UnitedHealthcare Integrating Primary and Behavioral Health ...
Transcript of UnitedHealthcare Integrating Primary and Behavioral Health ...
UnitedHealthcare
Integrating Primary and
Behavioral Health Care
Overview of Children’s
Behavioral Health Services
© 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019
• Overview of Optum and UnitedHealthcare
• Behavioral Health Services for Children and Families
• Resources and Tool to Support the Integration of
Primary and Behavioral Health
Today’s Agenda
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Our United Culture
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• Dedicated to providing benefits to the economically
disadvantaged and medically underserved
• Manage benefits in 24 states, plus Washington D.C
• Serves more than 5 million beneficiaries
• Uniquely designed to address
the complex the chronically ill,
disabled, and people with higher
risk medical, behavioral and
social conditions
UnitedHealthcare Community Plan
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Behavioral Health Services for
Children and Families
Medicaid Redesign Team (MRT) Goals for Children's
Medicaid Transformation
• Keep children on their developmental trajectory
• Maintain child at home with support and services
• Maintain the child in the community in least restrictive settings
• Identify needs early and intervene
• Focus on recovery and building resilience
• Prevent escalation and long term need for higher end services
• Maintain accountability for improved outcomes and delivery of quality care
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© 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019
Children and Family Treatment Services and Supports
(CFTSS) Six Core Principles
. Child Centered • Ensure services are child-specific
• Consider child’s:
Family
Community
Development
Strengths
2. Community Based • When possible, services are
delivered in the child’s home
• Draw on formal and informal
community resources
Culturally Competent • Ensure agencies demonstrate congruent behaviors, attitudes, skills
policies and procedures that allow care givers to work effectively and
efficiently with persons and communities of all cultural backgrounds
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4. Family Focused • Empower families to advocate for themselves
• Promote family participation in all decisions & treatment planning
5. Multi System • Services planned in collaboration with all child-serving systems
• Family and system representatives collaborate to:
Define Goals
Identify Resources
Evaluate Progress
6. Least Restrictive/Intrusive • Services take place in settings that meet the needs of the child and
family
• Least restrictive and intrusive as available
• Most appropriate and natural for the child and family
Children and Family Treatment Services and Supports
(CFTSS) Six Core Principles (Continued)
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Develop Service Plans
Provide Support
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Children and Family Treatment and Supports
Implementation Timeline
January 1, 2019
Children and Family Treatment and Supports
(CFTSS)
• Other Licensed Practitioner (OLP)
• Community Psychiatric Supports and Treatment (CPST)
• Psychosocial Rehabilitation (PSR)
July 1, 2019
Children and Family Treatment and Supports (CFTSS)
• Family Peer Support Services
SSI children begin receiving State Plan behavioral
health services in managed care including:
• Three-year phase in of Level of Care (LOC) expansion
begins
© 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019
All Children and Family Treatment and Support
Services (CFTSS)
• Youth and Peer Support and Training
• Crisis Intervention
Home and Community Based Services
Consolidated Waiver
SSI Children Only - Children and Family
Treatment and Support Services (CFTSS)
• Youth and Peer Support and Training
• Crisis Intervention
Children and Family Community Support Services
Implementation Timeline
October 1, 2019
January 1, 2020
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Mental Health Services Covered by Medicaid
Managed Care
Assertive Community Treatment (ACT)
Personalized Recovery Oriented Services (PROS)
Inpatient Psychiatric Services
Operation of Outpatient Programs
• Continuing Day Treatment (CDT) Program
• Partial Hospitalization
Comprehensive Psychiatric Emergency Program (CPEP)
Clinic Treatment Programs
• Outpatient Clinic Services
