Programmatic Structure
and the PaymentIncentive
Paradigm
James Gavin President and Chief Executive Officer
Community Care Behavioral Health Organization
June 14 2012
copy 2012 Community Care Behavioral Health
DUE TO THE CURRENT
FINANCIAL RESTRAINTS
THE LIGHT AT THE END OF THE TUNNEL
WILL BE TURNED OFF UNTIL FURTHER NOTICE
THE TRAIN WILL REMAIN
IN MOTION
Overview of Presentation
bull About Community Care
bull Recovery Transformation Essentials
bull Financial Management of Public
Behavioral Health
bull Practical Applications
3
About
Community Care
4
Community Care
5
bull A Pennsylvania based owned and
operated company
bull Employs over 500 people throughout the
Commonwealth
bull Part of UPMC which employs over 55000
people within Pennsylvania
Community Care
bull Serves approximately 110000 people
annually
bull Eight offices across Pennsylvania
bull Statewide network of approximately
1600 providers
bull Only behavioral health managed care
organization in all HealthChoices regions
6
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
DUE TO THE CURRENT
FINANCIAL RESTRAINTS
THE LIGHT AT THE END OF THE TUNNEL
WILL BE TURNED OFF UNTIL FURTHER NOTICE
THE TRAIN WILL REMAIN
IN MOTION
Overview of Presentation
bull About Community Care
bull Recovery Transformation Essentials
bull Financial Management of Public
Behavioral Health
bull Practical Applications
3
About
Community Care
4
Community Care
5
bull A Pennsylvania based owned and
operated company
bull Employs over 500 people throughout the
Commonwealth
bull Part of UPMC which employs over 55000
people within Pennsylvania
Community Care
bull Serves approximately 110000 people
annually
bull Eight offices across Pennsylvania
bull Statewide network of approximately
1600 providers
bull Only behavioral health managed care
organization in all HealthChoices regions
6
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Overview of Presentation
bull About Community Care
bull Recovery Transformation Essentials
bull Financial Management of Public
Behavioral Health
bull Practical Applications
3
About
Community Care
4
Community Care
5
bull A Pennsylvania based owned and
operated company
bull Employs over 500 people throughout the
Commonwealth
bull Part of UPMC which employs over 55000
people within Pennsylvania
Community Care
bull Serves approximately 110000 people
annually
bull Eight offices across Pennsylvania
bull Statewide network of approximately
1600 providers
bull Only behavioral health managed care
organization in all HealthChoices regions
6
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
About
Community Care
4
Community Care
5
bull A Pennsylvania based owned and
operated company
bull Employs over 500 people throughout the
Commonwealth
bull Part of UPMC which employs over 55000
people within Pennsylvania
Community Care
bull Serves approximately 110000 people
annually
bull Eight offices across Pennsylvania
bull Statewide network of approximately
1600 providers
bull Only behavioral health managed care
organization in all HealthChoices regions
6
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Community Care
5
bull A Pennsylvania based owned and
operated company
bull Employs over 500 people throughout the
Commonwealth
bull Part of UPMC which employs over 55000
people within Pennsylvania
Community Care
bull Serves approximately 110000 people
annually
bull Eight offices across Pennsylvania
bull Statewide network of approximately
1600 providers
bull Only behavioral health managed care
organization in all HealthChoices regions
6
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Community Care
bull Serves approximately 110000 people
annually
bull Eight offices across Pennsylvania
bull Statewide network of approximately
1600 providers
bull Only behavioral health managed care
organization in all HealthChoices regions
6
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
7
Community Care Office
Southwest Region
Lehigh-Capital Region
Chester County Region
Northeast Region
North Central Region ndash County Option
North Central Region ndash State Option
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield Centre
Huntingdon
Adams
Mifflin Snyder
Union
Tioga Bradford
Columbia Montour
Northumberland
York
Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sulliva
n
North Central Region ndash County Option
HealthChoices Regions
Served by Community Care
7
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
8
Western NY Region
Central NY Region Hudson
River Region
New York City Region
Long Island Region
Warren
Washington
Saratoga
Schenectady
Rensselaer Schoharie
Greene Columbia
Ulster Dutchess Sullivan
Orange Putnam
Westchester Rockland
Albany
Community Care Office
Serving New Yorkrsquos Hudson River Region
8
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
9
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
493589 570659 562436 606663 954938 1043125 1097645 1297458 1377419 1528003
Membership Trend
9
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
10
(in 000rsquos)
FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010 FY2011 FY2012
$217158 $273073 $310480 $351207 $663874 $707912 $759020 $803684 $836818 $963794
10
Revenue Trend
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
bull Improve the health and well-
being of the community through
the delivery of effective and
accessible behavioral health
services
bull Improve the quality of services
through a stakeholder
partnership focused on
outcomes
bull Support high-quality service
delivery through a nonprofit
partnership with public agencies
experienced local providers and
involved members and families
Mission and Vision
11
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Making a Difference
bull Excellent Quality and Outcomes
ndash External review agency findings
