New York State Behavioral Health Value Based Payment Readiness Program Workplan and Budget Templates
February 8, 2018 2 Table of Contents • • Purpose Quality Oversight • • Upcoming Dates Clinical Integration • • Preliminary Workplan Annual Budget • • Organizational Structure Resources • Data Analytics
February 8, 2018 3 Purpose • This funding opportunity aims to help prepare behavioral health providers to engage in Value Based Payment arrangements. • The final deliverable is to contract in a Level 2 or higher arrangement as a Level 1 provider network or as a contracted entity in a Level 2 or higher arrangement. • A main goal is to improve the integration of physical and behavioral health. • The funds are intended to be used to enhance quality care through clinical and financial integration and the use of community- based recovery support services. • Funds will also allow the BHCC to collect, analyze, and respond to service data to improve behavioral and physical health outcomes.
February 8, 2018 4 Upcoming Dates First Year One Payment: Upon contract signature between BHCC lead entity and MCO partner* Preliminary Workplan Due: March 22, 2018 Second Year One Payment: After preliminary workplan approved
5 VBP Readiness Preliminary Workplan
February 8, 2018 6 Major Workplan Areas The BHCC preliminary workplan template includes each of the four BHCC readiness areas: • Organization Structure • Data Analytics • Quality Oversight • Clinical Integration
February 8, 2018 7 Preliminary Workplan • Release of BHCC Year One Second Payment, and any subsequent funding is contingent upon submission and approval of the preliminary workplan. • Submitted preliminary workplan must include a timeline for each workplan area, which ties back to the proposed budget.
8 Organizational Structure
February 8, 2018 9 Organizational Structure and Rules 1. Describe in detail BHCC Entity Type, i.e. IPA, independent network of providers, etc. (current or projected); and directional purpose of the BHCC 2. Describe and detail a plan, including a schedule and activities for communication and engagement activities A. Within the BHCC B. With the BHCC MCO partner -This must include a discussion about submission of: Quarterly summary status report and other means of engagement (e.g. phone call(s) if needed)
February 8, 2018 10 BHCC Network and Affiliate Providers 1. Update and submit the BHCC Member Submission Template (Excel) https://www.omh.ny.gov/omhweb/bho/bhcc_member_submission_template_09152017.xlsx 2. Submit initial organizational chart 3. Describe plan to: 1. Address BHCC gaps, if any, in care continuum 2. Create BHCC Membership Standards 3. Create a process for Joining/Leaving/filing a grievance with the BHCC
February 8, 2018 11 Financial Structure Plans and timelines to support: 1. Bringing in the input of BHCC: OMH Art 31, OASAS Art 32, and designated HCBS BHCC provider partners in decisions regarding funds allocation and for funds distribution to support BHCC activities in the four readiness areas 2. Collecting dues (if any) 3. Identifying funding sources beyond the BH VBP Readiness Program 4. Developing a Sustainability Plan Submit proposed State-provided budget Budget should include summary of items and activities for each readiness area as described, but not limited to those, in the budget template provided by the State.