• OMH Licensed SED designated clinics
• Integrated Outpatient Clinic Services (IOP)
• Licensed Behavioral Health Practitioner Services (LBHP)
July 1, 2019
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Substance Use Disorder (SUD) Services Covered by
Medicaid Managed Care
Part 816 - Withdrawal and Stabilization Services
• Hospital Based Medically Managed Inpatient Detox
• Medically Supervised Inpatient Withdrawal
and Stabilization
• Medically Supervised Outpatient Withdrawal
and Stabilization
Part 818 - Chemical Dependence Inpatient
Rehabilitation Services
Part 820 - Residential Services Stabilization
and Rehabilitation
Part 822 - Outpatient Services
• Chemical Dependence Outpatient (CD-OP) Clinic
• Rehabilitation Services
• Opioid Treatment Programs (OTP)
July 1, 2019
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Resources and Tools to Support the
Integration of Primary and Behavioral
Health Care
Behavioral Health - Health Homes
• A Health Home is not a physical place. It is a group of health care
and service providers working together to help the member map out
and follow a care plan
• Criteria – individual must be enrolled in Medicaid and have:
Two or more chronic conditions (e.g. substance use disorder, asthma,
diabetes) OR One single qualifying condition which includes only
HIV/AIDS, Serious Emotional Disturbance (children), Complex Trauma
(children) or Serious Mental Illness (adults)
• To learn more or make a referral for Health Home services, contact a
Health Home in the area where the member lives. Each Health
Home has a referral line or web portal for easy referral:
health.ny.gov/health_care/medicaid/program/medicaid_health_homes/h
h_map/index.htm
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Clinical Practice Guidelines (CPG)
• A series of documents intended to assist clinical decision making
by presenting systematically developed patient care strategies in a
standardized format
• Evidence-based and emerging best practice recommendations
• Resources include:
American Academy of Child & Adolescent Psychiatry:
aacap.org/aacap/Resources_for_Primary_Care/Practice_Parameters_
and_Resource_Centers/Practice_Parameters.aspx
American Psychiatric Association CPGs for Bipolar Disorder,
Schizophrenia, Depression, Substance Use Disorders:
psychiatry.org/practice/clinical-practice-guidelines
American Academy of Pediatrics CPG for Attention Deficit
Hyperactivity Disorder:
pediatrics.aappublications.org/content/128/5/1007/
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Depression, Anxiety and Other Behavioral Health
Conditions
• Estimated 13%-20% of US children have been diagnosed with a
mental disorder *
• Pediatric primary care providers often identify and manage their
patients’ behavioral health problems
• Optum Behavioral Health Tool Kit for Medical Providers
• providerexpress.com/content/ope-provexpr/us/en/clinical-resources/PCP-
Tool-Kit.html
• Resources to help better understand BH conditions:
National Federation of Families for Children’s Mental Health: ffcmh.org
Mental Health Conditions Affecting Children and Adolescents:
samhsa.gov
National Alliance on Mental Illness (NAMI): nami.org
* Behavioral Health Integration in Pediatric Primary Care: Considerations and Opportunities for Policymakers, Planners, and Providers by Elizabeth Tobin Tyler, JD, MA, Rachel L. Hulkower, JD, MSPH, and Jennifer W. Kaminski, PhD March 2017
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Screening Tools: Depression, Anxiety and Other
Behavioral Health Conditions
• Substance Abuse and Mental Health Administration Evidence Based
Practice (EBP) Web Guide: samhsa.gov/ebp-resource-center
• Depression Patient Health Questionnaire (PHQ-9):
uspreventiveservicestaskforce.org/Home/GetFileByID/218
• Generalized Anxiety Disorder 7-item Screener (GAD-7):
integration.samhsa.gov/clinical-practice/gad708.19.08cartwright.pdf
• Children with Special Health Care Needs Screener (CSHCN Screener):
cahmi.org/projects/children-with-special-health-care-needs-screener/
• Ask Suicide-Screening Questions (ASQ) Toolkit for youth (aged 10 to 21
years): nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml
• Columbia Suicide Severity Rating Scale (C-SSRS):
cssrs.columbia.edu/scales_cssrs.html
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Substance Use
• Pediatric care providers have a unique opportunity to provide
educate about the dangers of substance use
