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$ 15 $1.4 1.89 Billion Billion for Million In 2016 Behavioral - PowerPoint PPT Presentation

Nov 20, 2022 •270 likes •348 views

$ 15 $1.4 1.89 Billion Billion for Million In 2016 Behavioral Health Members 70% in 40% of 62% Mental Health Managed State 14% Substance Use Care Budget 24% Pharmacy Network Covered Management Services and for Quality Delivery

  1. $ 15 $1.4 1.89 Billion Billion for Million In 2016 Behavioral Health Members 70% in 40% of 62% Mental Health Managed State 14% Substance Use Care Budget 24% Pharmacy

  2. Network Covered Management Services and for Quality Delivery Improvement Models Quality Financing and Measurement Payment & Monitoring Models Network Development & Technical Assistance

  3. Towards a Strong, Sustainable System of Community-Based Care: Improve Access, Coordination, and Continuity of Care Across the Continuum Outpatient Behavioral Inpatient Behavioral Health Care Health Care • Behavioral Health Care • Range of crisis • Recovery communities Fully Integrated into stabilization services integrating housing, Primary Care woven into fabric of local treatment, recovery and communities • Screening and Early social supports • Timely, Equitable Access • Safe, Timely, Equitable, Intervention • Expansion of Urgent Care • Care Planning with Inter- to Full Range of Evidence- Efficient, and Patient • Chronic Condition Management agency Coordination • Enhanced Community-based Centered Care for Acute Based Mental Health & • Awareness-building and crisis ESP / Mobile Crisis Intervention • Access to Community-Based Behavioral Health SUD Treatment prevention • Expansion of Select Diversionary Services and Episodes • Open /Real-time Access to OP Diversionary Services Recovery Supports Care • Expanded Capacity and • Access to Residential Care and • Robust Care Coordination and Automated capacity Supportive Housing teaming across continuum management • Evidence-Based Practice • Enhanced Inpatient settings for Complex, Specialized Care • Accountability for transitions Urgent and Diversionary Community Stabilization Primary Behavioral Health Care and Residential Care Care Evolve Delivery Models, Identify Financing, Build Capabilities & Infrastructure

  4. Towards a Strong, Sustainable System of Community-Based Care: Advancing Value- Based System Transformation “Within the Waiver” Access Within the Waiver: Strategies to Further Strengthen the System • Network Adequacy • Open Access • Capacity Growth and Retention Network/ Quality Payment System Design Management 1115 Waiver Implementation & Alignment: Coordination & Continuity Rate Quality Reporting ESP Optimization • ACOs Normalization & Monitoring • Bi-Directional Communication • BH/LTSS CPs • Effective Transitions of Care • SUD Waiver • Wrap Services & Supports Directed Network ED Boarding Payments for • Managed Development & Reduction Specialized Management Services LTSS Technical Quality SUD System BH Payment Assistance for Redesign Innovations Integration • Performance Measurement &Transformation • Evidence-Based Practices • Continuous Improvement Infrastructure within MassHealth & Delivery System

  5. Leveraging Digital to Support System Transformation: From Optimizing Access to Optimizing Intervention • Extend / expand workforce • Enable timely access Access • Reduce no shows • Facilitate primary care/hospital consultation with psychiatry/addiction medicine/specialized BH • Crisis intervention rapid response and triage Integration • Facilitate case management/collaborative care • Concentration of most intensive face-to-face services and supports around highest risk members • Remote/digital therapeutic interventions coupled with CSP, recovery, and peer supports Efficiency • Optimizing clinical workflows for intake and assessment • Integration of platforms for digital self-management and social/peer support with real time alerts and tele- access to case management and clinical services • Interoperability with scheduling, messaging, EHR, care management systems Extensibility

  6. Leveraging Digital to Support System Transformation: From Optimizing Access to Optimizing Intervention • Extend / expand workforce • Enable timely access MassHealth MCEs currently provide coverage Access • Reduce no shows for telepsychiatry and teletherapy with established patients. • Facilitate primary care/hospital consultation with psychiatry/addiction medicine/specialized BH • Crisis intervention rapid response and triage Integration • Facilitate case management/collaborative care We are conceptualizing the potential of mobile integrated health to connect the EMS and ESP systems. • Concentration of most intensive face-to-face services and supports around highest risk members • Remote/digital therapeutic interventions coupled with community service, recovery, and peer supports We are exploring how alternative payment Efficiency • Optimizing clinical workflows for intake and assessment models could allow for more flexible combinations of live and virtual interventions. • Integration of platforms for digital self-management and social/peer support with real time alerts and tele- access to case management and clinical services 1115 Waiver provides DSRIP dollars to ACO and • Interoperability with scheduling, messaging, EHR, care management systems Extensibility CP to support investment in technologies to improve engagement and outcomes.

  7. Seeking Solutions that: - Demonstrate Efficacy - Understand themselves in the broader context of value-based care - Can successfully develop partnerships within the existing system

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