Handout 2

Report
Administrative Service Organization (ASO) Role and
Lessons Learned in Managing a State’s Service System
Kathy Enerlich, Executive Director
Challenges of rapid, large-scale system
transformation impacting leadership, the
provider community and families.
Objectives
Lessons learned and strategies for system
of care integration for individuals with
developmental disabilities and cooccurring mental illness.
1
Quick Look - Who We Are
PerformCare is a full-service managed behavioral health care
organization (MBHO) that supports individuals and providers
through programs in both the public and private sectors.
Founded in 1994 by a group of leading behavioral health providers,
PerformCare is a member of the AmeriHealth Caritas Family of
Companies, one of the largest Medicaid managed care organizations
in the United States.
PerformCare is NCQA Accredited.
2
PerformCare NJ
As the Administrative Service Organization (ASO) for the State of
New Jersey's Division of Children's System of Care (CSOC) since 2009,
PerformCare New Jersey utilizes significant expertise and integrated
technologies to register, authorize, and coordinate services for
children, youth, and young adults who are experiencing emotional
and behavioral challenges, are developmentally and intellectually
disabled or need certain substance use treatment services.
3
Who is integrated?
The NJ Children’s System of Care serves:
Behavioral health: Youth with moderate to severe needs, entire NJ
population (over 45,000 youth in the last fiscal year).
Child welfare: Youth with child welfare involvement and a treatment
need.
Developmental disabilities: Youth eligible for services based on
regulatory definition of functional impairment (over 17,000 youth).
Substance use: Youth who are underinsured and have a treatment need
(1143).
Housing: Young adults experiencing homelessness (573).
4
Historical Perspective*
July 2012
2006
1999
NJ wins a federal system of
care grant that allowed NJ to
develop a system of care.
2001
NJ restructures the
funding system that
serves children.
Through Medicaid and
the contracted system
administrator, children
no longer need to enter
the child welfare
system to receive
behavioral health care
services.
The Department of
Children and Families
(DCF) becomes the first
cabinet-level department
exclusively dedicated to
children and families
[P.L. 2006, Chapter 47].
Intellectual/developmental
disability (I/DD) services for
youth and young adults
under age 21 is
transitioned from the
Department of Human
Services (DHS) Division of
Developmental Disabilities
to the DCF Children’s
System of Care (CSOC).
July 2013
Substance use treatment
services for youth under
age 18 is transitioned
from DHS, Division of
Mental Health and
Addiction Services, to
DCF/CSOC.
2005
Closed State
Psychiatric
Hospital
For Children
2007 – 2012
May 2013
The number of youth in
out-of-state behavioral
health care goes from
more than 300 to three.*
Unification of care
management, under
CMO,
is completed statewide.
December
2014
Behavioral
Health Home
Pilot
*How did NJ do this? Careful individualized planning and the development of
in-state options (based on research about what kids need) using resources that were
previously going out of state.
*Source-State of NJ Division of Children’s System of Care PowerPoint
System Foundation
Child Centered & Family Driven
Community Based
Culturally Competent
Outcome Based
Needs Driven
Accessible
Strengths Based
Family Involvement
Individualized
Unconditional Care
Collaborative
Home, School &
Community Based
Promoting
Independence
Cost Effective
Team Based
Comprehensive
System of Care Vision*
To help youth succeed…
At home
Successfully living with their families and reducing the need for
out-of-home treatment settings.
At school
Successfully attending the least restrictive and most appropriate
school setting close to home.
In the community
Successfully participating in the community and becoming
independent, productive and law-abiding citizens.
*Source: NJ Division of Children’s System of Care slide
The ASO’s Role as a Partner with the State
Vision/policy for system of care
Access to Care: 24/7/365 single point of contact for
families
Setting data collection priorities
Developing/enhancing electronic medical record
Using data to refine service array
Data collection, reporting and trending
Contract management and service line manager
Provider training, communication, technical
support
Rate setting, new services (via notice of funds
availability), funding priorities
Leverage braided and blended funding streams to
maximize services and availability of Federal
Funding Participation (FFP)
Defining new service and population rules,
Rapidly implementation ensuring capacity for new
requirements, and criteria, ensuring compliance with services/populations
statutes and regulations
Reasons for Integration of Developmental Disability Services*
“Synchronized service coordination and elimination of duplicate
services.
Support sustainable communities and balanced resource
coordination.
Bring all children’s services into a single department.
Further current progress and achievement of strategic objectives of
the Department of Children and Families.”
Source: NJ Division of Children’s System of Care slide
9
State Leadership Challenges
How do you handle uncertainty, ambiguity and rapid change?
Workforce competencies
Reexamination of service models: not merely managing but transformation treatment.
Shifting certain responsibility from a state entity to ASO.
Policy makers faced with no new dollars
Building an accountable oversight structure
Building a fair, equitable service model to access services based on
level of need.
10
State Leadership Strategies
Understand and communicate the vision of where you are going.
Recall the vision when things get murky.
Be transparent to all system partners - families, providers, staff and state,
giving current status and acknowledging challenges.
Provide comprehensive training to system providers perhaps through a
university contract.
Share and report progress regularly.
Develop partnerships with family, and with advocacy and provider groups
and organizations.
Be flexible and acknowledge what you don’t know yet.
