IAP Medicaid Innovation Accelerator Program Medicaid Innovation Accelerator Program Physical and Mental Health Integration Medicaid Strategies for Promoting Provider Capacity for Physical and Mental Health Integration National Dissemination Webinar February 6, 2018, 3:00 pm-4:30 pm ET
Logistics for the Webinar • All lines will be muted during the presentation • You may use the chat box on your screen to ask a question or leave a comment – Note: chat box will not be seen if you are in “full screen” mode • To participate in a polling question, you will need to exit out of full screen mode • Please complete the evaluation in the pop-up box after the webinar to help us continue to improve your experience I AP Medicaid Innovation 2 I Accelerator Program
Facilitator • Laurie Hutcheson, Policy Fellow, National Academy for State Health Policy I AP Medicaid Innovation 3 I Accelerator Program
Agenda • Welcome and Introductions • Overview of the Medicaid Innovation Accelerator Program (IAP) Physical and Mental Health (PMH) Integration Initiative • Key Principles to Expand Provider Practice Capacity for PMH Integration • Insights from Two States: – New Hampshire – Hawai’i I AP Medicaid Innovation 4 I Accelerator Program
Presenters • Melissa Cuerdon, Disabled and Elderly Health Programs Group, Center for Medicaid and CHIP Services • Dr. Benjamin Miller, Chief Strategy Officer, Well Being Trust • Kelley Capuchino, Senior Policy Analyst, New Hampshire Department of Health and Human Services Division for Behavioral Health • Dr. Judy Mohr Peterson, MED-QUEST Administrator, Hawai’i Medicaid Director I AP Medicaid Innovation 5 I Accelerator Program
Medicaid IAP: Overview • A technical support program funded by the Center for Medicare and Medicaid Innovation that is led by and lives in the Center for Medicaid and CHIP Services • Supports s tates’ Medicaid delivery system reform efforts 6
Background • IAP worked with nine states over twelve months to enhance or expand diverse PMH integration approaches by providing technical support on issues such as: – Administrative alignment – Payment and delivery system reform – Quality measurement • This webinar is the third in a series of four national dissemination webinars for the IAP PMH Integration program area I AP Medicaid Innovation 7 I Accelerator Program
Participating Teams • Idaho • Illinois • Hawai’i • Massachusetts • New Hampshire • New Jersey • Nevada • Puerto Rico • Washington 8
Key Principles to Expand Provider Capacity for PMH Integration Dr. Benjamin F. Miller, Chief Strategy Officer, Well Being Trust I AP Medicaid Innovation 9 I Accelerator Program
Overview of Presentation • Context • Problem and Solutions • Enhancing Provider Capacity – Practice Level – Provider Level • Key Principles for State Policymakers • Additional Resources 10
Context for Provider PMH Integration • Recent report from the Trust for America’s Health and the Well Being Trust: Pain in the Nation • Documents a national crisis in behavioral health: – 44.7 million Americans experienced a mental health issue in 2016 – 20.1 million Americans experienced a substance use disorder – 8.2 million experienced both – One in five children/teens have had a serious mental health disorder • Recommendations for building a National Resilience Strategy 11
Problem • Behavioral health issues not identified • Providers/settings siloed • Reactive model of care 12
Solution: Practices and Providers with Capacity to Deliver Integrated Care • Evidence-based treatment strategies • Systematic mental health and substance use screening • Multidisciplinary teams with behavioral health (BH) capacity • Whole person treatment planning and care coordination • Commitment to quality improvement • Electronic health records (EHRs) • Strong linkages to clinical specialists and social services 13
Challenge: Infrastructure Workflow and Access to Care Leadership and Culture Change Tracking Patients and Using Data Davis, M., Balasubramanian, B. A., Waller, E., Miller, B. F., Green, L. A., & Cohen, D. J. (2013). Integrating Behavioral and Physical Health Care in the Real World: Early Lessons from Advancing Care Together. The Journal of the American Board of Family Medicine, 26 (5), 588-602. I AP Medicaid Innovation 14 I Accelerator Program
