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Proprietary and Confidential

Mercy Maricopa Integrated CareProvider Leadership Meeting

February 4, 2016


Eddy D. Broadway, Chief Executive Officer

Welcome


Mercy Maricopa Integrated CareProprietary and Confidential

Meeting Overview

• Welcome

• CEO Update

• Topic Highlight: Neonatal Abstinence Syndrome

• Medical Management & Systems of Care Updates

• Operations Update

• Finance Update

• Q & A Session

• Adjourn

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Mercy Maricopa Integrated Care Strictly Confidential

Populations Served

Population Program Eligible

Medicaid eligible individuals with a Serious Mental Illness

Integrated physical, behavioral health, and substance abuse services

19,926

Medicare-Medicaid eligible individuals with a Serious Mental Illness

Integrated physical, behavioral health, and substance abuse services

1,099

Medicaid eligible individuals with general mental health/substance abuse needs

Behavioral health and substance abuse services 415,168

Medicaid eligible children Behavioral health and substance abuse services, case management for high needs children

443,469

Total Medicaid Eligible Members 878,563

Non-Medicaid eligible individuals with a Serious Mental Illness

Behavioral health and substance abuse services, housing, and supported employment

5,717

Any of the 4M Maricopa County residents may access the RBHA for crisis services

Updated December 2015

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Mercy Maricopa Integrated Care Strictly Confidential

CEO Update

• DBHS transition to AHCCCS

• Services to foster children and working with foster parents (HB 2442)

• Services for justice system-involved populations

• Substance abuse services and AHCCCS-led workgroup

• RFI for in-state residential targeting complex needs youth

• Mercy Maricopa strategic plan

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Mercy Maricopa Strategic Plan

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Mercy Maricopa: Strategic Plan Pillars

Right Care,

Right Place,

Right Time

GOAL: To enhance the system’s ability to serve members

in community-based settings, promoting greater

independence, health, and well-being.

Culture

Transformation

GOAL: To create an internal and external culture that

creates a service delivery system that is transparent and

responsive to the physical, behavioral, and social needs of

our members, state customers, and stakeholders;

supports professional capacity-building of employees and

providers; and promotes compliance with contractual

requirements and stakeholders expectations.

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Mercy Maricopa: Strategic Plan Pillars

Integrated Care

GOAL: To implement a fully integrated program for individuals

determined to have a serious mental illness and to expand

integrated care to children and members with general mental

health and substance abuse needs.

Value-based

Purchasing

GOAL: To align payment methodologies to system goals by

compensating providers for delivering services that meet

performance standards related to access, quality, and member

outcomes.

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Topic Highlight: Neonatal Abstinence Syndrome

Dr. Ann Negri, Adult Medical Director


Ann Negri, MD, FAPA, DFAPA

Robin S. Richardson, RN

Carolyn C. Lengua, RN, BSN

NAS Prevention Treatment Efforts and Preliminary Outcomes Data

Proprietary and Confidential <#>


Neonatal Abstinence Syndrome (NAS)NAS is when a newborn baby has withdrawal signs from certain prescription medications or street drugs used by the mother during pregnancy.

The baby may have withdrawal symptoms because he or she is no longer getting the drugs or medications from their mother’s womb. NAS symptoms can start within hours to a few days to a few weeks following birth.

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Common drugs or medications that can cause NAS include:Prescription Medication:• Methadone

• Oxycodone (Percocet)

• Hydrocodone (Vicodin)

• Suboxone

• Fentanyl

• Ativan (lorazepam)

• Xanax (alprazolam)

• and Alcohol

Illicit Drugs Such As:• Heroin• Methamphetamine• Amphetamine• Cocaine • Cannabis/marijuana• Crack• Bath salt

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Use of opioids during pregnancy

In 2013, 645 newborns were positive for the presence of narcotics.

This same analysis found that newborns in AZ with NAS were:

• 3 times more likely to be low birth weight

• 3 times more likely to have respiratory symptoms

• 17 more likely to have seizures

• 5 times more likely to have feeding difficulties compared to those with out NAS

An Arizona newborn with NAS has a median length of stay of 13 days in the hospital compared to non-NAS with a median length of stay of 2 days

Source: Arizona Statewide Task Force on Preventing Prenatal Exposure to Alcohol and

Other Drugs Strategic Plan 2015-2010

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NAS-Neonatal Abstinence Syndrome Program Objectives

• Identify pregnant women with substance

use and abuse issues risks and effects of

prenatal exposure to alcohol and others.

