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Title: Managed Care Readiness Draft: 2/5/15 MCTAC For Agency Executives and members of the Agency Leadership Team Author: Daniel A Ferris Last modified by – PowerPoint PPT presentation

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Title: New York


1
New Yorks Transition to Medicaid Managed
CareNYS Care Management Coalition2015 Annual
Training ConferenceAndrew Cleek, PsyDDan
Ferris, MPA
2
Learning Objectives
  • To Understand
  • The basic principles of Managed Care as a payment
    vehicle for health care services
  • The structure of the current NYS Medicaid Managed
    Care program
  • The changes anticipated as the State rolls out a
    new Medicaid Managed Care Model to support those
    with Behavioral Health needs.

3
Setting the Stage
4
4
  • Governors Vision for Medicaid Reform
  • It is of compelling public importance that the
    State conduct a fundamental restructuring of its
    Medicaid program to achieve measurable
    improvement in health outcomes, sustainable cost
    control and a more efficient administrative
    structure.
  • - Governor Andrew Cuomo, January 5, 2011
  • EXPECTED OUTCOMES
  • Improved Health Status
  • Improved Quality of Care
  • Reduced Costs
  • Care Management for All

5
Medicaid Expenditures 2013
  • 49.1 billion

6
Managed Care 101
7
Managed Care Definition
  • An integrated system that manages health services
    for an enrolled population rather than simply
    providing or paying for the services
  • Services are usually delivered by providers who
    are contracted under a capitated payment
    structure or employed by the plan

8
Managed Care Key Ingredients
  • Care management
  • Utilization management
  • Health management
  • Vertical service integration and coordination
  • Financial risk sharing with providers

9
Managed Care Goals
  • Control Costs
  • Health care costs growing faster than GDP
  • Reduce inappropriate use of services
  • Increase completion Focus on Value
  • Improve Service Quality
  • Improve Population Health
  • Increase Preventive Services Promote Health (not
    just treat illness)

10
Managed Care Key Components
  • Network of providers created via contracting
  • Medical home created w/primary care provider
    functioning as a gatekeeper
  • Prior approval required for inpatient admissions,
    specialty visits, elective procedures, etc.
  • Benefits package with a defined set of covered
    services
  • Contained list of covered pharmaceuticals
    (Formulary)
  • Utilization review practices to manage inpatient
    admissions and length of stay

11
How Capitation Works
  • Managed Care Organization receives a fixed
    amount of money each month for each member Per
    Member Per Month (PMPM)
  • Fixed fee is for a specific time period
    (typically a month)
  • Fee covers a defined set of services (these are
    the benefits)
  • Provider accepts risk for delivering services
  • Agrees to comply with prior authorization and
    utilization management practices
  • May enter into pay for performance arrangement

12
How Providers May Be Paid
  • Capitation Rate MD groups, hospitals or
    Accountable Care Organizations (ACOs) may enter
    into such agreements.
  • May include shared risk/savings arrangement
  • Negotiated fee for service some MDs, ancillary
    services, labs, etc..
  • Per diem/ fixed daily payment hospitals, SNF
  • Payment based upon the episode of care
  • Diagnostically Related Groups (DRGs)- Today
  • Acute /post acute bundled payments- Future

13
Determining Service Provision and Payment
The answers to all of the above questions must be
YES if the service is to be paid for by the MCO
14
What Does the NYS Medicaid Managed Care Program
Look Like Today?
15
Publicly Funded Behavioral Health System Today
  • Managed Care
  • No Managed Care

16
Remaining System Challenges
  • 20 of people discharged from general hospital
    psychiatric units are readmitted within 30 days.
  • A majority of these admissions are to a different
    hospital.
  • Discharge planning often lacks strong
    connectivity to outpatient aftercare.
  • Lack of assertive engagement and accountability
    in ambulatory care.
  • Contributes to readmissions, overuse of ER, poor
    outcomes and public safety concerns.
  • Lack of Substance Use Disorder (SUD) care
    coordination for people with serious SUD problems
    leading to poor linkage to care following a
    crisis or inpatient treatment.
  • A significant percentage of homeless singles
    population has serious mental illness and/or
    substance use disorder.

