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THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS. Presented At The Rehabilitation Summit, NYSRA Saratoga Springs, NY Monday September 16 th , 2013. Jonas Waizer, PhD, Chief for Healthcare Policy FEGS Health and Human Services.

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slide1

THE CHANGING HEALTHCARE ENVIRONMENT:

POSITIONING COMMUNITY REHABILITATION AGENCIES

FOR SUCCESS

Presented At

The Rehabilitation Summit, NYSRA

Saratoga Springs, NY

Monday September 16th, 2013

Jonas Waizer, PhD, Chief for Healthcare Policy

FEGS Health and Human Services

slide2

Today’s Themes

  • Change Is Constant: Who Moved My Cheese
    • Personal Journey
    • State Medicaid Redesign
  • Provider Actions
    • Challenges
    • Models
    • Actions
  • Next Steps
slide3

CHANGE IS CONSTANT: A PERSONAL JOURNEY

  • 1968 –Autism: Parental Upbringing vs. Neurobiology
  • 1980’s – Deinstitutionalization vs. Trans-institutionalization
  • 1990’s – Programs vs. Consumer Centered
  • Today – F-F-S vs. Managed Care, Service Integration, Risk Sharing
slide4

NYSDOH: Special Plans for High-Need Medicaid Populations

Total Complex

N=976,356

$2,338 PMPM

32% Dual

51% MMC

$25.9 Billion

slide6

SOME PROVIDER CHALLENGES

  • Maintain Services to Disability Groups - Shifting from FFS to MC
  • Partnerships and Networks - Forming New Business Models
  • Risk-Sharing Arrangements – Contracting with MCOs
  • New Models of Care Coordination - DISCO, HARP, FIDA
  • Integrating Services - Health, Behavioral Health, SA, Habilitation, etc.
  • Focus on Outcomes – e.g. Recidivism, Employment, Housing Stability
  • Focus on Measures - Performance, Health and Quality Metrics
    • Upgrade EHR - Tracking, Reporting, RHIOs , Customer Centered Services
slide7

The Best Way

To Predict the Future

Is to Invent It

Abraham Lincoln

Peter Drucker

Steve Jobs

slide8

FEGS Health & Human Services

One of the Nation’s Largest and Most Diversified Nonprofit Health and Human Services Organizations.

Mission:

To help each person served achieve greater success, independence and dignity at work, at school, at home and in the community.

Operating Areas:

  • Health
  • Disabilities
  • Homecare
  • Housing
  • Employment
  • Education
  • Youth and Families

FEGS by the numbers:

  • 100,000+ New Yorkers Served Annually
  • $300 Million Annual Budget
  • 5,000 Staff
  • 3,000 Interns, Volunteers and Consultants
  • 350 program locations across New York City, Long Island and Westchester County
  • 14 Subsidiaries
  • 1.6 Million Square Feet

FEGS Health & Human Services

Presentation to: HealthPlus Amerigroup

2

slide9

FEGS - New Healthcare Partnerships

Managed Special Needs (Simplified View)

NYS Medicaid MRT Program

(NYS DOH)

Managed Care Organizations

Medical Payment

Risk Arrangements

Payment for Care Management Services

Developmental Disabilities

Homecare

Behavioral Health

Risk Sharing Partnerships

Under MRT

IPAs

Service Provider

Service Provider

Continue as Service Providers

Service Provider

Service Provider

Service Provider

FEGS Health & Human Services

slide10

ACA Structure

State

Advance of Greater NY, LLC

Alliance Care Network, LLC

LI Alliance, LLC

$

owners

Advance Care Alliance, LLC

EmblemHealth (MCO)

Care management contract

Contract for risk sharing, claims payment, IT, back office services

ACA IPA

Providers

slide11

PROVIDER ACTIONS FOR THE 21st CENTURY

  • Focus on Engagement, Outreach, Adherence (esp. Rx)
  • Care Coordination for Complex Cases – Keep People at Home
  • Prepare for Variable Payment Systems: FFS, Case Rates, PMPM
  • Pilot Innovative Services - e.g. Health Coordination, Employment Support, Residential and Crisis Beds, Self-Directed, etc.)
  • Partnerships*
  • IT Upgrades*
slide12

PARTNERSHIPS AND NETWORK DEVELOPMENT

  • Acute Care Partners: Local Hospitals , Urgi-centers
  • Primary Care Community Partners: FQHCs, Medical IPAs
  • Specialized IPA: With Other Licensed Providers
  • Families and Consumers: Promote Governance and Choice
  • Managed Care Companies for Shared Savings, Shared Risk
slide13

IT REQUIREMENTS

  • Track/Monitor Consumers Inside and Outside the Agency
  • Import & Export Data (Network Providers, Hospitals, RHIOs)
  • Link to MCOs for Referral Stream
  • Collect and Process Standardized Measures, Metrics
  • Process Data Analytics, Report Cards
slide14

NEXT STEPS: FOR PROVIDERS (& GOVERNMENT)

  • Capitalize IT Upgrades (Inside and Outside)
  • Train Provider Management and Staff in Risk–Sharing Models
  • Simplify /Centralize Credentialing
  • Standardize Measures, Data Analytics, Report Cards
  • Simplify State Regulations (vis-a-vis MCO Requirements)
  • Re-invest Resources