprogram in the US isformedPhase I:I/DD targeted HBCSand I/DD populationsare transitioned toCare CoordinationOrganization CareManagementPhase II:Voluntary enrollment inI/DD specializedmanaged care planswith I/DD benefitAugust 2018Phase III:Mandatory enrollmentinto managed careplans2022
7What is People First Care Coordination?A connected group of health care and serviceproviders for developmental disabilities workingtogether – for individuals and families. Care Coordination Organizations (CCOs) are neworganizations designed by providers with I/DDexperience to:– Coordinate services across multiple systems, primary care,behavioral health, community-based services– Develop and manage specialized Person-Centered LifePlans, with the individual and family, based on his/herneeds– Increase accountability for a person’s well-being by drivingvalued outcomes
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9The Goals of People FirstCare Coordination1. Enhance person-centered planningand focus on outcomes2. Create a foundation of personcentered planning for specialized DDmanaged care3. Eliminate conflict of interest4. Incorporate a person's services in asingle Life Plan overseen by a caremanager5. Incentivize performance6. Keep the same level of familyinvolvement as before7. Develop/train Medicaid ServiceCoordinators (MSCs) as Care Managers
10CCOs are Required to Provide SixCore Services Through HealthHome Care ion idual &HealthHome CareManagerReferral toCommunity &Social al &Family Support
11How to Get There? Communicate early and oftenListen to, and hear stakeholdersProvide resourcesBuild on the strengths of the current systemSet forth in governing documents clear anddetailed expectations Consider both the short and long term goalsin the model design Commitment
12Care Coordination Organization (CCO)/HealthHome (HH) Implementation TimelineAugust 2017 Public Comments on Draft CCO Application received 1115 Waiver Amendment posted for public commentSummer 2017 DRAFT State Plan Amendment shared with CMS to add I/DDdiagnoses as a single qualifying diagnosis for Health HomesOctober 2017 Final Health Home application releasedDecember 2017 Designation applications due to OPWDD/DOH, includingproposed Care Management Networks 1115 Transition Plan is published for public commentDec. 2017– Feb. 2018 Review and approval of Health Home Applications by the State;awarding of grantsFeb. – June 2018 Completion of CCO/HH and network partner readiness reviewand activitiesJuly 1, 2018 Transition to I/DD Health Home Care Management
13NYS I/DD TransformationResources Background and Policy Information for ServingIndividuals with Intellectual and/or DevelopmentalDisabilities Individuals with Intellectual and/or DevelopmentalDisabilities (I/DD) 1115 Waiver Transition State Plan Amendment FAQs Webinars CCO/HH Provider Manualhttps://www.health.ny.gov/health care/medicaid/program/medicaid health homes/idd/index.htm
14CCO Education and OutreachFall/Winter 2017& Spring 2018Began in December 2017and Continue Today Regional ForumsHosted across the state to educate individuals andfamilies about CCOS and the care managementservices available Information SessionsIn December 2017, OPWDD began offering webinarsas part of ongoing efforts to support the transition CCO SummitsFebruary & April 2018Two, two day, summits held in February and Aprilwith the CCOs to discuss enrollment and readiness
15Care Manager Toolkit Developed OPWDD, in collaboration with stakeholders, developeda “Toolkit” for MSCs to use as a resource as theyeducated individuals and families and assisted them asthey transitioned to care management The toolkit consists of:-CCO Informational BrochureScripts for MSCs to engage and educate individuals andfamiliesExample Individualized Information Letter that will go toindividuals and families about transitioning to CCODocuments for the individual’s selection of care managementFrequently Asked Questions Supplemental Resources:– FAQs and Step-by-Step Training Guide
16CCO/HH ApplicationRequirement Overview1. Person-CenteredComprehensiveAssessment4. OPWDD Integrationincluding CareCoordination DataDictionary Compliance2. Integrated CQLPersonal OutcomeMeasures (POMs)3. Integrated Health andSafety Supports,Individual ProtectiveOversight Plans (IPOP)5. Use of Electronic LifePlan6. Electronic CareCoordination Systemwith CommunicationsAmong Circle ofSupports7. Meets I/DD HealthHome Requirements8. Data Exchange withRegional HealthInformationOrganizations (RHIOs)
17Electronic Person-CenteredLife Plan Description of the person and demographic information Desired quality of life, health, and functional outcomes Safeguard description and supports needed to reducethe likelihood of harm Employment status; Services, including physical, behavioral health, andHCBS long term services and supports Behavioral support needs Physical health conditions and treatment information Emergency plan