(IPRO - state quality review entity)
ndash Provider feedback
ndash Consumer feedback
bull Innovations
ndash PHBH initiatives Connected Caretrade
ndash Shared Decision Making
ndash Accountable Clinical Home
School-based
ndash Youth and Family Training Institute
12
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
bull National Recognition for Ethical Practices
ndash Moffic Award from the American Association of
Community Psychiatrists
bull Tax Exempt
ndash Received tax-exempt status in July 2003 filed under
section 501 (c) of the Internal Revenue Code
bull NCQA Accreditation
ndash Received full accreditation status from the National
Committee for Quality Assurance (NCQA)
ndash Highest possible level perfect score
Strategic Essentials
13
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
DevelopingImplementing
High Fidelity Wraparound Services
bull Member of the original planning team
bull Ongoing financial supportannual grant
bull Community Care counties with HFW Allegheny
Chester Erie and Northumberland
bull Supports stakeholder (youth and family) involvement
bull Statewide youth advisory structure
14
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Partner in Problem-Solving
Ongoing Challenges
bull Working to ensure sustainability and scalability
bull Focused on appropriate clinical integration
bull Participated in developing functional outcomes
bull Participated in financial paradigm analysissavings
15
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Recovery
Transformation
Essentials
16
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Recovery Transformation Essentials
bull Leadership ndash Leadership ndash Leadership
bull Stakeholder influence enhancements
bull Culture change for providers
bull Financial model adaptation (change)
bull The prescription for change is uncovered
when we promote and embrace
meaningful dialogue among stakeholders
17
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Financial Management
of Public
Behavioral Health
18
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Current Practices
bull Volume-based reimbursement
bull Outcomes-based reimbursement models remain
illusive
bull Medical necessitymedical delivery system
bull Only 14 of 50 states have a Medicaid waiver allowing
behavioral health to be carved out of the managed
care program
bull In most states Medicaid-funded behavioral health
services are provided on a fee-for-service basis
bull Services are organized around models rather than
the person
19
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Financial Transformation Challenges
bull Current financing mechanisms are inflexible
medically-based and challenge the
fundamental shifts to person-centeredness
and recovery-based services
bull Volume-driven health care undermines quality
bull Payment by the hour encourages volume and
dependencies
20
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Practical
Applications
21
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Systems Change
bull $4-5 billion in savings due to the Behavioral
Health program alone (1998-2008)
bull Access to services and variety of services
have both increased
bull Reinvestment opportunities sparked
innovative practices and cost-effective
alternatives to current practices
22
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
23
16
13
2215
13
10
12
2008
Inpatient
Outpatient
BHRS
Residential
Drug amp Alcohol
Community Services
Other
Systems Redesign
Move to Less Restricted Care Settings
23
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
24
Access Performance Indicators (Penetration Rate) All
PI 1a SMI and No Substance Abuse Ages 18-64 52
PI 1b SMI and Substance Abuse Ages 18-64 65
PI 21 Mental Health Service Ages 18-64 African American 33
PI 22 Substance Abuse Service Ages 13-17 African American 41
PI 23 Substance Abuse Service Ages 18-64 African American 27
PI 24 Mental Health Service Ages 18-64 46
PI 25 Substance Abuse Service Ages 13-17 -1
PI 26 Substance Abuse Service Ages 18-64 30
QualityProcess Performance Indicators All
PI 3a At Least One Day in a Residential Treatment Facility Under Age 21 Mental Health 35
PI 3b Cumulative RTF Bed Days 120 or Greater Under Age 21 Mental Health 1
PI 4a Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Under Age 21 5
PI 4b Psychiatric Inpatient Readmitted Within 30 Days Post-Discharge Ages 21-64 12
PI 5a Discharged from RTF With Follow-Up Service(s) Within 7 Days Post-Discharge -3
PI 5b Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Under Age 21 19
PI 5c Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 21-64 20
PI 5d Discharged From Psychiatric Inpatient With Follow-Up Service(s) Within 7 Days Post-Discharge Ages 65+ NC
PI 5e Discharged From Non-Hospital Residential Detox Rehabilitation and Halfway House Services for DampA Dependency or Addiction with Follow-Up Services Within 7 Days Post-Discharge Under Age 65
9
Percentage Change (0 to 65) in 16 HealthChoices
Quality Performance Measures 2003ndash2008
24
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Paying for Performance
bull Strong use of outcomes management to improve
quality
bull Pay-for-Performance projects for the following
ndash Blended case management and specialty case
management services
ndash Family-based mental health services
ndash Outpatient services
ndash Preferred Providers for Best Practice evaluations
ndash Alternative payment arrangements tied to quality
indicators
25
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Health Home Service Definition
bull Defined by Affordable Care Act
ndash Comprehensive care management
ndash Care coordination and health promotion
ndash Comprehensive transitional care from inpatient to
other settings ndash appointment follow-up
ndash Individual and family support including authorized
