Oregon’s Behavioral Health System:

An Action Plan for the

21st Century

Royce Bowlin, OHA, Behavioral Health Director

Jackie Fabrick, OHA, Behavioral Health Policy Analyst

October 30, 2017

Behavioral

Health Collaborative (BHC)

What will be covered?

1.Behavioral Health Collaborative (BHC) Overview

2.Accountability Structure

3.BHC Work Group Deliverables & Status Update

4.Timeline & Communication Plan

5.Questions

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BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

Oregon’s Current Behavioral

Health Status

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36% of

teenagers

perceive no risk

from smoking a

pack of

cigarettes a day

14.6%Of teenagers

experienced a

major

depressive

episode in the

last year

Suicide is the

2ndleading

cause of death

for young

adults in

Oregon

4.5% of

adults had

serious

thoughts of

suicide last

year

Oregon ranks

4th

nationally in

opioid use

Illicit drug use

among

teenagers is

2.5% higher

than national

average

Binge drinking

among

teenagers is

2.5% higher than

national

average

35.8% of

teenagers

perceive no risk

from smoking a

pack of

cigarettes a day

Only 46% of adults who

receive mental

health help, say

it helps

7%Of Oregonians

over 12

experience

alcohol

dependence or

abuse

11% of

Oregonians

dependent on

illicit drugs

receive

treatment

Only 45%of youth who

had a major

depressive

episode receive

treatment

Oregon is

ranked 14th

nationally in

youth suicide

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Going forward: A behavioral health system

that works for all Oregonians

Priorities

• Improve behavioral health outcomesfor consumers

• Improve equitable access to effectiveservices in every part of the state

• Improve efficiency and cost-effectivenessin services

• No wrong door approach

• Mental health and substance services areseamlessly tied to all aspects of care

• Focus on prevention and health promotion

• System-wide accountability forimproved outcomes

BHC Recommendations Overview

Recommendations will transform behavioral health system so that all

Oregonians (both Medicaid and non-Medicaid) will be served by a

coordinated care model for behavioral health needs.

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• Focused on person and family

• Fully integrated behavioral health

with physical and oral health

• Build on existing efforts and

complement, not duplicate

• Reduce administrative burden and

system complexity

• Shared financial risk

• Outcomes that are measurable and

sustainable

BHC Recommendations

Recommendations will transform behavioral health system

so that all Oregonians (both Medicaid and non-Medicaid)

will be served by a coordinated care model for behavioral

health needs.

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1. Governance and Finance:

Regional governance model for

behavioral health

2. Standards of Care and

Competencies

3. Workforce

4. Information Exchange and

Coordination of Care

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

BHC Work Group

Deliverables & Status

Updates

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Governance and Finance Work Group

Deliverables:

(Completed 8/31/17)

• Define Single Point of Shared Accountability and define elements of

Single Plan of Shared Accountability

(To be completed Sept/Oct 2017)

• Identify incentives Risk / Benefit sharing

• Ensure alignment of contracts

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Governance and Finance Work Group

Update

Four phased approach to development and implementation of the

regional behavioral health Single Point of Shared Accountability

(SPOSA):

Phase 1: Letter of Intent (LOI)

Phase 2: Community-based priorities and rationale

Phase 3: Action Plan

Phase 4: Performance and Reporting

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Standards of Care and Competencies

Work Group

Deliverables:

(Completed 8/31/17)

• Established core competencies for providers

(To be completed Sept/Oct 2017)

• Established minimum standards of care, stateside standards for

assessment, placement and billing criteria.

• Established minimum standards for care coordination and payment

mechanisms are in place for care coordination to meet the minimum

standards.

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Standards of Care and Competencies

Work Group Update

• Core competencies for providers

• Endorsed existing standards from the Substance Abuse and Mental

Health Services Administration (SAMHSA) and the University of

Colorado Eugene Farley Center.

• Minimum Standards of Care

• Statewide standards for assessment, placement and billing criteria.

• Care Coordination

• Establish minimum standards for care coordination.

• Ensure payment mechanism is in place for care coordination to meet the

minimum standard, including travel time.

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Workforce Work Group

Deliverables:

(Completed 8/31/17)

• Recommend recruitment and retention strategies.

(To be completed Sept/Oct 2017)

• Recommend standards for a well-trained behavioral health

workforce, inclusive of certified, licensed and unlicensed, peer

support specialists and community health workers throughout the

state.

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BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

Workforce Work Group Update

• Workforce assessment

– Farley Center

• Retention and recruitment

– Loan repayment programs

– Outreach efforts

– Trainings

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Peer Delivered Services Work Group

Deliverables:

Completed 8/31/17

• Establish system standards and expectations for Peer Delivered

Services (PDS) workforce.

• Establish the certification/licensure program for becoming a PDS

supervisor.

• Minimum standards and ongoing training requirements for peer

support specialist competence and training.

• Monitor for effective and appropriate use of employing peer

services.

• Research methodologies to establish target ratio of PDS to

members.

– PDS Core Team will be submitting recommendations on target

ratio of peer support specialist to member based on setting.

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BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

Peer Delivered Services Work Group

Update

• System Standards

• Standardized Training Model

• Supervision

(Enter) DEPARTMENT (ALL CAPS)

(Enter) Division or Office (Mixed Case)

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Health Information Technology

Workgroup

Deliverables:

• Advance the implementation of technology to further care

coordination across the state and behavioral health system.

• Identify ways for the state and regional collaborations to support the

continued adoption and utilization of electronic health records and

information sharing across payers and platforms.

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Health Information Technology Update

• Completed environmental scan of Health Information Technology

(HIT) use by behavioral health agencies

– Preliminary results

– Key informant interviews underway

• In December, the Health Information Technology Oversight

Committee will review report on behavioral health and HIT

– Identify gaps and opportunities

– Additional recommendations for supporting behavioral health

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Commercial Health Plans

Deliverables:

• Work plan will be developed upon completion of Parity Policy

Academy.

• Will include technical assistance from OHA’s Transformation

Center to educate providers about parity.

• OHA will work with Department of Consumer and Business

Services and commercial payers to identify the states collective

authority to integrate commercial and publicly insured behavioral

health efforts to produce results, efficiencies and parity

compliance.

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Data Work Group

Deliverables:

Work to begin October 2017

• Develop an outcomes-focused, person-centered behavioral health

measurement framework to assess the impact of integrated

services.

• Align outcomes measurement with identified standards for

behavioral health.

• OHA will work with its current systems to coordinate information and

track progress and outcomes across the state.

• Work group will submit recommendations to the Health Plan Quality

Metrics Committee for metrics to hold the CCOs accountable.

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Transformation Center

• Series of webinars

– Data sharing

– Organizing local structures around shared outcomes

– Blended funding models

– Using data to improve services

– Ensuring equity and transparency within the governance model

• Learning Collaborative

– One day event

– Hiring, retaining and using peer delivered services

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Health Policy and Analytics

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BHC Timeline

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Implementation Timeline

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Phase Four

• OHA Core Team

• Contract changes for CMHPs and CCOs

• Oregon Administrative Rule changes

BEHAVIORAL HEALTH POLICY

Health Policy and Analytics

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Questions?