18I/DD Tailored Quality MeasuresGoal: Improve outcomes (health/personal/social) for individuals with I/DD through care coordinationMeasuresData SourceMeasure DescriptionImplementation of Councilon Quality Leadership(CQL) Personal OutcomeMeasures (POMs)*CCO ReportingPercentage of Life Plans that have minimum of two POM measures. CCO mustrecord in Life Plan Personal Outcome Measures(POM) drawn from CQL reportingguidelines. Life Plan must reflect at least three personal goals, of which two mustbe POM directed.Implementation of personalsafeguardsCCO ReportingPercentage of Life Plans that reflect personal safeguards for all enrollees. CCOmust record personal safeguards in Life PlanTransitioning to a moreintegrated settingClaims TABSOf those enrollees who are in a 24-hour certified setting, the number/percentage ofenrollees who move to a more integrated settingEmploymentCCO ReportingOf those enrollees who indicate in their Life Plan they choose to pursueemployment, the number/percentage of individuals who are employed (comparedto the previous reporting period). CCO will record enrollee progress and verifysupport to find and maintain community integrated employment in Life Plan.Self-directionClaimsOf those enrollees who select self-direction as indicated in the Life Plan, thenumber/percentage of individuals who enroll in self- direction) compared to theprevious reporting period). CCO will identify those who choose to self-direct theirsupports and services with either or both employer authority and budget authority inthe Life Plan
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20CCO Regional Coverage Map
21Health ITRequirementsAugust 30, 2018HCBS Conference
22Highlighting the InformationTechnology RequirementsEach Care Coordination Organization Must: Adhere to all State & Federal legal, statutory & regulatoryrequirements Have structured information systems, policies and practices toelectronically create, document, execute and update a LifePlan for every enrollee Have an electronic record system to allow each enrollee’sinformation to be shared among the team of providers Use health technology and a health record system that’squalified under the national HITECH Act Commit to joining regional health information networks fordata exchange & data sharing Support the use of evidence-based decision-making tools &consensus guidelines to achieve optimal outcomes
23Preparing for NY Transformation2014: OPWDD CareCoordination Pilot beginswith MediSked, PHP, and fiveproviders “It’s All About MeAssessment” firstOPWDD approvedcomprehensiveassessment.2014-2015: PHP Approvedby CMS to as only FIDADD in the US. Model ofCare receives score of95% from CMS. MediSkedsystems used throughout.2016201420132012-2013: Partnership with PHPand five providers to design andimplement care coordination datadictionary and model of care Comprehensive Assessment CQL Valued Outcomes/Healthand Safety Supports Life Plan/ISP Hab Plan/Active TreatmentPlan Goals, Supports, Tasks Observation Charts Monthly Summaries Notification of Change2016: PHP beganenrolling first everOPWDD dualeligible members inManaged Care on4/1/2016 throughFIDA.MediSked continues tohost the CareCoordination platformfor Partner’s HealthPlan’s FIDA-IDD CareComplete Plan.20152015: MediSked CareCoordination Stack passesCMS/DOH/OPWDD review2015: Coordinate Life Planapproved to replace ISPrequirements
24CCO/ HH Health ITImplementation Milestones
25Model of Care Using MediSked Software StackAssessmentReview ofProgress /AnalyticsNotification ofChangeLife PlanCare Coordination OrganizationProvider AgencyModel of CareMonthlySummaryStaff ActionPlan, IPOPCharting, DailyGoals andSupports25
26All Seven Regional Groups Use MediSkedCare Coordination Suite for NY IDD CCO lity-Care-Coordination
27Comprehensive CareManagement ToolCare ManagementCare CoordinationAugust 30, 2018Individual FamilyHCBSTransitionalCareConferenceSupportSocial Service ReferralHealth InformationExchange / HealthcareInformation Technology
MediSked Coordinate – Care Management PlatformMediSked Coordinate is the platform dedicated to the daily activities of CareManagement, and is intended to be used daily by Care Managers, along withother CCO/HH employeesActivities include: Individual RecordManagement Plan Development Event/Contact Logging Information Sharing Reporting Task Workflows Note Audit Billing
29MediSked Coordinate – Life Plan Development CCOs create, edit and review current orpast Life Plans and associated servicedelivery information, including: Personal outcome measures(POMs) Individualized plans of protectivecare Needed supports and services Plan progress toward goals andvalued outcomesIntegrated with IAM assessment, todynamically populate Life PlanCCO to document, edit and review planmeetings, attendance and minutesCCO to share draft and completed LifePlans with the individual and membersof his or her IDT using the MediSkedPerson-Centered Portal
