FAMILY DRIVEN CHILD AND ADOLESCENT HEALTH HOME SYSTEM DEVELOPMENT Confe r e nc e of L oc al Me ntal Hygie ne Dir e c tor s amilie s Committe e Childr e n and F JUNE 1 0 , 2 0 1 4
PURPOSE
PURPOSE • Sha re the wo rk c urre ntly unde rwa y b y le a de rs fro m Hillside F a mily o f Ag e nc ie s a nd No rthe rn Rive rs F a mily Se rvic e s to a sse ss the fe a sib ility o f c re a ting a re g io na l F a mily Drive n Child a nd Ado le sc e nt He a lth Ho me to c o ve r multiple c o untie s a c ro ss Upsta te Ne w Yo rk. • T his He a lth Ho me wo uld: • He lp a ssure q ua lity o f fa mily drive n, yo uth g uide d c a re ma na g e me nt to c hildre n a nd yo uth with ne e ds in the re g io n • He lp a ssure a c c e ss to the se rvic e s within the c hildre n’ s syste m o f c a re • Suppo rt c o st e ffe c tive ma na g e me nt o f the Childre n’ s He a lth Ho me thro ug h sha ring infra struc ture
PRESENTERS
PRESENTERS • T he Ro llo ut o f Adult He a lth Ho me s: • Jo hn L e e , He a lth Ho me s o f Upsta te Ne w Yo rk (HHUNY) • Pla nning fo r Childre n’ s He a lth Ho me s in NYS: • E liza b e th No la n, Hillside F a mily o f Ag e nc ie s • Hillside - No rthe rn Rive rs Childre n’ s He a lth Ho me Mo de l: • Ra y Sc himme r, CE O, No rthe rn Rive rs • Q a nd A
STATUS: ROLL OUT OF NYS ADULT HEALTH HOMES
WHAT IS A HEALTH HOME? • I t is a pro g ra m tha t pro vide s Car e Manage me nt to High Ne e d Me dic aid Re c ipie nts • All o f the pro fe ssio na ls invo lve d in a me mb e r’ s c a re c o mmunic a te with o ne a no the r so tha t a ll ne e ds a re a ddre sse d in a c o mpre he nsive ma nne r. • Me dic al, be havior al he alth and soc ial se r vic e ne e ds a re to b e a ddre sse d
HEALTH HOME SYSTEM He a lth Ca re Pro vide rs Co mmunity Re so urc e s E duc a tio n Individual & Car e Manage r Vo c a tio na l Se rvic e s Se rvic e s Ag e nc ie s Ho using
WHAT IS A HEALTH HOME? De sire d Outc ome s: • I mpro ve he a lth c a re a nd he a lth o utc o me s • L o we r Me dic a id c o sts • Re duc e pre ve nta b le ho spita liza tio ns a nd E R visits • Avo id unne c e ssa ry c a re fo r Me dic a id me mb e rs
NYS ADULT HEALTH HOMES Who qua lifie s? • Me dic a id re c ipie nt: • Ma y b e a Me dic a id Ma na g e d Ca re Me mb e r o r re c e iving se rvic e s o n a F F S b a sis. • Ma y ha ve b o th Me dic a id a nd Me dic a re • Must ha ve o ne o f the fo llo wing : • T wo o r mo re c hro nic he a lth c o nditio ns (suc h a s a sthma , dia b e te s, he a rt dise a se , BMI > 25, SUD, me nta l he a lth c o nditio n) • SMI , o r • HI V/ AI DS
NYS ADULT HEALTH HOMES Prog ra m Size : • Appro xima te ly o ne millio n Me dic a id re c ipie nts (o ut o f 5 millio n) me e t the fe de ra l c rite ria fo r He a lth Ho me s • T a rg e t e nro llme nt fo r NYS: • 2013-2014= 151,000 • 2014-2015= 225,000 T he re a re c urre ntly 49 de sig na te d He a lth Ho me s (33 uniq ue e ntitie s) se rving 58 c o untie s in the Sta te .
NYS ADULT HEALTH HOMES Who Is Providing He a lth Home Ca re Ma na g e me nt? • T a rg e te d Ca se Ma na g e me nt Slo ts a re b e ing c o nve rte d to He a lth Ho me Ca re Ma na g e me nt • COBRA Ca re Ma na g e me nt slo ts a re b e ing c o nve rte d a s we ll. • Ne w a g e nc ie s ha ve a g re e d to pro vide He a lth Ho me Ca re Ma na g e me nt to e xpa nd c a pa c ity • Ca pa c ity will b e drive n b y ne e d, no t limite d to a spe c ific numb e r o f a ppro ve d slo ts
NYS ADULT HEALTH HOMES What make s this c ar e manage me nt diffe r e nt fr om ICM/ SCM? • Slo t c a pa c ity is no t c a ppe d. Ca pa c ity is drive n b y ne e d • Ac c e ss is no t limite d to tho se in the Me nta l He a lth syste m. T ho se with SU ne e ds a nd c hro nic physic a l he a lth ne e ds a re e lig ib le • T he HH c a re ma na g e rs a re a ske d to suppo rt the me dic a l, b e ha vio ra l he a lth a s we ll a s so c ia l ne e ds o f the individua l • Sho rte r a pplic a tio n a nd simple r pro c e ss tha n use d fo r SPOA sub missio ns • Ac c e ss pro c e ss ha s b e e n simplifie d with input fro m e a c h c o unty.