Know who is responsible for what messaging.
11
Provider Challenges
Looking to a new entity for solutions (ASO)
How can you organization provide greater value?
(strength-based treatment, access to care, quality standards,
outcomes and cost effectiveness)
Processes for budgeting and monitoring of revenues
Use or interact with a new IT platform (foundation for data
collection)
Provide improved access
12
Provider Strategies
Accountable oversight structure that defines and monitors:
• Organization’s role and position in the market.
• Staff productivity
• Documentation and treatment planning – and progress against
identified goals (quality standards)
• Standardize process for client flow from initial request
• Project revenues, deficiencies, surplus, break-even
• Understand program utilization and if you are meeting utilization
benchmarks – data driven performance.
13
Data Challenges
Agreeing up front on what really matters.
Common definitions are needed to crosswalk definitions and data
sets.
Technical questions: how do we get the file?
Privacy concerns: who owns the data, and what can be seen or
shared?
Setting priorities for “Day 1” reports.
14
Data Strategies
Get the right people in the room: content experts, decision makers
(all sides), data analysts and IT.
Recognize that “the perfect is the enemy of the good.” Having
some kind of data decision points early is critical – then fine tune.
Need for specialized data collection: expanded modules for CANS
tools, Level of Care Indicator (LOCI) and custom family support
application.
Build reporting functions to capture discrete data for service
penetration and utilization, and track braided funding of unique
youth populations.
15
Family Engagement
Address system change and worries early on with families
• Behavioral health: will the system forget about us?
• Developmental disabilities: do you really understand what we need?
• Substance abuse: will it be more difficult to access services?
Establish stakeholder groups
• State-stakeholder group.
• ASO-family leader group.
Be in front of families frequently
16
Where are we now?
Intellectual and developmental disabilities with dual mental health
diagnoses 1915(c)-like pilot program
The primary goal of the DD/MI program is to provide a safe, stable and
therapeutically supportive environment in the community for children and
young adults with significantly challenging behavior needs.
• ensure the safety of the child or young adult and all participating staff
by providing individual specific training and on- site technical supports;
• decrease elopement risk and safeguard the environment by providing
one-time funds to ensure safety;
• keep families united by placing the child or young adult in close
proximity to the individual’s family or guardian in the least restrictive
setting;
• reunite the child or young adult with the family whenever possible
18
New Services for DD/MI Youth
Under the Pilot the DD/MI youth can receive these new services:
Case/Care Management
Individual Supports
Natural Support Training
Intensive In-Community (II-C) Habilitation
Respite
Non-Medical Transportation
Interpreter Services
19
Intensive In-Home Services
Intensive In-Home (IIH) services specifically Behavioral Interventions
and Clinical Therapeutics were designed and are being implemented.
Our role in the design impacted the treatment plan - allows users to
input clinical information such as the youth’s Needs and Strengths,
as well as Strategies, Techniques and Barriers to treatment. The user
can see all the associated information at once.
20
Optimally Managed Through Innovative Solutions
Family Support Services Application - ensures resources are
prioritized to families with greatest needs.
Family Portal - electronic eligibility application reduces family
burden and increases operational efficiencies.
DD Eligibility Average Decision Time - Reduced from 195 days to 49
days with improved information for families through clinical and
administrative processes.
Restructured Electronic Record & Consent Process - for exchange of
substance abuse information in compliance with 42 CFR-Part 2.
21
Assessing Family Support Service Needs (Respite)
Use of a standard tool that:
Assesses capability of the family to care for the youth
Identifies special needs of the youth requiring care
Considers individual family factors
22
Family Support Services Application for DD Eligible Youth
Single point of access for Family Support Services that consist
primarily of respite services & assistive technology.
Assesses the caregiver’s ability to support the youth in the
community.
Scored based upon severity of needs of the youth, caregiver, and
family.
Challenged to increase the number of families receiving FSS and
number of new families without increasing costs.
23
Family Support Services Summary of Aggregate Assessments
From January 1 to September 30, 2014 a total of N=3,358 FSS applications for
services were received.
24
DD/ID Youth Authorized Mobile Response
23% - diagnoses with moderate-severe medical disability
57% - had a prior MRSS dispatch within prior 12 months
83% - caretakers reported aggression requiring Mobile Response
50% - families cited school or afterschool difficulties as main
problem
25
Outcome of Mobile Response
100% resulted in de-escalation of harmful, disruptive behaviors
Families reported services were helpful & beneficial
Families became aware of other resources & how to access them
Mobile Response consistently made collateral contacts with youth’s
treating providers or agencies involved to communicate needs &
coordinate service delivery
60% referred to the Care Management Organization for ongoing care
management
26
Expanding Services While Keeping Down Costs
As youth with Intellectual/Developmental Disabilities were added to the population served by
PerformCare, we linked them to needed family support services without raising costs – providing more
efficiency to the system, and better distributing care.
7000
2012
5838
6000
2013
In 2014 PerformCare
estimates that some
10,000 BH services will
be authorized for DD
youth.
5210
5000
4000
4,582
$5,034
2014
$4,216
3839
$3,309
3124
$3,078
DD Youth with BH Services
Cost Per Youth
3000
1,813
2000
1562
1021
1000
0
DDYouth
Questions?

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