mercy maricopa integrated care maricopa integrated care november 18, ... and decision-making related...

Proprietary and Confidential

Mercy Maricopa Integrated Care

November 18, 2014

Meeting with Provider CEOs


Eddy D. Broadway, CEO Mercy Maricopa

Welcome



Wendy Briggs, Director Veridus, LLC

Legislative Updates

2015 Legislative Session

Wendy G. Briggs

Veridus

Election Results

• Doug Ducey elected Governor by a wide margin.

• Former CEO of Coldstone Creamery.

• Will need educating about Healthcare issues

• Budget Concerns, Jumpstarting Arizona’s Economy, Quality of K-12 Education are his stated priorities.

Election Results

• House will remain 36-24 in favor of the Republicans.

• Arizona Senate maintains its 17-13 Republican majority.

• Although the numbers remain the same in both chambers, the respective GOP Caucus leadership teams chosen the day after Election Day are definitely more conservative.

Election Results

• House Leadership:

– Speaker: David Gowan.

– Majority Leader: Steve Montenegro.

– Majority Whip: David Livingston.

– Minority Leader: Eric Meyer.

– Asst. Minority Leader: Bruce Wheeler.

– Minority Whip: Rebecca Rios.

Election Results

• Senate Leadership:

– Senate President: Andy Biggs.

– Senate Majority Leader: Steve Yarbrough.

– Senate Majority Whip: Gail Griffin.

– Senate Minority Leader: Katie Hobbs.

– Senate Minority Leader: Steve Farley.

– Senate Whips: Lupe Contreras and Martin J. Quezada.


• House Health Chair continues to be Rep. Heather Carter.

• Senate Health Chair continues to be Sen. Nancy Barto.

• Senate Appropriations Chair continues to be Sen. Don Shooter.

• House Appropriations Chair is Rep. Justin Olson.


• Budget Issues will be the focus.

• Where the revenue goes:

Graph Source: John Arnold, Office of Governor Jan Brewer

2015 Legislative SessionRevenue

FY 2014 Projected Actual

General Fund 3.6% 1.8%

Individual Income 3.1% 1.9%

Corporate -4.1% -13.1%

TPT 5.7% 3.7%

Source: John Arnold, Office of Governor Jan

Brewer

2015 Legislative SessionRevenue History

FY 2014

Source: John Arnold, Office of Governor Jan Brewer

2015 Legislative SessionHow Big of a Problem Do We Have?

FY 2014

Source: JLBC Finance Advisory Committee Briefing Materials


Finance Updates

Ramon Dominguez, CFO Mercy Maricopa

Mercy Maricopa Integrated CareProprietary and Confidential

Mercy Maricopa Integrated CareDoing the right thing for the right reason


November 18, 2014

Mercy Maricopa Business Priorities



Mercy MaricopaSix Business Priority Areas

17

• Arnold v. ADHS

• Children’s System

• Crisis System

• GMH/SA Network

• Integrated Care for Members with SMI

• Block Payment Reform


Mercy Maricopa Business PrioritiesKey Terms

18

Executive Sponsor: A member of the Leadership Team who is ultimately responsible for strategic direction, resource allocation, and decision-making related to the project.

Business Owner: Key leader who reports to the Executive Sponsor and is responsible for daily oversight of project activities and communication with internal staff and external stakeholders


Arnold v. ADHS


Arnold v. ADHS

20

Arnold v. ADHS Overview

Executive Sponsor: Tad Gary, Chief Clinical Officer

Business Owner: Blythe FitzHarris, Adult System of Care Administrator

Intended Outcome: Fully implement a system of care for members determined to have a serious mental illness that supports the member in achieving their recovery goals, is consistent with evidence-based practices, and adheres to the Arnold v. ADHS agreement.


Arnold v. ADHS

21

Goals

1. Fully implement SAMHSA evidence-based practices related to Assertive Community Treatment (ACT), Consumer-Operated Services, Permanent Supportive Housing (PSH), and Supported Employment (SE)

2. Transform the service delivery system to promote and incentivizehigh-quality care

3. Increase the network’s capacity to deliver ACT services

4. Increase network capacity to provide Supported Employment services

5. Increase permanency through Supportive Housing

6. Improve the accessibility of peer and family support services


Arnold v. ADHS, Supported Employment

22

Accomplishments To-Date

Area(s) of Influence/Impact

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Launched two new ACT teams; CBI Forensic ACT team (FACT) in August; SW Network in November for a total of 17 teams across the system

Launched co-located SE services at the SMI clinics starting in November 2014

Launched PSH expanded capacity for an additional 425 subsidies and support services as well as expanded capacity for PSH support services for 200 members


Arnold v. ADHS

23

Accomplishments To-Date (continued)


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In process of finalizing the developmentof the Information and ReferralManagement Program based on RFI responses.