17
Remaining System Challenges
  • People with mental illness and/or substance use
    disorders are over represented in jails.
  • Unemployment rate for people with serious mental
    illness is 85.
  • 33 of people entering detox were homeless and
    66 were unemployed in 2011.
  • People with serious mental illness die about 25
    years sooner than the general population, mainly
    from preventable chronic health conditions.
  • Poor management of medication and pharmacy
    contributes to inappropriate poly-pharmacy,
    inadequate medication trials, inappropriate
    formulary rules, poor monitoring of metabolic and
    other side effects and lack of person centered
    approach to medication choices.

18
Managed Care Timeline -- NYC
  • July - October 2015 NYC HARP passive enrollment
    letters distributed
  • October 1, 2015 Mainstream plans and HARPs
    implement non-HCBS behavioral health services for
    enrolled members, HARP enrollment phases in.
    Childrens Health Homes go live.
  • October 1, 2015 Rest of state implementation
    HARP passive enrollment letters distributed
  • January 1, 2016 HCBS Begins for HARP
    population
  • January 1, 2017 - NYC Long Island Childrens
    Transition to Managed Care

Accurate as of 5/12/15
19
Managed Care Timeline --Rest-of-State
  • June 30, 2015 RFQ distributed (with expedited
    application for NYC designated Plans)
  • October 2015 Conditional designation of Plans
  • October 2015-March 2016 Plan Readiness Review
    Process
  • April 1, 2016 First Phase of HARP Enrollment
    Letters Distributed
  • July 1, 2016 Mainstream Plan Behavioral Health
    Management and Phased HARP Enrollment Begins
  • July 1, 2017 - Childrens Transition to Managed
    Care

Accurate as of 5/12/15
20
What We Know About the Anticipated Changes.
21
Managed Care SUD Providers
22
SUD Providers
OASAS Vision System integrated with healthcare,
with access to high quality services for all in
need
  • LOCADTR
  • Level of care in least restrictive setting
    appropriate for needs or client
  • Continued efforts to place individuals needing
    medical support for withdrawal in medically
    appropriate settings
  • Bolstering Outpatient Clinic Capacity
  • Develop ancillary withdrawal protocols
    integrate into clinic flow
  • Integrate medication assisted treatment
  • Coordinate care with other healthcare providers
  • Supporting Opioid Treatment Providers
  • Develop utilization management protocols with
    MCOs
  • Incorporate other medications (e.g.,
    buprenorphone) into clinic settings
  • Long-Term Residential Redesign
  • New levels of care covered by Medicaid
  • Develop ancillary withdrawal protocols
    integrate into clinic flow
  • Integrate medication assisted treatment
  • Coordinate care with other healthcare providers
  • Home and Community Based Services
  • Developing service models
  • Integrating with other care providers

23
Current Treatment System
Current Medicaid Billing Current Medicaid Billing
FFS MCO Outside Medicaid
Inpatient Detox ? ?
Inpatient Rehab ? ?
Outpatient Treatment ?
OTP/Methadone ?
LTR ?
24
SUD Providers LOCADTR
  • LOCADTR
  • Reflects OASAS clinical judgment about
    appropriate level of care
  • Based on ASAM
  • Tailored to NY
  • Policy to increase MAT for opioids
  • Residential redesign
  • Required for MMC services
  • OASAS would like to extend beyond Medicaid
  • Training needs
  • Diverse workforce
  • Designed for someone with SUD clinical background
  • Eventually will be used by other providers
  • Working with managed care to develop workflow

25
What does this Mean for SUD Providers?
  • Plan for Change ahead
  • Stay engaged with MCTAC and CASA
  • Use resources and trainings available to you