• Two National Institute on Drug Abuse (NIDA) screening tools to
assess for substance use disorder risk among adolescents 12-17
years old:
drugabuse.gov/nidamed-medical-health-professionals/screening-tools-
for-adolescent-substance-use
• "Substance Use Screening, Brief Intervention, and Referral to
Treatment" (SBIRT) to guide physicians released in June 2016
pediatrics.aappublications.org/content/pediatrics/early/2016/06/16/peds.2
016-1210.full.pdf
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Substance Use: Screening and Brief Intervention and
Referral to Treatment (SBIRT)
• Screening : quickly assesses the severity of substance use and
identifies the appropriate level of treatment
• Brief Intervention: focuses on increasing insight and awareness
regarding substance use and motivation toward behavioral change
• Referral to Treatment: provides those identified as needing more
extensive treatment with access to specialty care
American Academy of Pediatrics' SBIRT guide
aap.org/en-us/Documents/substance_use_screening_implementation.pdf
New York State Office of Substance Abuse Services (OASAS)
oasas.ny.gov/AdMed/sbirt/index.cfm
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Children and Youth with
Serious Emotional Disturbance (SED)
• Serious Emotional Disturbance (SED)
Children ages 4-18
Diagnosable mental health problem
Mental health problem that severely disrupts functioning
• SED characteristics and behaviors include prolonged periods of:
Hyperactivity, short attention span and impulsiveness
Aggression or self-injurious behavior such as acting out or fighting
Withdrawal, failure to initiate interaction with others or avoid social
interactions through fear or anxiety
Immaturity characterized by inappropriate crying and temper tantrums,
and poor coping skills
Learning difficulties exhibited by academic performance below grade level
New York State Multiple Systems Navigator: msnavigator.org/
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Early Childhood: 0-5 Years Old
• 8%-10% of children younger than 5 years experience mental
health problems*
• New York State Early Childhood Direction Centers (ECDCs)
Information and referral services for children with disabilities
(0-5)
Professional development and technical assistance for families
and preschool providers
p12.nysed.gov/specialed/techassist/ecdc/home.html
• The New York State Early Intervention Program (EIP) is part of the
national Early Intervention Program for infants and toddlers with
disabilities and their families
* Mary Margaret Gleason, Edward Goldson, Michael W. Yogman, Council on Early Childhood, Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics
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Early Childhood: 0-5 Years Old
• Early Intervention (EI) is a statewide program that provides many
different types of therapeutic and supportive services to infants and
toddlers (0-3) with disabilities and their families: health.ny.gov/community/infants_children/early_intervention/
• New York State Department of Health (DOH), in coordination with
the Bureau of Early Intervention, created a specialized Health
Home care coordination program: health.ny.gov/health_care/medicaid/program/medicaid_health_home
s/hh_children/early_intervention.htm
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Intellectual and/or Developmental Disabilities (I/DD
• Intellectual and Development Disabilities are most often first
identified by the doctor
• Referring to treatment is challenging and involves multiple systems
with their own processes and pathways to care
• New York State Department of Health (DOH), in coordination with
New York State Office for People with Developmental Disabilities
(OPWDD), created a specialized Health Home care coordination
program specific to the I/DD population called People First Care
Coordination Organization Health Homes (CCO/HHs): health.ny.gov/health_care/medicaid/program/medicaid_health_homes/idd/i
ndex.htm
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Transition Age Youth (TAY)
• Teens and young adults with disabilities ages 16-22 who typically
have experience in the children’s public mental health system or
other child-serving systems, including education, child welfare and
juvenile justice
• Need is to strengthen emotional and social development and
learning as the individual transitions into adulthood and more
independence
• Connect to information and resources specifically for young people