Providing TA opportunities to Consumer Run Agencies.

Implemented peer MHC and hospital transition programs

Implemented Family Psychoeducational Program


Arnold v. ADHS

24



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14 Fidelity Reviews have been completed or are in process by Western Interstate Commission on Higher Education (WICHE)

Offered technical assistance to providers in response to WICHE findings and review process

Implemented incentive based contracts for ACT and PSH


Arnold v. ADHS

25

Priorities Moving Forward


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Implement two additional ACT teams; Feb 2015 & May 2015

Monitor service utilization of available SE expanded capacity (375)

Offer expanded rental subsidies and supportive housing services per PSHmodel (425).

Implement Information and Referral Management Program

Implement Peer Health Navigator Program


Arnold v. ADHS

26

Priorities Moving Forward (continued)


Item

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Continue to expand peer and family service capacity (500)

Continue providing technical assistance to address fidelity challenges and to assist the system to align with SAMHSA requirements and implement self-monitoring process

Continue to identify and implement incentive-based contracts.


Children’s System


Children’s System

28

Children’s System Overview

Executive Sponsor: Tad Gary, Chief Clinical Officer

Business Owner: Karrie Steving, Children’s System of Care Administrator

Intended Outcome: Transform the children's system in a way that actively engages families and system influencers in the process and promotes member and family choice in where, how, and from whom they receive their services.


Children’s System

29

Goals

1. Evaluate the children’s service delivery system to identify efficiencies and opportunities to enhance quality

2. Create a proactive service delivery system

3. Improve service coordination for children in foster care and children involved in multiple systems

4. Implement processes to support transition-age youth in successfully transitioning to adulthood


Children’s System

30



Item

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Completed analysis of the children’s delivery system and system focus groups

Completed the Birth to Five environmental scan for clinical practice and adding a psychiatric care scan

Completed environmental scan of transition-age youth services


Children’s System

31



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Developed pilot project to provide comprehensive behavioral health servicesto children, youth, families, and caregivers involved in child welfare system and CMDP

Convened monthly meetings of the Mercy Maricopa Youth Leadership Council

Conducted System of Care Practice Reviews and Brief Practice Reviews to guide systems-level performance improvement


Children’s System

32



Item

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Implement the Children’s Redesign Plan

Implement the CMDP Pilot Project

Hold Youth Involvement Kick-off Event (January 2015)

Continue Birth to Five Learning Consortium

Continue System of Care Practice Review and Brief Practice Review to inform the CSOC


Crisis System


Crisis System

34

Crisis System Overview

Executive Sponsor: Don Fowls, Chief Medical Officer

Business Owner: Gabriella Guerra, Head of Crisis and Cultural Services

Intended Outcome: Collaborate with system partners to enhance the current crisis system to maximize and align resources, and connect individuals to the services and supports they need to achieve their recovery goals and promote resiliency.


Crisis System

35

Goals

1. Enhance crisis system capacity and effectiveness

2. Facilitate communication and information sharing across the provider network

3. Expand community-based service options


Crisis System

36



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Engaged stakeholders and community partners at the Crisis 360 stakeholder and workgroup meetings to discuss needs of children, youth, adults, and families during a crisis episode

Published the Crisis 360 Evaluation Final Report which included key findings and recommendations for Arizona’s crisis system

Identified recommended changes for the SMI and adult outpatient providers contract and provider manuals


Crisis System

37



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Developed and posted a Crisis Call Center and Dispatch Services RFI to solicit innovative ideas and implementation strategies for a comprehensive Crisis Call Center that includes:▪ nurse line ▪ centralized inpatient bed management▪ transportation▪ hospital rapid response▪ mobile crisis services▪ developmental disabilities and tribal team▪ children and youth rapid-response and

stabilization services▪ crisis navigators


Crisis System

38



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Convened groups (e.g., internal steering committee, external stakeholderworkgroup) to address ED/hospital holds issues

Created enhanced systems and procedures (e.g., daily data updates with hospitals, data dashboards) to track and address ED/hospital holds

Held discussions with providers about Crisis Respite and expanded locations for court-ordered treatment amendment


Crisis System

39



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Achieve and sustain hospital hold percentages of 10% or less, and 5% overlap by February 2015

Develop an approach for linking clinicalperformance measures to incentives

Enhance system partnerships to coordinate member access to services and support to prevent crisis episodes


General Mental Health/Substance Abuse (GMH/SA)


GMH/SA

41

GMH/SA Overview

Executive Sponsor: Eddy Broadway, President and CEO, Mercy MaricopaMark Fisher, President and CEO, Mercy Care Plan

Business Owner: Christi Lundeen, Chief Innovation OfficerMily Schroeder, Network Development AdministratorGabriella Guerra, Head of Crisis and Cultural Services

Intended Outcome: Implement an integrated and coordinated model of care for members with general mental health and substance abuse needs.


