The Massachusetts Behavioral Health Partnership:

1. The Massachusetts Behavioral Health Partnership: A “Learning Organization” In Health Care Transformation The Medicaid Delivery Commission November 2012

2. “In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.” – Eric Hoffer 2

3. In our time with you today • The MBHP story: • Our background • Our responsibility on behalf of the Commonwealth • Introducing the next generation of MBHP: • Care Management • CMS Innovation Grant • Integration • Continued Excellence in Behavioral Health • Ideas for the future of Medicaid delivery 3

4. MBHP in summary Under State contract since 1996, MBHP: • Manages a comprehensive system of behavioral health care for members in MassHealth’s Primary Care Clinician (PCC) Plan. • Provides quality improvement & network management for both behavioral health and primary care clinicians. 4

5. Our scope of service For more than 430,000 PCC Plan and other MassHealth members: • Credentialed network of >1,200 clinics, facilities, and providers for inpatient, diversionary, outpatient, emergency, and other behavioral health services • Over 120,000 members access care each year • Care management • Provider contracting and credentialing • Utilization management • Quality management for behavioral health and primary care clinicians • Provider profiling • Claims payment • Support for state agency programs • Fraud and abuse monitoring • Full NCQA accreditation • Work with over 380 primary care practices across Commonwealth 5

6. Improving care. Reducing cost. Many of our collaborations over the years have become national models: • Lowered inpatient costs by decreasing length of stay, increasing diversionary services and reducing recidivism. • Primary care clinician training in depression, ADHD, substance abuse, serious mental illness. • Children’s Behavioral Health Initiative uses intensive care coordination and family support to keep children with serious emotional disorders in their homes and communities. • Massachusetts Child Psychiatry Access Project (MCPAP) provides psychiatric consultation with primary care providers. • Reduced behavioral health costs for chronically homelessthrough increased community support. • Helped launch and guide several consumer-run organizations, including Consumer Quality Initiatives, Recovery Learning Communities, Dual Recovery Anonymous and The Transformation Center. • Increased cultural and linguistic capacity of behavioral health clinicians. • Trained parents to advocate for the needs of their disabled children with emotional problems. • Developed a web-based system to track real-time availability of acute care beds and other behavioral health services. • Linked behavioral health practitioners with PCCs through consultation and referral. • Enhanced “community tenure” through intensive care coordinationand medication management. • Trained pediatricians to screen children for behavioral health issues. • Expanded peer support to Emergency Services programs. • Lowered behavioral health and medical spending through intensive care management programs. • And much more. 6

7. Proven results We commissioned the independent, actuarial firm Milliman to estimate the return on investment of MBHP since its inception: • Their conclusion is that MBHP has conservatively allowed MassHealth to avoid between $882 million and $1.06 billion in behavioral health claim costs between FY1997 and FY2011. • This represents an ROI of between 2.25:1 and 2.5:1. • Importantly, unlike many program interventions where early savings plateau after a period of time, Milliman found that MBHP’s return on investment has continued to grow over the life of the contract. 7

8. The Next Generation of MBHP Focus on integration of behavioral and medical health, on supporting new models of care, and on technology that enables system transformation for the PCC Plan. • New contract effective October 1, 2012 • A contract structure that incorporates pay for performance, risk/reward for program outcomes and increased risk for medical savings • With MassHealth, we continue to build infrastructure to support PCCs, behavioral health providers and members. 8

9. Care Management Our new care management program brings a significant increase in capacity, reaching out to 40,000 PCC Plan members and enrolling more than three times the number of members presently in our care management programs. • Algorithms and analytics to identify members who can benefit – extensive outreach and no wrong door for entry • Integrated, local care management teams • Internist added to enrich medical leadership Our shared technology platform enables: • Comprehensive assessments and care plans accessible to all service providers • Member interventions tracked at the member / provider level and at the program level • Availability of quantitative outcome measures 9

10. Care Management Additionally, our practice-based care management partners will each be using the same processes, information, and metrics: • Mass General Hospital and its health centers • UMass Memorial Medical Center and Hahnemann Health Center • Northeast Health Systems • Behavioral Health Network • Community Counseling Of Bristol County The practice-based model will support the medical home initiative. 10

