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Erie County RFP Presentation

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Title: Erie County RFP Presentation Author: smitma2 Last modified by: schusterjm Created Date: 3/22/2010 2:07:35 PM Document presentation format – PowerPoint PPT presentation

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Title: Erie County RFP Presentation


1
NYAPRS 7th Annual Executive Seminar on Systems
Transformation Integration Strategies for
Behavioral Health Managing Care, Outcomes, and
Costs While Preserving our Recovery
Vision Turning Health Homes Into Recovery Homes
  • James Schuster, MD, MBA
  • Chief Medical Officer Community Care Behavioral
    Health Organization
  • Albany, NY
  • April 27, 2011

2
About Community Care
  • Behavioral health managed care company founded in
    1996 part of the University of Pittsburgh
    Medical Center
  • Federally tax exempt non-profit 501(c)(3).
  • Major focus is publicly-funded behavioral health
    care services currently doing business in PA and
    NY.
  • Licensed as a Risk-Assuming PPO in PA NCQA
    Accredited Quality and Disease Management
    Programs.
  • Serving over 1.3 million individuals in 36
    Pennsylvania counties through a statewide network
    of over 1,800 providers.

3
Community Care Counties
Erie
Susquehanna
Crawford
Wyoming
Venango
Lackawanna
Pike
Lycoming
Mercer
Clinton
Clarion
Luzerne
Jefferson
Monroe
Lawrence
Butler
Carbon
Armstrong
Northampton
Beaver
Schuylkill
Indiana
Mifflin
Lehigh
Juniata
Blair
Cambria
Lebanon
Berks
Perry
Bucks
Dauphin
Westmoreland
Washington
Cumberland
Montgomery
Lancaster
Chester
Bedford
Somerset
Franklin
Fayette
Fulton
York
Greene
Adams
Philadelphia
Delaware
Community Care Contract
4
Recovery Initiatives
  • Multi-year plan to change the clinical approach
    and culture of clinical systems
  • Annual Recovery Institute for consumers and
    providers.
  • Shared decision-making focus.
  • Learning Collaborative model.
  • Steps of Hope Focus on wellness.
  • Statewide Member Advisory Board.

5
Models for Integrating Physical and Behavioral
Health
  • Co-location of physical health and behavioral
    health providers.
  • Integrated system.
  • Coordination among disparate providers.

6
Connected Care
  • Initiative to improve the connection and
    coordination of care for those with Serious
    Mental Illness among health plans, PCPs, and
    behavioral health providers in outpatient,
    inpatient, and ED care settings.
  • Based on Patient Centered Medical Home model with
    integrated care team and care plan to address all
    medical, behavioral, and social needs.
  • Partnership between
  • Center for Health Care Strategies (CHCS)
  • Department of Public Welfare (DPW)
  • UPMC for You
  • Community Care Behavioral Health
  • Allegheny County Department of Human Services

7
Connected Care
  • Data sharing care plan viewable by staff from
    both health plans.
  • Team meetings for integrated care.
  • Resulted in reduced medical and BH admissions and
    reduced use of ER.
  • Improvement opportunities include more structured
    provider health home and more consistent function
    of health navigators.

8
Toward Integrated/ Well-Coordinated Care Next
Steps
  • Expand Steps of Hope to include smoking cessation
    and weight management.
  • Train peers and case managers to support members
    as system navigators.
  • Build health homes for consumers with serious
    mental illness or substance dependency that can
    functionally integrate care.

9
Recovery Homes Based in Behavioral Health
Agencies
  • Provide a person-centered system of care.
  • Develop a virtual team for each individual.
  • Enhance physical health competencies in the
    behavioral health team.
  • Develop person-centered plans with individuals.
  • Coordinate physical, behavioral, and supportive
    services.
  • Manage integrated reporting.
  • Integrate health focused activities into existing
    recovery initiatives to create true health homes.

10
Like Politics, All Health Care is Local
  • The challenge
  • Create local and regional models of Physical
    Health/ Behavioral Health recovery homes.
  • Participants include
  • Counties/local governments.
  • Behavioral health and physical health provider
    systems.
  • Consumers.
  • Advocacy organizations.
  • Behavioral health managed care/payers.
  • Physical health managed care/providers.
  • Content experts.

11
Contact Information
  • James Schuster, MD, MBA Chief Medical Officer
  • Community Care Behavioral Health Organization
  • One Chatham Center, Suite 700
  • 112 Washington Place
  • Pittsburgh, PA 15219
  • 412-454-2120 www.ccbh.com
  • Schusterjm_at_ccbh.com
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