26
Managed Care Organizations and Health and
Recovery Plans (HARPs)
27
MCO HARP
  • What will Change?
  • All Medicaid recipients will be members of a
    Managed Care Plan
  • More services (including recovery services)
    covered by Managed Care Plans
  • Individuals w/significant needs can become a part
    of a Health and Recovery Plan (HARP) - receive
    services not available through the standard BH
    plan
  • Imbeds process / resource changes w/in a specific
    philosophical model
  • Person centered, recovery focused practices
  • Reliance on care management for high need
    individuals
  • Greater reliance on community services rather
    than inpatient services
  • Service integration
  • Greater accountability for achieving outcomes

28
Covered Populations and Eligibility Criteria
  • Covers the inclusion of Medicaid BH services for
    adults in mainstream MCOs. Dual eligibles (with
    both Medicaid and Medicare) are not eligible
  • Eligibility for Mainstream Managed Care Plans
    All mainstream Medicaid eligible and enrolled
    individuals 21 and over requiring behavioral
    health services
  • Children Young Adult System moving to managed
    care in 2016.

29
Services To Be Covered by MCOs as of October 1,
2015 for NYC and July 1, 2016 for rest of
state(Not paid for by MCOs today)
  • Continuing Day Treatment
  • Partial hospitalization
  • PROS
  • ACT
  • SUD outpatient services Including OTP
  • Residential Rehabilitation (SUD residential
    services to be redesigned and clinical services
    to become billable)
  • Inpatient Psychiatric services (currently FFS for
    all SSI Medicaid recipients)
  • Rehabilitation services for residents of
    community residences (beginning in year 2)

30
Health and Recovery Plans (HARPs)
  • Who is eligible?
  • Must either meet the target risk criteria and
    risk factors or be identified by service system
    or service provider identification
  • Target Criteria
  • Medicaid enrolled 21 and older
  • SMI/SUD diagnoses
  • Eligible for Mainstream enrollment
  • Not dually eligible
  • Not participating in OPWDD program
  • 140,000 individuals are estimated to be eligible
    (60,000 in Upstate NY)
  • All will be expected to have a Health Home Care
    Manager

31
Services To Be Covered by HARPs
  • (These Services will be paid for by MCOs if
    person is shown to be eligible for a HARP)
  • Referred to as Home and Community Based Services
    (HCBS) for Adults Meeting Targeted and Functional
    Needs. Proposed under the 1115 Demonstration
    Amendment.
  • Rehabilitation (Psychosocial Rehab, Community
    Psychiatric Support and Treatment CPST, crisis
    intervention)
  • Peer Supports
  • Habilitation (Habilitation, Residential Supports
    in Community Settings)
  • Respite (Short Term Crisis Respite, Intensive
    Crisis Respite)
  • Non-medical transportation
  • Family Support and Training
  • Employment Supports (Pre-voc, transitional
    Employment, Intensive Supported Employment,
    Ongoing Supported Employment)
  • Educational Support Services
  • Supports for Self-Directed Care (To be phased in
    as a pilot)(Information and Assistance in
    Support of Participation Direction)

32
MCO HARP System Reform Goals
  • It is necessary to ensure each MCO has adequate
    capacity to assist NYS in achieving system reform
    goals including
  • Improved health outcomes and reduced health care
    costs through use of managed care
    strategies/technologies
  • Transformation of the BH system from inpatient
    focused system to a recovery focused outpatient
    system of care.
  • Improved access to more comprehensive array of
    community-based services grounded in person
    centered recovery principles.
  • Integration of physical and behavioral health
    services and care coordination through program
    innovations

33
MCO HARP Operating Principles
  • Reliance on specialized expertise for the
    assessment, treatment, and management of special
    populations
  • Medical necessity determinations that consider
    level of need as well as environmental factors,
    available resources and psychosocial
    rehabilitation standards
  • For MH, Level of Care and clinical guidelines
    approved by the State
  • For SUD, Level of Care determinations based on
    OASAS LOCADTR tool
  • Use of data-driven approaches to performance
    measurement
  • Heightened monitoring of the quality of
    behavioral health and medical care
  •  

34
MCO HARP Operating Principles
  • Use of financial structures that support and/or
    incentivize achieving system goals.
  • Separate tracking of BH expenditures and
    administrative costs to ensure adequate funding
    to support access to appropriate BH services.
  • Medical Loss Ratio (MLR) for HARPs and BH MLR for
    Mainstream MCOs.
  • Reinvestment of behavioral health savings to
    improve services for behavioral health
    populations.
  • Enhanced pharmacy management for individuals with
    co-occurring complex MH and SUD challenges.