NYS ADULT HEALTH HOMES Wha t ma ke s this c a re ma na g e me nt diffe re nt from ICM/ SCM? • Ca re ma na g e rs a re e nc o ura g e d to visit the individua l if ho spita lize d a nd to wo rk c lo se ly with the ho spita l / fa c ility to suppo rt a suc c e ssful disc ha rg e to a fte r c a re . • Pe r Me mb e r Pe r Mo nth (PMPM) pa yme nts drive n b y a c uity e sta b lishe d b y DOH • 3 mo nths a re g ive n fo r Outre a c h& E ng a g e me nt (pa id a t 80% o f the PMPM fo r a c tive me mb e rs) • Re po rting o f me mb e r sta tus a nd HH CM a c tivitie s a re ro utine ly re po rte d up thro ug h the Sta te ’ s He a lth Co mme rc e Syste m (HCS). • Use o f He a lth I nfo rma tio n te c hno lo g y is re q uire d
NYS ADULT HEALTH HOMES Wha t ma ke s this c a re ma na g e me nt diffe re nt from ICM/ SCM? • Ca re Pla n is to b e sha re d with o the r me mb e rs o f the Ca re T e a m a nd re -sha re d a ny time the re a re c ha ng e s • Ca se lo a d re q uire me nts a re hig he r in HH CM tha n I CM (40-50 c o mpa re d to 12-16). • NYS re q uire s a sta nda rd a sse ssme nt b e use d fo r a ll individua ls: F ACT -GP a nd HH F unc tio na l Asse ssme nt • Numb e r o f visits pe r mo nth de live re d sho uld b e b a se d upo n ne e d, unlike I CM whic h re q uire d 4 pe r mo nth.
NYS ADULT HEALTH HOMES HEALTH HOMES OF UPSTATE NEW YORK He a lth Home s of Upsta te Ne w York (HHUNY) c o ve rs 22 c o untie s in We ste rn, So uthe rn T ie r a nd Ce ntra l Ne w Yo rk • Ca re ma na g e me nt se rvic e s a re de live re d b y a ppro xima te ly 50 do wn-stre a m c a re ma na g e me nt a g e nc ie s • Administra tive func tio ns suc h a s ma king a ssig nme nts, sub mitting re q uire d tra c king a nd CMART info rma tio n, b illing (fo r no n-c o nve rting a g e nc ie s), q ua lity a ssura nc e a nd MCO re la tio nships a re ha ndle d b y HHUNY in a c e ntra lize d, c o st e ffe c tive fa shio n. • HHUNY c urre ntly ha s a ppro xima te ly 10,000 a c tive me mb e rs.
NYS ADULT HEALTH HOMES Why a re He a lth Home s Importa nt ? • Offe rs a dditio na l re so urc e s in suppo rting the ne e ds o f c o mple x, ha rd to se rve Me dic a id c lie nts • I mpro ve s pro vide r c o mmunic a tio n • He lps ma ke c e rta in tha t so c ia l ne e ds o f individua ls a re me t • Assists in a vo iding unne c e ssa ry re -a dmissio ns • Assists in a vo iding unne c e ssa ry E me rg e nc y De pa rtme nt visits • Pa rtne r in re duc ing he a lth syste m c o sts • I mpo rta nt c o mpo ne nt o f the ro ll o ut o f Ma na g e d Ca re fo r a ll
PLANNING FOR IMPLEMENTATION OF CHILDREN’S HEALTH HOMES
CHILDREN’S HEALTH HOME IMPLEMENTATION opic s to c ove r : T • Ho w do we se e the c hildre n’ s a ppro a c h ne e ding to b e diffe re nt fro m the a dult a ppro a c h? • T he Sta te ’ s visio n a nd pla n fo r Childre n’ s He a lth Ho me a nd the g o o d wo rk the y a re do ing • T ime ta b le
CHILDREN’S HEALTH HOME IMPLEMENTATION How do we se e the c hildr e n’s a ppr oa c h ne e ding to be diffe r e nt fr om the a dult a ppr oa c h? • Childre n a nd yo uth ha ve diffe re nt c a re ne e ds tha n a dults • A fo c us o n c hro nic c o nditio ns is mo re a pplic a b le to a dults • Childre n a re still de ve lo ping . E ve n se rio us BH c o nditio ns ide ntifie d in e a rly c hildho o d c a n o fte n b e re so lve d whe n tre a te d a ppro pria te ly • Childre n with se rio us BH c ha lle ng e s do no t ha ve the sa me hig h ra te s o f e xpe nsive c o -mo rb id physic a l he a lth c o nditio ns a s fo und in a dults with SMI . • Childre n with se rio us BH c o nditio ns te nd to ha ve dia g no se s diffe re nt fro m tho se o f a dults with SMI (ADHD, e tc .) • Ne e d to c o nside r invo lve me nt o f c hild we lfa re a nd / o r juve nile justic e . • Ca re ma na g e me nt ne e ds to fo c us o n b o th the c hild a nd his / he r fa mily/ c a re g ive rs… A fa mily drive n yo uth g uide d syste m o f c a re is e sse ntia l. • Ca re ma na g e me nt tha t wo rks fo r c hildre n ma y b e mo re c o mple x tha n tha t whic h wo rks fo r a dults … Invo lving fa mily, DSS, e tc .
HEALTH HOMES ARE A CRITICAL PART OF MRT ACTION PLAN TO FUNDAMENTALLY REFORM THE MEDICAID PROGRAM CARE MANAGE ME NT F OR AL L UNIVE RSAL ACCE SS T O HE AL T H HIGH QUAL IT Y HOME S PRIMARY MRT CARE MUL T I-YE AR ACT ION PL AN T ARGE T ING GL OBAL SOCIAL SPE NDING DE T E RMINANT S CAP OF HE AL T H 21
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