Minnesota Behavioral health Homessuccesswithchws.org/mental-health/wp-content/uploads/... ·...
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BEHAVIORAL HEALTH HOMES IN MINNESOTA Framework for Innovation Southern Prairie Community Care Health Model Care and Support Workgroup December 5, 2014 Redwood Falls, MN ~A comprehensive system of care coordination integrating behavioral health and primary care for Medicaid enrollees with Serious Emotional Disturbances, Serious Mental Illnesses, and Serious and Persistent Mental Illness.
Transcript of Minnesota Behavioral health Homessuccesswithchws.org/mental-health/wp-content/uploads/... ·...
BEHAVIORAL HEALTH HOMES IN MINNESOTA
Framework for Innovation Southern Prairie Community Care Health Model Care and Support Workgroup December 5, 2014 Redwood Falls, MN
~A comprehensive system of care coordination integrating behavioral health and primary care for Medicaid enrollees with Serious Emotional Disturbances, Serious Mental Illnesses, and Serious and Persistent Mental Illness.
Medicaid State Plan Option under Affordable Care Act Section 2703
Better integration and coordination of primary, acute,
behavioral health and long-term services and social and community supports for persons with chronic illness
Person-centered, better health outcomes, better services
and value
Health Home overview
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Presenter
Presentation Notes
The place where an individual’s healthcare lives, not where the individual lives.
DHS joint project between Health Care Administration Chemical and Mental Health Administration
Children’s Mental Health Adult Mental Health
Working with large stakeholder BHH Advisory Group
Public input and Request for Information Consumer, family, diverse communities
engagement
Minnesota state planning
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Presenter
Presentation Notes
2013 RFI Through a contract with DHS, NAMI-MN is conducting a series of focus groups to obtain input/information from consumers about health care access, barriers, preferences and cultural considerations that will, in part, assist DHS in design of BHH model
Starting with Medicaid population (adults and children) experiencing serious mental illness barriers to health care access high co-occurrence of chronic health conditions early mortality
Framework for additional complex populations in
the future
Health Homes in Minnesota
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Presentation Notes
DHS believes that more integrated care, regardless of setting, contributes to improved health and decreases the risk of adverse outcomes, including hospital admissions.
Health Homes Medical Health Homes/ Health Care Homes
For specific populations with chronic conditions.
Not population specific.
Behavioral Health Homes • Adults with SMI or
SPMI • children and youth
with SED
Made for the general population.
Medicaid only. All payer system.
Health Homes and Health Care Homes
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Children, youth, and adults with SMI, SPMI, SED Medicaid eligible – fee-for-services and managed care
(capitated) – about 109,000 individuals identified as potentially eligible – expansion population of adults with SMI
Current provider may become a BHH and give eligible clients the opportunity to participate.
DHS and BHH providers will recruit eligible individuals not connected to services.
Potential pre-enrollment/sign up strategy
Client eligibility
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Presenter
Presentation Notes
Lisa start
Must meet federal and Minnesota state
requirements/standards and certification standards Likely candidates:
Community Mental Health Centers Pediatric clinics Fully integrated primary care clinics
Behavioral Health Home providers
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Presenter
Presentation Notes
Fully integrated primary care clinics (i.e. NorthPoint).
Client Team Leader Integration Specialist
• (Care Management) Behavioral Health Home Systems Navigator
• (Case Management/Care Coordination) Qualified Health Home Specialist
• (Peer Specialist, Community Health Worker) Consulting Professionals External Professionals
Behavioral Health Home Team Members
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Comprehensive Care Management collaborative process manage medical, social, and mental health
conditions more effectively based on population health data and tailored to the individual patient
Care Coordination plan, implement, and monitor Health Action Plans
(developed with individual) provide linkages, referrals, coordination, and
follow-up to needed services and supports
Behavioral Health Homes Services
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Presenter
Presentation Notes
6 federally required services Health Action Plan – individualized, holistic
Health Promotion Services encourage and support healthy lifestyle
behaviors promote better management of health and
wellness
Comprehensive Transitional Care specialized care coordination services movement of individuals between or within
different levels of care or settings shifting from reactive care and treatment to
proactive care via health promotion and health management
BHH Services cont.
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Referral to Community & Social Support Services assist with setting up appointments,
accompanying clients, and coordinating follow-up
Individual Family Support Services activities, materials, or services reduce barriers to achieving goals increase health literacy and knowledge about
chronic condition(s) increase self-efficacy skills improve health outcomes
Services cont.
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Presenter
Presentation Notes
Talk briefly about the team
Federally required to link services, as possible and appropriate Electronic Health Registry Electronic Health Records
Requirements may evolve as experience is gained and as permitted by Minnesota law.
Expected ramp-up period for providers
Health Information Technology
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Coordinates but does not replace other health services.