Challenge: Capacity to Address a Range of Needs To address all aspects of health, integrated primary care practices need the expertise and resources to appropriately treat the full range of presentations: Miller, B. F., Brown Levey, S., Payne-Murphy, J. C., & Kwan, B. (2014). Outlining the scope of behavioral health practice in integrated primary care: Dispelling the myth of the one-trick mental health pony Families, Systems & Health . 15
One State Solution: Creating Standards for Workforce 16
Developing and Disseminating Key Provider Competencies • Colorado convened the Consensus Conference to agree on eight core competencies for BH providers working in primary care • The 50+ attendees included Colorado’s provider organizations, state agencies, and university representatives • Competency = the knowledge, skills, and attitudes—and their interconnectedness necessary to work effectively in settings 17
Developing and Disseminating Key Provider Competencies (cont.) • Revisions to the core set developed were debated and finalized by conference participants the following month • Plans were developed and discussed regarding how best to disseminate to practices 18
A Few Principles for State Policymakers • Enhancing capacity begins with seeing BH as a critical facet of primary care — no different than investments in practice-based care management, measurement and other data use competencies, technology and practice transformation support • State can be a convener and disseminator/trainer regarding best practices for effective integration 19
A Few Principles for State Policymakers • Payments should allow for BH providers to not be trapped in a workflow designed to maximize volume-based payments, or pigeon holed into distinct “physical” and “mental health” coding categories where what they do is limited by set criteria • Allow for primary care practices to “own” their BH resources and be fully accountable for measured outcomes • Leverage technologies to augment or enhance BH presence in rural primary care practices 20
More Resources • Make Health Whole • Oregon.gov Behavioral Health Collaborative • Virginia's Addiction Treatment Services Delivery System Transformation 21
Thank You! Dr. Benjamin F. Miller Chief Strategy Officer Well Being Trust ben@wellbeingtrust.org 22
Q&A I AP Medicaid Innovation 23 I Accelerator Program
Overview of State Strategies to Promote Provider Capacity for PMH Integration Laurie Hutcheson, Policy Fellow, National Academy for State Health Policy I AP Medicaid Innovation 24 I Accelerator Program
State Strategies to Promote Provider Capacity State Medicaid programs have a variety of policy levers • Shift payment away from fee for service toward alternative payment models that facilitate providers adopting key practice elements of PMH integration; • Using Medicaid state plan and waiver options to support delivery system reform and models that support the care coordination and service components of integrated care; • Collaborating with public health agencies and state universities to develop/assist with provider practice PMH integration transformation trainings/learning collaboratives. I AP Medicaid Innovation 25 I Accelerator Program
State Strategies to Promote Provider Capacity (cont.) • Using managed care contracting to incent Managed Care Organizations (MCOs) to: – Promote alternative payment with provider networks; – Promote development of standardized quality measurement and effective data reporting/exchange. I AP Medicaid Innovation 26 I Accelerator Program
Building Provider Capacity for PMH Integration: New Hampshire Kelley Capuchino, Senior Policy Analyst, New Hampshire Department of Health and Human Services Division for Behavioral Health I AP Medicaid Innovation 27 I Accelerator Program
Overview of Presentation • New Hampshire Context, Background, Goals • Delivery System Reform Incentive Payment (DSRIP) waiver strategies focused on enhancing provider capacity for PMH integration – SAMHSA Clinical Framework – Comprehensive Core Assessment Process – Health Information Technology – Building Workforce Capacity – Payment Strategies • Lessons Learned 28
New Hampshire Context • New Hampshire long-standing “whole person” approach to addressing the needs of individuals • DSRIP waiver program builds on existing initiatives • Aligns delivery system to better integrate physical and behavioral health care for Medicaid beneficiaries • Key feature of waiver: Integrated Delivery Networks (IDNs) in all geographic regions of the state to ensure that providers in all areas of the state are engaged in integrated care 29
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