GMH/SA

42

Goals

1. Expand integrated care service delivery models

2. Increase network capacity and infrastructure to deliver services according to an integrated care model


GMH/SA

43



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Expanded capacity of the network by increasing number of providers, modifying contracts, and/or establishing partnerships in the areas of:▪ women and children’s services ▪ behavioral health ▪ PCMH practices and FQHCs▪ ACOs▪ first responders ▪ hospital holds


GMH/SA

44



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Developed process of collecting data from contracted providers to determine number of GMH/SA providers and staff providing services

Identified and updated comprehensive provider roster monthly to determine service capacity


GMH/SA

45

GMH/SA Provider Network Overview

GMH/SA Provider Type Number

Contracted Providers-Agencies 42

Outpatient Clinics 133

Sub Acute 8

Community Services Agencies 4

Behavioral Health Medical Professionals (BHMP) 67

Behavioral Health Professionals (BHP) 520

Behavioral Health Technicians (BHT) 1,249

Behavioral Health Para Professionals (BHPP) 262

Methadone Prescribers 16

Buprenorphine Prescribers 19

(Totals as of 11/14/14)


GMH/SA

46



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Implement the care management plan for integration at PCMHs, high volume community-based and FQHCs by December 2014

Identify a dual contracting process and payment methodology that allows providers to treat members for both physical and behavioral health services, when possible/practical


GMH/SA

47

Priorities Moving Forward (continued)


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Successfully launch the health information exchange (HIE) in collaboration with HINAz and BHINAz April 2015

Successfully implement the population health management and care management tools April 2015

Recruit and train care managers/navigators to support providers

Enhance method to collect and update provider data


Integrated Care for members determined to have a Serious Mental Illness



49

Integrated Care for Members with SMI Overview

Executive Sponsor: Don Fowls, Chief Medical Officer

Business Owner: Christi Lundeen, Chief Innovation OfficerMichael Hedden, Integrated Care Administrator

Intended Outcome: Transform the service delivery system for members determined to have a serious mental illness into a fully integrated care model that delivers high-quality medical and behavioral health services.



50

Goals

1. Expand system capabilities for providing integrated care

2. Promote care coordination across all providers

3. Enhance and improve systems to focus on member outcomes and quality of life



51



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Deployed care management/coordination teams to provider network organization (PNO) sites to work with community-based case managers

Embedded care management staff at certain facilities to coordinate discharge planning for members (SMI, COE/COT)

Completed Phase 1 of HIN scope of work



52



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Defined details for each of the various models (virtual, PCMH, PCHCH, etc.), developed provider requirements for consideration, and implementation details

Developed ongoing processes to provide data and support to ensure members’ physical/behavioral health needs are met



53



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Collaborated with Learning and Performance to develop training modules for providers

Aligned Mercy Maricopa Integrated Care Academy with the MCP Integrated Care Academy to expand the provision of training and education to providers


Integrated Care for Members Determined to have a Serious Mental Illness

54



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Expand behavioral health services offerings at current PCMH, FQHC, and FQHC-like providers during 2015

Expand the number of integratedpractices available to persons with SMI by 3-5 centers each quarter

Continue to identify ways to expand the network of providers


Integrated Care for Members Determined to have a Serious Mental Illness

55



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Complete the Participation Agreements with HINAz and BHINAz

Increase trainings offered through the Integrated Care Training Academy to at least one per quarter in 2015


Block Payment Reform



57

Block Payment Reform Overview

Executive Sponsor: Eddy Broadway, President and CEO

Business Owner: Ramon Dominguez, Chief Financial Officer

Intended Outcome: Align payment processes and incentives to purchase high-quality, cost-effective services that improve member outcomes and increase accessibility.



58

Goals

1. Transform the payment system in a transparent way that actively engages stakeholders/influencers

2. Develop payment methodology(ies) that incentivize high-quality care and improved member outcomes

3. Implement new payment mechanisms in a systematic way across the network



59



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First payment pilot implemented August 2014

Stakeholder forum convened September 2014

Second pilot project will be implemented in November 2014



60



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Full implementation of block payment reform by October 2017


Discussion and Next Steps


Thank You!

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