35
MCO HARP Expected System Outcomes
  • Improved individual health and behavioral health
    life outcomes
  • Improved social/recovery outcomes including
    employment
  • Improved members experience of care
  • Reduced rates of unnecessary or inappropriate
    emergency room use
  • Reduced need for repeated hospitalization and
    re-hospitalization
  • Reduction or elimination of duplicative health
    care services and associated costs, and
  • Transformation to a more community-based,
    recovery-oriented, person-centered service
    system.
  •  

36
MCO HARP State Goals
  • Based upon provider feedback, NYS recognizes the
    need to
  • Build the service capacity to support the HARP
    enrollees
  • Further define the role of the Health Home in
    conjunction with the role of the MCO
  • Identify approach for making HARP service
    payments (1st two years will be FFS)
  • Determine which agencies will be considered
    qualified to provide HCBS services and develop
    the procedure coding, etc.
  • Determine the Care Management model for HARP
    members and HARP eligible who are not enrolled in
    Health Homes.

37
MCO HARP Questions
  • What does this mean to the work of your
    organization?
  • Is your agency delivering services on the lists
    of additional Managed Care covered services, but
    have never had a contract with an MCO?
  • What will you need to do differently moving
    forward?

38
Lets Not Forget Other Initiatives Are Underway
  • Health Home Care Management
  • Delivery System Reform Incentive Payment (DSRIP)
    Plan

39
Why Health Homes?
  • Outgrowth of the Affordable Care Act
  • Expands on the traditional medical home model to
    build linkages to other community and social
    supports
  • Enhances coordination of medical and behavioral
    health care for individuals with multiple chronic
    illnesses
  • Improves health care and health outcomes
  • Lowers Medicaid costs
  • Reduce preventable hospitalizations and ER visits
    Avoid unnecessary care for Medicaid members

40
What is a Health Home?
  • A program that provides Care Management to High
    Need Medicaid Recipients
  • All of the professionals involved in a members
    care communicate with one another so that all
    needs are addressed in a comprehensive manner.
  • Medical, behavioral health and social service
    needs are to be addressed

41
What is the Work of a Health Home?
  • Work is done through a care manager who oversees
    and coordinates access to all of the services a
    member requires including those being covered
    by Managed Care Organizations
  • Care manager ensures that the member receives
    everything necessary to stay healthy
  • All the services and partners are considered
    collectively as the Health Home

42
Delivery System Reform Incentive (DSRIP) Plan
43
Changes Anticipated Through the Delivery System
Reform Incentive Payment (DSRIP) Program
  • 7.567 Billion over 5 years
  • Theme Communities of providers encouraged to
    work together to develop DSRIP project proposals
  • Focus on reducing inappropriate hospitalizations
  • Open to a wide array of safety net providers
  • Payments are performance based
  • Must choose from a menu of 25 CMS-approved
    programs
  • Goal Reduce avoidable hospitalizations by 25
    over five years.

44
NYS DSRIP Key Components
  • Key focus on reducing avoidable hospitalizations
    by 25 over five years
  • Statewide initiative open to large public
    hospital systems and a wide array of safety-net
    providers.
  • Payments are based on performance, on process,
    and on outcome milestones
  • Providers must develop projects based upon a
    selection of CMS approved projects from each of
    the domains
  • Key theme is collaboration! Communities of
    eligible providers will be required to work
    together to develop DSRIP project proposals

45
Performing Provider Systems (PPS) Local
Partnerships to Transform The Delivery System
Partners Should Include
Responsibilities Must Include
  • Hospitals
  • Health Homes
  • Skilled Nursing Facilities
  • Clinics FQHCs
  • Behavioral Health Providers
  • Home Care Agencies
  • Other Key Stakeholders