30Assessment Development Crafted to ensure people are living richerlives Questions are written so that everyone canhave their voice heard Experienced psychologists collaborated withindividuals and their families to develop anextensive assessment Input from CQL, Self Advocacy Association(SAANYS), providers, and industry thoughtleaders
31Comprehensive Assessments Populates LifePlanAssessment dynamically populates care managementplatform to assist Care Manager in: Scheduling facilitating planning meetings Life Plan approval process Sharing information with service provider agencies
ConsentMediSked Coordinate drives timely collection and review of Member consent documentationthrough the use of structured workflowsEnrollNY IDDCCO HH(TBD)HH DOH5055(Over ateAssessmentand PlanningProcessConsent to EnrollConsent to ReferHH DOH-5201(Under 18)Consent to Share Information
33Regional Health InformationOrganization (RHIO) Overview Regional Health Information Organizations(RHIOs) bring together health carestakeholders within a defined geographicarea and govern health informationexchange among them New York is served by eight RHIOs acrossthe state, all connected to SHIN-NY Traditionally, RHIOs have focused onaggregating traditional clinic health data
34Individual and FamilyAccessAugust 30, 2018HCBS Conference
MediSked Portal – Person-Centered Platform The Portal is a web-based tool that allows people, providers and any family member aperson chooses to get a clear, complete view of life and records to track plans, services, andeven message directly with the Care Manager List view shares individuals that are associated with that provider/member agency Family members/natural supports/other service providers may be granted access Securely view and share information (messages, forms, charts, plans) depending on thelevel of access
36Population Data Collectionand Business IntelligenceToolAugust 30, 2018HCBS Conference
MediSked Connect Exchange –Multi-Agency Business Intelligence PlatformA multi-agency business intelligence platform,MediSked Connect Exchange is being leveraged toexpand the breadth of available data and superchargetraditional care coordination tools and workflows inNew York Enables real-time population management andenterprise reporting for CCO/HH across the state Includes powerful reporting tools and a customreport builder to allow CCO/HH entities to viewtrends and outcomes across the state Comprises tools to perform quality oversight andperformance management
38NY IDD CCO HH Quality MeasuresDD-focused quality measures were developed to track performance andhelp manage quality outcomes using stakeholder engagementInpatient staysEmergency room visitsDisease-Related Care for Chronic ConditionsPreventive CareTransitional CareCQL POMs (3 Personal Goals, 2 POMs)Implementation of Personal Safeguards (IPOP)Transitioning to a More Integrated SettingEmploymentSelf DirectionBladder and Bowel ContinenceFallsChokingSupporting Individuals’ Transition from Institutional Settings to Community SettingsCore Responsibilities Ensure high quality caremanagement services Monitor quality andperformance Track and report keyperformance measures toCMS and stakeholders
39Best Practices and LessonsLearnedAugust 30, 2018HCBS Conference
40Individuals EnrolledJuly 1, 2018Total Enrolled: 99,28796.77% of total populationHealth Home Care Management:97.04% of total enrolledBasic HCBS Plan Support:2.96% of total enrolled
41Bringing it All Together To be successful, strong stakeholdercollaboration is vital Ensuring the tenants of person-centeredapproach in implementing managed care Early investment and piloting helpsachieve incremental change Choosing a vendor with the ability andflexibility to meet the requirements
42NY IDD CCO/HH TimelineThe CCO enrollment process began in April and ran through July 2018. This process required coordinationacross the Individuals’ existing MSCs, the MSC Provider Agencies, OPWDD and the CCOs.CCO HH’sNov – DecJan - ilMayJuneJulyAugust.Readiness Review CompletedRHIO Integration and MaintenanceCCO and Service Selection RecordedMSCConsents submitted to CCOEnrollment/Disenrollment Roster Sent to CCOsNYS OPWDDMSC Provider AgencyCCO Care ManagerIndividual DataUploaded to CCOConsents Uploaded to CoordinateHH Transition Checklist CompletedQualityReportingDDP2 -- CAS
43How to Ensure a Quality Transition Be an active participant implementing in thesechanges Communicate. Communicate. Communicate.– Across all levels of your organization– With colleagues and families Help families and everyone who has contact withthem understand what to expect Learn to articulate the “value proposition” Articulating value and be accountable foroutcomes – culture, data, HIT systems, etc.
44Thank YouQuestions?August 30, 2018HCBS Conference
OPWDD is the entity driving the transformation in New York State and MediSked, LLC holds contracts with each of . drives efficiencies and generates innovations for human service organizations that support our community. . – FAQs and Step-by-Step Training Guide. 15. CCO/HH Application Requirement Overview. 16. 1. Person-Centered Comprehensive