transitioning to adulthood, their families and service providers:
omh.ny.gov/omhweb/consumer_affairs/transition_youth/resources/
omh.ny.gov/omhweb/consumer_affairs/transition_youth/resources/ment
al_health.html
cbhny.org/
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First Episode of Psychosis (FEP)
• An estimated 60,000 New Yorkers have psychotic illnesses1
• Around 2,000 new cases of psychotic illnesses each year in NYC2,3
• Typical age of onset 18-24, most cases appear at 13-30, with males
exhibiting signs 1-2 years earlier4
• 40%-50% of individuals with psychotic illness receive ongoing care5,6
• Average duration of untreated psychosis is 1-3 years
• Without follow-up treatment, 25% of individuals with first episode
psychosis will be re-hospitalized within 1-year7,8,9
NYC DOHMH Patient Characteristics Survey 2011 2) Bladwin P et al. Schiz Bull 2005 31;3, 624-38. 3) Kirkbride JB et al. Int J Epi. 2009; 38-1255-64. 4) https://www.earlypsychosis.ca/pages/curious/who-gets-psychosis 5) NYC DOHMH Medicaid analysis
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6) Buchanan RW, et.al. Schizophrenia Bull. 2010;36(1):71-93 7) Marshall M, et al. Archives of General Psychiatry 2005; 62:975- 983. 8) Perkins D, Gu H, Boteva K, Lieberman J. Am J Psychiatry 2005;162:1785–1804. 9) Hegelstad W, et al. Am J Psychiatry 2012;169:374-380
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First Episode of Psychosis (FEP): Signs and Symptoms
• Delusions
• Paranoia
• Hallucinations in any of the five senses
• Disorganized thought process, speech or behavior
Positive Symptoms
• Flat affect
• Restricted speech and verbal fluency
• Slowed thought process
• Decreased motivation
• Social isolation
Negative Symptoms
• Cognitive symptoms
• Mood shifts, anxiety
• Suicidal thoughts or behaviors
• Substance use
• Sleep disturbance
• Decline in function
Other Symptoms
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First Episode of Psychosis (FEP): Resources
OnTrackNY:
• Offers specialized clinical service for adolescents and young adults
between the ages of 16 and 30 who have been experiencing psychotic
symptoms for more than a week but less than 2 years
• Our NY BH Assessment and Triage (A&T) call center will notify
OnTrackNY when a member fitting the above criteria is admitted into an
inpatient unit
• To learn more or make a referral visit the OnTrackNY website and click
on Providers tab: ontrackny.org/
NYC Start (Supportive Transition and Recovery Team):
• Employs the evidence-based practice of Critical Time Intervention (CTI)
to engage adolescents and young adults between the ages of 16 and 30
experiencing their first adult hospitalization for psychosis
• To learn more visit the NYC Start website:
1.nyc.gov/site/doh/health/health-topics/crisis-emergency-services-nyc-
start.page
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First Episode of Psychosis (FEP): Resources
Center for Practice Innovations (CPI) out of Columbia Psychiatry/ New
York Psychiatric Institute:
• Funded by New York State Office of Mental Health (OMH) to develop
resources and web-based trainings that promote recovery principles
and best practices, including engagement and treatment of individuals
experiencing first episode of psychosis
• To learn more visit the CPI website: practiceinnovations.org/
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Trauma Informed Care Strategies
• Health policymakers and practitioners increasingly recognize the
destructive effects of trauma on the health status of children and
adults
• Adopting trauma-informed approaches can improve patient
engagement, enhance outcomes, and reduce avoidable care and
excess costs for both the health care sector and social service
systems
• Practicing Trauma Informed care may include:
Educating clinical and non-clinical workforce about the impact of trauma
Incorporating patient voice and choice (e.g. input on treatment plan)
Creating a safe environment (e.g. well lit, ask permission to close door)
• Trauma Informed Care Resources: store.samhsa.gov/system/files/sma14-4816.pdf
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Free Trainings on UHC On Air
• UHC On Air is an online provider education resource where you can earn
free CEU/CMEs
• Go to uhcprovider.com and log into Link with your Optum ID, click on the
UHC On Air app, and go to the New York channel to find programs for all
lines of business and topics that you want to see