11. Care Management Accountable outcomes for the care management program 1. Reduction in polypsychopharmacology for CMP members 2. Reduction in preventable hospitalizations 3. Improved Enrollee “Health Related Quality of Life” 4. Member satisfaction survey 11

12. The Next Generation of MBHP CMS Health Care Innovation Award Using recovery support navigators and incentives to improve substance abuse Medicaid client outcomes and costs • Collaboration between MBHP, Brandeis, and provider partners (High Point, NBH, Spectrum, SSTAR) • Target population: members with repeat detox use (2+ admissions past year) • Implement and evaluate two strategies to: • Reduce readmissions • Reduce total health care costs • Improve engagement with outpatient substance use disorder (SUD) care and other recovery support • Improve health outcomes • 3 yr anticipated savings of $7.84 million • Develop alternate payment method • Develop workforce of recovery peer navigators 12

13. The Next Generation of MBHP Integration/Transformation of Behavioral and Medical Health • New services for members – outreach and engagement: • Outreach to and health needs assessment for all new PCC Plan members • Engagement center • Fully integrated care management services for both medical and behavioral health, including Nurse Advice Line • Expanded pre-discharge peer support services • Member-centric care anchored in primary care, patient-centered medical homes; behavioral health homes with increased accountability • Profiling and data exchange across all PCC Plan providers and delivery systems with greater transparency for members 13

14. The Next Generation of MBHP Integration/Transformation of Behavioral and Medical Health • Integrated network management to improve linkages among providers • New internal leadership and structures within MBHP • VP of Integration and Transformation added to Senior Team • Regionally-based integration managers • Internist • Build new care system for future as ICO for dual eligibles (with BCBSMA) 14

15. The Next Generation of MBHP Continued excellence in behavioral health management • Extensive regionally-based work with members, providers, state agencies to improve quality • Continuing development of innovative service models and alternate payment approaches • Utilization management programs that use data and quality improvement methods to control costs • Accountable for improving performance on four outcome measures 15

16. Pay for Performance Outcome Measures 1. Initiation and engagement in alcohol and drug dependence treatment 2. Improve service integration for DMH clients with diabetes 3. Improve follow-up after hospitalization for mental illness 4. Improve follow-up for children prescribed ADHD meds 16

17. Strategic alignment Our journey – and our new contract and initiatives – are closely aligned with the direction the Commonwealth is taking for health care transformation. • Integrated care management with incentives for positive outcomes • CMS Innovation Grant to improve substance use treatment outcomes • Enhanced integration of primary care and behavioral health • Network management for both behavioral health and PCCs • Patient-centered medical homes that span the behavioral / medical spectrum • Focus on data sharing, web-based dashboards, use of enabling technology • Expectation of improved care quality and cost management • Developing and supporting new payment models • Increased risk assumption including quality incentives through P4P 17

18. What our experience has taught us As the Commonwealth realizes its strategic vision for an integrated health care system built around patient-centered medical homes, we respectfully offer observations from our 16 years of experience: • Care must be taken to ensure that behavioral health care continues to improve and does not get lost in a bundled, integrated approach to services. • Transformative change requires bold vision + everyday effort. Much of the enduring change we’ve fostered has been the result of many little steps taken collaboratively with MassHealth, provider partners, state agencies, members, advocates, and others. • Incentive measures, risk and shared savings methodologies, and other building blocks of transformation must be carefully vetted and tested. 18

19. Parting thought In MBHP, the Commonwealth has built a “learning organization” with much of the infrastructure needed for health system integration and PCC-based care. • Our size allows us to credibly influence, measure, and evaluate program effectiveness. • Our technical platform enables data exchange, dashboards, and tracking of interventions at the program, provider, and member level. • We have demonstrated our ability to work hands-on with both medical and behavioral health providers, and to bring these resources together for the benefit of MassHealth members. • We look forward to helping the state capitalize on the investment made in our program. 19

20. Thank you. 20