• Provide NAS education and discuss treatment options. For opiate use, replacement therapy is recommended and has been shown to reduce NAS symptoms.

• Talk with members addicted to opioids about a management plan and how prescribing of opioids will be handled during the pregnancy.

• Emphasize the continued need for regular visits to the obstetrician.

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NAS-Neonatal Abstinence Syndrome Program Objectives • Support the mother's adherence to treatment

prenatally and after delivery.

• Reduce neonatal intensive care unit (NICU) admissions and hospital stays from NAS complications.

• Initiate care management for the hospitalized infants to improve discharge planning and parent/guardian training during the infant's hospital stay.

• Screen for depression during pregnancy and post-partum

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Mercy Maricopa NAS ProjectIntegrated Care Management Schematic

Member

Identification

Ongoing Assessment

and Evaluation

Monitoring and

Intervention

Coordination

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Providers Collaboration Treating Pregnant Women Using Substances/Opioids

Behavioral Health and Addiction

Services

Medical specialists, endocrinologists, Pulmonologist

Pain managements specialists

OB/ neonatologists Pediatricians

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Provider Fact Sheet

CONSIDER substance issues with all pregnant

women

DISCUSSsubstance issues with all pregnant

women

COORDINATE substance issues with all providers

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Mercy Maricopa Integrated CareProprietary and Confidential 19


Number of Births by Month (353 total) April 2015 to October 2015

2123

19

26

22

12

25

12

21

0 0 0

1719

2022

13

20

4

0 0

1917

21

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014 2015

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Mercy Maricopa preliminary NAS data Total Births

353

229

124

Total Births Non-Substance Use Any Substance Use

65%

35%

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Mercy Maricopa preliminary NAS data Type of Substance Use (124 of 353 births)

35% or 124

14% or 49

10% or 38

1% or 5

17% or 59

*IdentifiedSubstance Use

*Other SubstanceUse

*Opiate Use *Alcohol Use Tobacco withOther Use

124 Births

*124 identified prenatal substance use*Other Substance use –meth/amphetamine,

benzos, Adderall, cocaine, cannabinoid

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Mercy Maricopa preliminary NAS data Type of Delivery

Vaginal Delivery47% or 166

C-Section29% or 102

Unknown 4% or 14

*Other20% or 71

Total = 353

*miscarriage, ectopic pregnancy, abortion, fetal demise

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MMIC preliminary NAS data Type of Delivery - Any Substance Use

Vaginal Delivery49% or 60

C-Section28% or 35

Unknown 3% or 4

*Other20% or 25

Total = 124

*miscarriage, ectopic pregnancy, abortion, fetal demise

• CDC statistics average C Section rate is 32.7% as of 2013• CDC miscarriage rate loss of fetus before 20th week of gestation is 15-20% in the US

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Mercy Maricopa preliminary NAS data Average prenatal visits for all births based on substance use

12

109

10 10

Non-SubstanceUse

Opiate Use *Other SubstanceUse

Alcohol Use Tobacco withOther Use

*Other Substance use –meth/amphetamine, benzos, Adderall, cocaine, cannabinoid

Average prenatal visits for a normal pregnancy is 10-15

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Mercy Maricopa preliminary NAS data Average Birth Weight

31573182

3011

2831

2996

Non-SubstanceUse

Opiate Use Other SubstanceUse

Alcohol Use Tobacco withOther Use

OB statistics from American Journal of Obstetrics ad Gynecology

Average birth weight for a normal pregnancy is 5.5 lbs or 2.5 to 4.5 KG

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Mercy Maricopa preliminary NAS data Newborn disposition as mothers used multiple substances

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Mercy Maricopa preliminary data of the 353 births Baby disposition related to NICU admission for any cause and for NAS

Reference : The New England Journal of Medicine May 28, 2015 - ..