• Care providers that need an Optum ID can go to uhcprovider.com and click
on New User in the upper right of home page to register
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Free Trainings on UHC On Air
Access trainings including many evidence-based and emerging best
practice topics:
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• Assertive Continuing Care &
Adolescent Community
Reinforcement Approach
• Dialectical Behavior Therapy
(DBT)
• Seven Challenges Program
• Trauma-Focused Cognitive
Behavioral Therapy (TF-CBT)
• Trauma-Informed Child-Parent
Psychotherapy (CPP)
• New York Children's Health
Home Understanding the
Program Requirements
• Multidimensional Family
Therapy (MDFT)
• Functional Family Therapy
(FFT)
• Mutisystemic Therapy (MST)
• Multi-Dimensional Treatment
Foster Care (MTFC)
© 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019
Free Trainings and CMEs on
OPTUM Health Education Portal
optumhealtheducation.com
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Additional Provider Resources on Provider Express Portal
https://store.samhsa.gov/system/files/sma14-4816.pdf http://www.cebc4cw.org/program/child-parent-psychotherapy/detailed
providerexpress.com
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Community Technical Assistance Center of New York (CTAC)
Managed Care Technical Assistance Center of New York (MCTAC)
• Training, consultation and educational resource center serving all
behavioral health agencies in New York State
• The goals of CTAC/MCTAC include:
Strengthening clinical and business infrastructure though training
opportunities focused on implementing evidence-based practices
Providing trainings and updates that address challenges associated
with recent changes in regulations, financing and overall healthcare
reforms
Provides credentialing, managed care, and business resources,
manuals and general guidance
• To learn more or access an archived or upcoming training, visit:
ctacny.org
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NYC Well
• Connects New Yorkers to free, confidential mental health support
• Speak to a counselor via phone, text or chat and get access to
mental health and substance misuse services, in more than 200
languages, 24/7/365:
Suicide prevention and crisis counseling
Peer support and short-term counseling via telephone, text and web
Assistance scheduling appointments or accessing other mental health
services
Follow-up to check that you have connected to care and it is working
for you
Referral to NYC adult and children mobile crisis services
• UHC partners with NYC Well if a caller identifies as a
UnitedHealthcare member to assist that individual with non-crisis
related inquiries: 1-888-NYC-WELL (1-888-692-9355)
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Project Training Education for the Advancement of
Children’s Health (TEACH)
• To strengthen and support the ability of New York’s pediatric primary care
providers (PCPs) to deliver care to children and families who experience mild-to-moderate mental health concerns
• Project TEACH provides specialized training, consultation, and linkage with mental health treatment for primary care physicians statewide
• Collaboration of OMH with the Department of Health (DOH), Conference of Local Mental Hygiene Directors, American Academy of Pediatrics
(AAP), and the New York State Academy of Family Physicians (AAFP)
• The program seeks to provide ongoing training and consultation services
to better meet the mental healthcare needs of some of the children seen in primary care practices
• To learn more about Project TEACH and how to access its resources, visit: projectteachny.org/
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State Offered Program Directories
• New York State Office of Mental Health (OMH) – Find a Mental
Health Program: my.omh.ny.gov/bi/pd
• New York State Office of Alcohol and Substance Abuse Services
(OASAS) – Find a Provider:
oasas.ny.gov/providerDirectory/index.cfm
• New York State Office of Children and Family Services (OCFS)
– Find Services for Children and Families:
ocfs.ny.gov/main/default.asp
• New York State Office of People with Developmental Disabilities
(OPWDD): opwdd.ny.gov/
37 © 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019
Contact information:
Thank you
Gayle Parker Wright, LCSW-R NY
Network Trainer
UnitedHealthcare Community Plan
Office: 1-612-642-7307
Questions?
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