46
Rather than think about these transformational
initiatives (BH Carve In, Health Homes and DSRIP)
as disparate initiatives, lets consider the
alignment that exists.
47
Common Themes Behavioral Health Carve-In Health Homes DSRIP
SHARED GOAL Reduce avoidable ED and Inpatient Reduce avoidable ED and Inpatient Reduce avoidable ED and Inpatient
SHARED THEMES
Collaboration New relationship expectation for MCOs and Providers Cross-systems Care Team required Essence of Regional Performing Provider Systems key for mutual accountability across NYS
Integration Goal for QHPs Required for HARPS Required for Health Homes (Unfunded) Required and potential dollars  
Care Management Available through QHP Required for HARP New dollars to expand care management availability Tool for achieving DSRIP goals
New Solutions Flexible supply of Medicaid payable HCBS Services Required focus on social determinants of health Key to success
Focus on Outcomes Core MCO value Core Health Home value Core DSRIP value  
48
What Should Providers be Doing to Prepare?
49
Competencies, Practices Skills that will
Support Success in Managed Care
  • To make sure you are meeting MCO expectations
  • Three Main Categories
  • Understand MCO business practices and imbed these
    practices in the work of your organization
  • Build organizational infrastructure to
    effectively work with MCOs
  • Demonstrate desired outcomes /value

50
Understand MCO Business Practices Build a
successful business relationship w/MCOs
  • MCO priorities
  • Contracting
  • Communication/Reporting data exchange in
    required formats, requests for clinical
    information, services authorization, member
    verification
  • IT systems requirements
  • Credentialing processes
  • Level of Care Criteria/Utilization Management
    Practices
  • Member Services/Grievance Procedures
  • Medical Management
  • Network Management
  • Quality Management/ Quality Studies/ Incentive
    Opportunities
  • Billing/Payment Practices
  • Auditing practices

51
Organizational Infrastructure
  • Build the infrastructure to support the changes
    necessary to succeed in the new managed care
    environment
  • Data Analytic Capacity
  • Collecting, housing and analyzing process and
    clinical data with CQI follow up
  • Innovation and Change Management Capacity
  • Identify and empower Change Champions.
  • Develop Leaders (not managers)
  • Share the power tied to establishing a
    strategic direction. Use those with a variety of
    experience and perspectives.
  • Fiscal Capacity Beyond FFS
  • Learn more about what MCOs currently require and
    possible future payment models
  • Training and Workforce Development
  • Develop a flexible and forward thinking workforce
    that responds positively to quantified
    performance feedback

52
Organizational Infrastructure
Develop Channels for Effective Communication
  • Within your Organization
  • Share changes with Board and engage them in the
    change process
  • Make certain the Leadership Team is clear on
    expectations that will support a successful
    transition
  • Encourage the sharing of information about
    Medicaid Redesign and the next phase of Managed
    Care with staff across the organization
  • Encourage cross- department conversations about
    the role each will play in the organization
    achieving identified outcomes.

53
Organizational Infrastructure
Develop Channels for Effective Communication
  • Support Cross-Discipline Efforts
  • Regardless of discipline, leaders must believe
    in and be champions of transformation and
    communicate expectations
  • Redesign care to optimize each professional
    disciplines expertise and knowledge.
  • Members of multidisciplinary teams must be
    collaborative, share a mutual respect for one
    another and rotate leadership based on the
    initiative and the skill set the project
    requires
  • Across the System of Care
  • Develop process to promote inter- organization
    communication in support of shared outcomes and
    opportunities for Continuous Quality Improvement.