From 2004 through 2013, the rate of NICU admissions for the NAS

nationwide that were attributed to the more than 20% of all NICU days 2013.28


Mercy Maricopa preliminary NAS data Post-Partum Depression Screening

Total Screened186 of the 353

Referred157%

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Program Evaluation: Key Points and Next Steps • Evaluate if the program improved identification of pregnant women using

substances

• Ongoing monitoring

• Evaluate if the program improved identification of infants with NAS and trend data

• Development and implementation of a new pilot program with SW human development for referral of Infants to 0-5 program

• Evaluate effectiveness of interventions and referrals of members to chemical dependency programs through the integrated intensive care management

• Screening for postpartum depression

• Track and document identified barriers to care

• Highlight “what works” along the way and success stories

• Identify areas for provider education and program change

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Questions?

Thank you


Dr. Sandra Zebrowski, Chief Medical Officer

Tad Gary, Chief Clinical Officer

Medical Management and Systems of Care Updates: Inpatient and Residential Utilization


Crisis System

Crisis System

Warm Line

Crisis Line

Transition Points

Access Points

Inpatient Hospitalizations

Mobile Team

Psychiatric Urgent Care

Emergency Department

Potential Services Post Crisis

ResidentialTransitional

Living

Permanent Supportive

Housing Services

Assertive Community Treatment

Home Environment with Outpatient

Supports and Services

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Inpatient and Residential Utilization Rates

0

20000

40000

60000

80000

100000

120000

Per 1 Per 2 Per 3 Per 4

Inpatient Utilization Residential Utilization

*Measurements reported in Units/Bed Days

12 month period – 9/14-8/15

130000

135000

140000

145000

150000

155000

160000

165000

170000

175000

180000

Per 1 Per 2 Per 3 Per 4

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Inpatient Activities

AdultCurrent Activities

• Alerting SMI clinics of member admission to inpatient care

• Have hired discharge coordinators to assist inpatient facilities and outpatient teams with discharge planning

• Intensive care management for members with complex medical conditions

• Developed provider education regarding available housing services and supports

• Increased availability of comprehensive community based services

Upcoming Activities

• Process to enhance SMI clinic involvement in member transition planning (reduce barriers to discharge and increase accountability with new workflows)

• Expansion of comprehensive community based services

• Assertive Community Treatment

• Permanent Supportive Housing Services

• Continued expansion of housing supports and services for adults within the GMH/SA and SMI system

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Residential ActivitiesAdultCurrent Activities

• Updating the scopes of work for basic residential, co-occurring and personal care residential treatment settings

• Creating criteria sets for prior authorization, continued stay and discharge for basic residential, co-occurring and personal care residential treatment settings

• AHCCCS criteria review in process

Upcoming Activities

• Plan to Implement a prior authorization process for new admits to residential treatment

• Monitoring member progress in residential treatment through concurrent review and transition of care planning

• Reviewing current residential providers to ensure service alignment with updated scopes of work

• Engagement of SMI clinics to decrease residential utilization and increase community based supportive housing

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Inpatient Activities

ChildrenCurrent Activities

• Notification process to alert providers of inpatient admissions

• Requirement for outpatient child providers to complete the level 1 discharge form within 24 hours of discharge

• Have hired discharge coordinators to assist inpatient facilities and outpatient teams with discharge planning

• Infused system with funding to support additional community based stabilization services to decrease length of stay and utilization of out of home treatment services

Upcoming Activities

• Process to enhance Children’s outpatient provider involvement in member transition planning (reduce barriers to discharge and increase accountability with new workflows)

• Continue to expand community based services

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Residential Activities

ChildrenCurrent Activities

• Conducting prior authorization and concurrent reviews for Behavioral Health Inpatient Facility (BHIF), Behavioral Health Residential Facility(BHRF) and Home Care Training to the Home Care Client (HCTC)

• Training High Needs Case Managers (HNCMs) in levels of care utilization and medical necessity criteria

• Providing “train the trainer” opportunities for supervisors of HNCM’s

• Monitoring member progress in residential treatment through concurrent review and transition of care planning

Upcoming Activities

• Creating more training opportunities to include increased use of community supports, developing targeted treatment goals and discharge planning

• Expansion of community based services to decrease out of home placement, utilization, readmission rates and improve outcomes.

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Operations Updates

Angelo Edge, Chief Operating Officer

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Administrative Efficiency Initiative

Goal: Evaluate options to align select requirements in the RBHA contracts with those of acute plans to reduce the administrative burden on contracted BH providers.