Federal requirements does not allow payment for duplicative services. May include:
Targeted Case Management Waivered Case Management Health Care Home Care Coordination
Interaction with other health services
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Will include 1) integration standards drawn from the
Behavioral Integration Capacity Assessment (BHICA)
2) the Health Home Core Set Measures from CMS 3) standards for the six BHH services 4) Minnesota state specific standards
Avoid duplication for providers with HCH certification
Provider Certification Standards
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Presenter
Presentation Notes
Standards are currently being developed. Blending HCH and how DHS certifies MH providers (hybrid)
Considering per-member, per-month (PMPM) tiered payment Includes outreach/engagement payment Two service reimbursement tiers
Goals: Reasonable for expected activities and time
requirements Reflect requirements for behavioral health and
medical care coordination Incorporate variable needs for different populations Reasonable claim submission and payment process
Payment structure
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Presenter
Presentation Notes
This model is subject to change, based on further analysis and stakeholder input.
Share best practices and receive support from DHS in preparation for certification • Regional meetings • Webinars around specific certification topics • Group-based technical assistance
Letters of intent and initial capacity assessment – 34 respondents
First Implementers group
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Monitoring State/DHS must have defined methodology and report on:
avoidable hospital admissions cost savings from improved care management the use of health information technology
Evaluation State/DHS must report to CMS inform submitted by
BHH provider to inform an evaluation and Reports to Congress
Measurement
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Presenter
Presentation Notes
Jen DHS must demonstrate a defined methodology, data sources and measurement specifications. DHS must provide assurance that it will report to CMS information submitted by Behavioral Health Home providers to inform the evaluation and Reports to Congress as described in Section 2703(b) of the Affordable Care Act as described by CMS.
Quality Measures CMS Core Set of measures recently published Additional Minnesota state measures
Additional state performance measures
Measurement continued
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Presenter
Presentation Notes
CMS technical specifications for BHH measures recently published. The Core Set of health care quality measures for Medicaid-eligible adults have been modified to allow for Health Home program reporting, which may also include children.
Spring/ Summer 2014 Planning work
Fall 2014 Implementation work
Winter 2015 Getting providers ready First Implementers group
Summer 2015 (subject to CMS approval of SPA) Services begin
Behavioral Health Home timeline
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Jennifer Menke Blanchard Care Integration Planning Coordinator Health Care Administration 651-431-3307 [email protected] Lisa Cariveau Care Integration Planning Coordinator Health Care Administration 651-431-5827 [email protected] Danielle Montoya-Barthelemy, MPH Mental Health Program Consultant Children’s Mental Health Division 651-431-5789 [email protected] Richard F Seurer Agency Policy Specialist Adult Mental Health Division 651-431-2248 [email protected]
Questions?
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BHH RESOURCES/LINKS How to Integrate Primary Care into a Behavioral Health Setting: Lessons Learned from the SAMSHA Primary and Behavioral Health Care Integration Program Friday, September 26, 1:30-3:00pm Eastern/10:30am-Noon Pacific Register for free at http://www.integration.samhsa.gov/about-us/webinars Federal report on models and clinical aspects of behavioral health homes entitled “Behavioral Health Homes for People with Mental Health and Substance Use Conditions”: http://www.integration.samhsa.gov/clinical-practice/CIHS_Health_Homes_Core_Clinical_Features.pdf "
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BHH RESOURCES/LINKS
Patient Protection and Affordable Care Act (Section 2703 Health Homes) http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf
Medicaid.gov Health Homes - Federal information about health homes: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Integrating-Care/Health-Homes/Health-Homes.html
Good set of question and answers about Health Homes: http://www.chcs.org/usr_doc/Health_Homes_FAQs_101211.pdf
SAMHSA guidance document – good set of questions: http://www.samhsa.gov/healthreform/docs/Guidance_Doc_Health_Homes_Consultation_Process.pdf
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BHH RESOURCES/LINKS
Integrated Care Resource Centers: http://www.integratedcareresourcecenter.com/hhstateresources.aspx
SAMHSA-HRSA Center for Integrated Health Solutions: http://www.integration.samhsa.gov/
SAMHSA Health Homes and Primary and Behavioral Health Care Integration:
http://www.samhsa.gov/healthReform/healthHomes/index.aspx
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BHH RESOURCES/LINKS Monograph that outlines the business case for integrating
behavioral health and primary care: http://www.integration.samhsa.gov/integrated-care-models/The_Business_Case_for_Behavioral_Health_Care_Monograph.pdf
A guide to resources, promising practices, and tools on integrating physical health services into behavioral health organizations: https://www.resourcesforintegratedcare.com/sites/default/files/Integration%20Guide_1.pdf
A website dedicated to resources on motivational interviewing: http://www.motivationalinterview.org/
A guide to approaches to supporting self-management for individuals with serious mental illness: https://www.resourcesforintegratedcare.com/node/32.
A site outlining existing CMS demonstrations and innovations: http://innovation.cms.gov/
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THANKS!
Questions?
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