representatives
ndash Referral to community and social support services
ndash Use of information technology to link services
ndash Not limited to any specific setting
26
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Connected Care Demonstration Project
bull Joint effort of DPW Allegheny County UPMC for
You Center for Healthcare Strategies and
Community Care
bull Data sharing between plans and with providers
bull Joint treatment planning with provider systems
bull Identification of gaps in metabolic monitoring of
consumers on antipsychotic medications for PCPs
bull Positive preliminary results more definitive analysis
underway
27
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Building on Our Foundation
New PHBH Initiatives
bull Building on lessons learned in Connected Care
developing a Connected Care Behavioral Health
Home Plus Program for implementation in our state
contract 23 rural counties in PArsquos north central region
bull Building virtual teams for adults with SMI and other
chronic physical conditions including a county-
operated system collaborating with a local health
center and a community mental health center
bull Expect increased access to and coordination with
appropriate physical and behavioral health services
28
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Behavioral Health Clinical Home
Principles for Children
bull Accountable clinical home
bull Economic paradigm analysis
bull Redefining the accountability (family) structure
bull Workforce management as dominant feature
ndash Workforce stability (economics)
ndash Workforce competencies (Learning Collaborative)
bull Evaluation and outcomes
ndash Domains of functioning within the child and family
ndash Academic performance
ndash Continued analysis of financial viability
29
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
30
Erie
Crawford
Mercer
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango
Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blai
r
Centre
Clinton
Huntingdo
n
Fulton Franklin Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northumberla
nd
Dauphin
York
Lancaster
Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Bucks
Montgomery
Juniat
a
Sullivan
Lawrence
Beav
er
Erie
Allegheny
Clarion
Forest
Warren McKean Potter
Cameron Elk
Clearfield Centre
Adams
Mifflin
Union
Tioga Bradford
Columbia
Montour
Northumberland
York Chester
Berks
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Juniata
Sullivan
Huntingdon
Jefferson
Community Care School-Based Counties Community Care Office
Note School-based services are provided in 9 counties 14 school districts
Snyder
Pennsylvania School-Based Counties
30
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Serving Adults with SMI
Community Care Recovery Institute
bull CommonGroundtrade Internet-based system with peers
supporting consumers to prepare for medications visits
ndash Positive impact on relationship between consumers
and physicians
bull Personal Medicine Power Statement Whole Health and
Decision Support toolkits
ndash 50 provider agencies participate in regional learning
collaboratives
ndash Strong emphasis on integrating recovery concepts in
psychiatric services with extensive physician outreach
31
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
copy 2012 Community Care
Recovery Learning Collaboratives
Philadelphia
Erie
Crawford
Mercer
Lawrence
Beaver
Washington
Greene Fayette
Allegheny
Westmoreland
Butler
Armstrong
Clarion
Venango Forest
Warren McKean Potter
Cameron Elk
Jefferson
Clearfield
Indiana
Cambria
Somerset Bedford
Blair
Centre
Clinton
Huntingdon
Fulton Franklin
Adams
Cumberland
Perry
Mifflin Snyder
Union
Lycoming
Tioga Bradford
Columbia
Montour
Northum-
berland
Dauphin
York
Lancaster Chester
Berks
Lebanon
Schuylkill
Luzerne
Wyoming
Susquehanna
Lackawanna
Wayne
Pike
Monroe
Carbon
Lehigh
Northampton
Bucks
Montgomery
Delaware
Juniata
Sullivan
Allegheny County Lehigh-Capital Region
Adams Hanover Counseling Services Inc Bell Socialization Berks Counseling Center Familicare Counseling Center Project Transition SAM Inc Threshold YorkAdams MHMR Program
Chester County
Elwyn Fellowship Holcomb Horizon House Human Services Inc Kelsh Associates Inc Penn Psychiatric Center Salisbury BH Inc
Northeast Region
BH Services of Wyoming Valley NHS Northeast Counseling Services Scranton Counseling Center
North Central Region
Beacon Light Behavioral Health Systems Clearfield-Jefferson Community MH Center Community Service Group SAM Inc ----------------------------------- Centre County MHMR Strawberry Fields Inc The Meadows Universal Community BH ----------------------------------- CMSU Laurel Health Services Northumberland County MHMR amp DA Services Tioga County DHS The Main Link Wellsprings
Carbon Monroe Pike
REDCo Resources of Human Development NHS Mt Pocono Salisbury Behavioral Health
Chartiers Community MRMR Inc Family Services of Western PA Mercy Behavioral Health Milestone Mon Yough Community Services Northwestern Human Services Residential Care Services Inc Staunton Clinic Transitional Services Inc Turtle Creek Valley MHMR Inc Western Psychiatric Institute and Clinic
32
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Focus on Development of Recovery-Oriented System of Care for Substance Abuse Disorders
bull Leadership from Marge Hanna Senior Director
Substance Abuse Initiatives
bull Close collaboration with county HealthChoices and
SCA directors
bull Goal is development of vigorous community-based
resources focused on long-term recovery
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
Contact Information
James Gavin
President and Chief Executive Officer
Community Care Behavioral Health Organization
One Chatham Center Suite 700
112 Washington Place
Pittsburgh PA 15219
412-454-2120 wwwccbhcom
35