54
Organizational Infrastructure
  • Build capacity to support continuous clinical
    improvement
  • Invest in clinical staff to review data
    reflective of key service delivery process and
    clinical outcome measures that are collected
    internally and externally ( e.g., reports
    prepared by State Agencies, PSYCKES, MCOs,
    etc.).
  • Develop process to review outcome measures
    w/clinical team members (including MDs when
    appropriate) on a routine basis. Team makes
    recommendations for improvement. Changes in
    practice are monitored.
  • Reports on the work of the Clinical Team are
    routinely distributed to leadership team members
    (including Board)
  • Organization consistently articulates its full
    support for ongoing quality improvement
    activities

55
Deliver and Demonstrate Impact Value
  • Determine the outcomes and related measures that
    define success for the MCOs with which you work
  • Inventory data sources that reflect impact
  • Work with or develop Quality Team to review
    available data and assess organizations position
  • Develop new data collection protocols as needed
  • Know your Cost Per Unit/Episode of Service
  • Build your value proposition (continuously
    improve)

56
How Can MCTAC Help?
57
What is MCTAC?
  • MCTAC is a training, consultation, and
    educational resource center that offers resources
    to all mental health and substance use disorder
    providers in New York State.
  • MCTACs Goal Provide training and intensive
    support on quality improvement strategies,
    including business, organizational and clinical
    practices to achieve the overall goal of
    preparing and assisting providers with the
    transition to Medicaid Managed Care.

58
Who is MCTAC?
59
MCTAC Offers
  • Support and capacity building for providers
  • Tools
  • Consultation
  • Informational forums
  • Assessment tools
  • Learning communities
  • Critical information along each of the domain
    areas necessary for Managed Care readiness
  • Feedback to providers and state authorities on
    readiness for Managed Care
  • A clearinghouse of information for other Managed
    Care technical assistance efforts

60
Unique Agency Participation
  • 537 agencies have participated in a MCTAC
    offering
  • 195 (46) of OASAS SUD Providers
  • 342 (62) of OMH Agencies
  • This includes attendance at kickoff forums,
    readiness assessment webinar attendance and tool
    completion, the co-sponsored NYAPRS Open Minds
    conference, and in-person/on-line contracting
    events through 3/1/2015.

61
Kickoff Forums
MCTAC hosted twelve kick-off events in
partnership with NYS DOH, OMH, and OASAS
  • Manhattan
  • Brooklyn
  • Queens
  • Long Island
  • Albany
  • Buffalo
  • Syracuse
  • North Country

1500 people attended one of the offerings and an
additional 450 viewed a live stream of the Albany
event. Slides, video recording, and an FAQ
generated from discussion at the sessions were
generated and are available at MCTAC.org
62
Managed Care Contracting
  • Contracting events to date
  • In-person contracting sessions, featuring Adam
    Falcone (618 total attendees)
  • November 14 Rochester
  • November 25 Long Island
  • December 9 New York City
  • December 10 Albany
  • January 13 New York City
  • 93 of feedback form respondents found the
    in-person contracting session with Adam Falcone
    useful.

63
Contracting (cont.)
  • Web-based offerings
  • Managed Care Contracting The Plan Perspective,
    featuring Harold Iselin and Whitney Phelps of
    Greenberg Traurig -- December 17, 2014.
  • Contracting Overview and Office Hours with Adam
    Falcone February 10, 2015.
  • Managed Care Contracting The Provider
    Perspective, featuring Mark Furlong and Ron
    Lampert of Thresholds  -- March 25, 2015.

64
RCM, UM Outcomes
  • In-person overview offerings
  • NYC April 17, 2015
  • Buffalo May 1, 2015
  • Albany May 29, 2015
  • Web-based Learning Communities
  • Revenue Cycle Management May 12th - June 4th
    Utilization Management Outcomes TBA

65
HCBS Infrastructure Development Trainings
  • Co-Sponsored Open Minds Conference on HCBS with
    NYAPRS December 11-12, 2014. All materials
    available on NYAPRS and MCTAC websites.
  • For Designated Providers or those outside NYC who
    are interested in applying with little or no
    experience with Medicaid and/or Managed Care
  • Part I. Introductory Webinar May 1, 2015
  • Part II. Full-day in-person training in NYC (May
    11, 2015), Syracuse (TBD), and Albany (TBD)
  • Foundations in Essential Business and Operations
    Practices
  • Exploring Options for Deploying Essential
    Practices
  • For all HCBS providers, Health Homes, and Care
    Managers HCBS Frontend and Workflow
    Walkthrough, Overview of each HCBS Service.
    Scheduled for 6/15/2015 in NYC.