12 Data Analytics
February 8, 2018 13 Data Management and Reporting Plans and timelines to support: 1. Identifying, by MCO, total MMC enrollees served by the BHCC 2. Identifying ongoing service utilization trends in Physical Health, Behavioral Health, Medication Assisted Treatment for Substance Use Disorders (SUD), Social Determinants of Health, and BH Home and Community Based Services
February 8, 2018 14 Data Analysis and Sharing Plans and timelines to support: 1. An Assessment of IT capability, including: • Applications/software used (e.g. EMRs) • Plan for sharing IT infrastructure • Plan for addressing confidentiality and consent issues • Data necessary for dashboard development, clinical data sharing, cost and quality reports for relevant stakeholders 2. Selection or design of a shared IT platform • Analysis should consider relationship to potential VBP contract requirements and existing regional IT resources 3. Overcoming barriers to the above IT goals
February 8, 2018 15 Shared IT platforms and tools • Ability to support internal and external: – Care coordination - Analytics – Communication - Customizable • NYS strongly encourages BHCCs to partner with one another and/or other regional entities such as: Performing Provider Systems -Medicaid managed care plans - - PSYCKES -Hospitals - RHIOs -Primary Care Providers
February 8, 2018 16 Using data Plans and timelines to support: 1. Using data to develop a BH and support services gap analysis for BHCC services areas 2. Implementing performance dashboards 3. Implementation and ongoing monitoring of care planning 4. Evaluating improvement opportunities and collaborate with MCOs 5. All data activity must be HIPAA and 42 CFR Part 2 compliant
February 8, 2018 17 PSYCKES • PSYCKES has developed three utilization reports for VBP: 1. Payer Mix 2. Provider Network 3. Volume and Service Setting • See recorded webinar and slide deck at: http://www.ctacny.org/training/psyckes- utilization-reports-webinar
February 8, 2018 18 PSYCKES Utilization Reports 1. Payer Mix – Which Managed Care Plans and product lines are my clients enrolled in? – Which plans and product lines should I focus on? WHY? 2. Provider Network – Which other providers do I share clients with, for what service types? • For example, my mental health clinic clients use which SUD services, medical ERs, or outpatient medical services? – Who should I partner with?
February 8, 2018 19 PSYCKES Utilization Reports 3. Service Setting and Volume – What services are my clients using? – from me – from other providers? – How many encounters per year, by service type (at my agency, at other providers, and in total)? – How can I use this volume data to model costs?
20 Quality Oversight
February 8, 2018 21 Quality Measurement and Reporting 1. Plans and timelines to support: A. Determining measures to use to monitor internal performance for continuous quality improvement B. Reporting collected metrics and outcomes to BHCC partners 2. A description of current VBP outcome and/or performance arrangements in the BHCC Member Submission Template
22 Clinical Integration
February 8, 2018 23 Clinical Integration Protocol and Standards 1. Plans and timelines to support: A. Development of clinical practices, protocols and service coordination activities that support care coordination and clinical activity integration across the BHCC B. Responding when access issues or quality indicators are not being met among the BHCC providers C. Monitoring individual programs for compliance with BHCC quality expectations and for corrective action when problems are identified among the BHCC providers
24 Annual VBP Budget
February 8, 2018 25 Release of Funds Program Year One: • First Payment upon final contract between BHCC entity and the BHCC plan Partner. • Second Payment upon submission, review and approval of preliminary workplan Program Year Two and Three: Parallel the State Fiscal Year (4/1/xx – 3/31/xx) • Payments released at two points in program year (anticipated release at six month intervals) • Payment release contingent upon submission, review and approval of updated workplans and deliverables. Note: Unspent funds may be carried forward into the next program year
February 8, 2018 26 BHCC and Lead Agency Acceptance of Funding Terms and Conditions 1. BHCC funds will be used only for approved readiness activities. Funds will be distributed based on BHCC policy and rules. 2. The lead agency, on behalf of the BHCC, will submit all required program items to the designated MCO. 3. The State reserves the right to retroactively review work plan activities and deliverables, and recoup BHCC funds from the lead provider in the event it is determined it inaccurately represented activity and/or progress.
February 8, 2018 27 BHCC and Lead Agency Acceptance of Funding Terms and Conditions Readiness Area : Organization Items eligible for funding include but are not limited to: Connectivity with entities across and beyond the BHCC, Formation of committees within the BHCC to ensure compliance and consistency, Creating governance and decision-making structures, Developing plans to address network gaps, Dues payment including any arrangements for smaller agencies, Plans to manage BHCC member concerns and issues, and Contracting with legal/business consultants Activities / Items (insert rows as necessary) SFY 2017-18 SFY 2018-19 SFY 2019-20 Total Total for BHCC:
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