Steering Committee formed by AHCCCS in December 2015

• Chaired by Tom Betlach at AHCCCS

• Mercy Maricopa is collaborating with AHCCCS, Arizona Council, Greater AZ RBHAs and select providers as committee members

• Committee considering policy changes that would reduce the administrative burden and associated cost related to the following areas:

‒ BH Provider Training Requirements and Workforce Development

‒ Demographics and Episode of Care data submission

‒ RBHA Reporting Requirements and Provider Deliverables

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BH Provider Training Requirements

Workgroup formed to modify Policy 403 governing Arizona’s fundamental approach to mandating, planning, evaluating the proficiency of the contracted BH workforce.

• Workgroup participants include AHCCCS/DBHS, RBHAs, TRBHAs and BH Providers

• Move from a mandatory one size fits all approach to individualized competency assurance approach based on the employee’s skills and experience (BHTs & BHPPs)

• Shift from training completion report requirements to provider record retention onsite reviews

• Workgroup is working on a Job Competency Development Matrix

• Workgroup has recommended the use of Relias Learning Management System to share training records between the RBHAs

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Episode of Care (EOC) and Demographics

Workgroup formed to improve the efficiency by examining the administrative demands of the demographic submission process and pursuing opportunity for improvement.

• Workgroup participants include AHCCCS/DBHS, RBHAs, TRBHAs, AZ Council

• Workgroup has recommended the elimination of the EOC construct:

‒ Relax the edits related to the EOC by 2/15/2016 (target)

‒ Remove unnecessary data fields during the next software update by focusing on fields in which the data can be pulled form other sources such as enrollment and claims.

‒ Mercy Maricopa is evaluating the IT system impact and will develop a schedule for implementing the required changes.

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Reporting Requirements and Provider DeliverablesWorkgroup formed to review and assess the value and benefit of all provider report deliverables to eliminate outdated , duplicative or non beneficial reports from the RBHA contracts.

• Workgroup participants include AHCCCS/DBHS, RBHAs, AZ Council

• Current review of report inventory is underway

• Targeting 7/1/16 timeframe for first round of changes

• Provider Notice will be posted to announce the official change and, the provider manual will be updated with the revised requirements.

• Design of a Provider “Deliverables Manager” application is underway that will improve the submission, collection, tracking and utilization of provider submitted deliverables.

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Landing Page

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Document LibrarySelecting a Deliverable


Document LibraryDeliverable Details


Enter/Upload DeliverableSelecting a Deliverable, Submission Type & Date/Period


Enter/Upload DeliverableDirect Entry Option


Enter/Upload DeliverableDirect Entry Option - Attestation


Enter/Upload DeliverableDirect Entry Option - Validation


Enter/Upload DeliverableDirect Entry Option - Results


Enter/Upload DeliverableSelecting a Deliverable, Submission Type & Date/Period


System Updates Improve Claims Submission and Processing• Enrollment Update Nov. 2015 – Updates to Enrollment Application were

deployed to improve the loading of both enrollment and demographic data provided in the states 834 transactions.

‒ Enables members to have immediate access to their prescriptions, medical and behavioral services

‒ Improves the providers ability to receive reimbursement on claims more timely while reducing the rework required with encounter submissions due to faulty enrollment data.

• New Benefit Plan – NTXIX Crisis – aligns benefits more closely to those for that segment of the population.

• Realigned ICD10 mapping to alleviate incorrect claims denials for NTXIX and GMHSA.

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Psychiatric Rate Increase

• Rate increase implemented on 10/1/15 but some providers reports lower than expected encounter value.

• Mercy Maricopa IT identified the issue related to system scoring for the 20% encounter value.

• A solution has been developed and is in the final stages of testing.

• Providers notice will be issued when testing has completed and update is ready for deployment

• Adjustment will be automatically applied by Mercy Maricopa to historical claims.

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Finance Updates

Ramon Dominguez, Chief Financial Officer


Finance Update

• Value-based purchasing

• Behavioral health fee schedule

• Encountering

• NTXIX – adjustments

• Submission timing

• Contract year ending 09/30/2015

• Provider financial reporting guide updates

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Q & A Session


Thank You!

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