66
MCO Priorities, Business Practices Strategy
  • Change Management Leadership for Managed Care
    webinar featuring Anthony Salerno, PhD.
  • National Provider Identifier (NPI) Training
    webinar featuring Boris Vilgorin, MPA.
  • Co-Sponsored 2-Day NYAPRS Open Minds Conference
    in December of 2015
  • Readiness Assessment Tutorial and Aggregate
    Findings Overview webinars featuring Andrew
    Cleek, PsyD.

67
MCTAC Readiness Tool
  • This MMC Readiness Tool is designed to provide
    organizations with 11 categories of processes,
    practices and change management activities needed
    to effectively prepare for and function during
    the early stages of a business relationship with
    a Managed Care organization. When completed,
    the self-assessment tool offers a snapshot of the
    organizations current level of readiness as well
    as an assessment of the need for technical
    assistance. This tool may be helpful as a
    planning resource to guide organizations in their
    preparation and decision making activities.

68
Readiness Assessment Findings Overview
  • 313 MCTAC Readiness Assessments were included in
    analysis
  • OMH, OASAS and OMH/OASAS were represented (30
    each)
  • 162 (52) agencies did not score in the Top 25
    in any Factor
  • There are no statistically significant
    differences by Region
  • There are statistically significant differences
    by Reimbursement
  • There are statistically significant differences
    by Agency Type

69
Domains of Readiness
Domain Name
1 Understanding MCO Priorities Present Managed Care Involvement MCO Priorities
2 MCO Contracting Contracting
3 Communication /Reporting (Services authorization, etc.) Communication
4 IT System Requirements IT
5 Level of Care (LOC) Criteria / Utilization Management Practices Level of Care
6 Member Services/Grievance Procedures Member Services
7 Interface with Physical Health, Social Support and Health Homes Interface
8 Quality Management/Quality Studies/Incentive Opportunities Quality
9 Finance and Billing Finance
10 Access Requirements Access
11 Demonstrating Impact/Value (Data Management Evaluation Capacity) Evaluation
Aggregate Total Score Total Score
70
Average Score by Domain
Domain Average Score
1. MCO Priorities 3.30
2. Contracting 3.18
3. Communication 2.64
4. IT 3.19
5. Level of Care 2.77
6. Member Services 2.83
7. Interface 3.93
8. Quality 2.86
9. Finance 3.25
10. Access 3.36
11. Evaluation 2.43
Total Score 3.07
71
What Next?
72
Steps to Take
  • Create a Managed Care Readiness Team
  • Identify a Readiness Team Leader that will
    function as the champion
  • Complete the Managed Care Readiness Assessment
    being provided by MCTAC
  • Consider assessing readiness by program
  • Develop a Managed Care Readiness Work Plan

73
Steps to Take
  • Participate in MCTAC Technical Assistance
    offerings based upon needs identified.
  • Educate and involve Board members
  • Educate and involve staff members at all levels
  • Look for opportunities to create synergy for your
    organization in your involvement in the various
    transformational initiatives
  • Develop relationships with Managed Care Company
    representatives

74
Acknowledgements
MCTAC is driven by a robust partnership of
academic, research, advocacy, and behavioral
health experts. All training and technical
assistance, including this presentation, are
informed and guided by real-time feedback and
input from the broad provider community and
policy makers. Special thanks to John Lee and
Joslyn Teter-McBride of Coordinated Care
Services, Inc. (CCSI) Dr. Charlie Neighbors and
Kate Federici of CASAColumbia Noah Isaacs
and Meaghan Baier of the Institute for Community
Living (ICL)
75
Visit www.mctac.org to view past trainings,
sign-up for upcoming events, and access
resources.
mctac.info_at_nyu.edu
_at_CTACNY
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