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Care Coordination Project: 2007-2011 Overview and Results

Westchester County Department of Community Mental Health. Care Coordination Project: 2007-2011 Overview and Results. Grant Mitchell, MD Commissioner. Westchester’s Care Coordination Program.

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Care Coordination Project: 2007-2011 Overview and Results

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  1. Westchester County Department of Community Mental Health

    Care Coordination Project:2007-2011 Overview and Results

    Grant Mitchell, MD Commissioner
  2. Westchester’s Care Coordination Program To improve health outcomes and reduce costs, Westchester County implemented a more self-directed, recovery-focused, care coordination program for individuals with historically poor outcomes and high costs. Goals: Individuals to have greater control of and responsibility for their own care Expand the “menu” of services beyond those reimbursed by Medicaid by providing self-directed funds. Improve health outcomes and reduce costs Ensure access to needed services Coordinate services to address fragmentation
  3. Westchester’s Care Coordination Program Eligibility: Voluntary Serious mental illness High service utilization/costs History of criminal justice involvement and/or homelessness (not required)
  4. Westchester’s Care Coordination Program Service-Resistant Clients? OR Client-Resistant Services?
  5. Traditional Approaches A Traditional Sequence of Delivering Services PERSON DREAM SUPPORT RESOURCES
  6. An Alternative to Traditional Approaches PERSON DREAM SUPPORT RESOURCES
  7. Goals of the Care Coordination Program Culture change to emphasize person-centered planning and recovery. Empower individuals through service planning that promotes choice and is shared across the service system . Coordinate services delivered by multiple providers. Implement evidence-based and best practices where available. Allocate resources based on individual need. Utilize information systems that provide timely, useful information. Determine performance by measuring outcomes.
  8. Care Coordinators Each Care Coordinator partners with 12 enrollees Individual creates an Individual Service Plan (ISP) that is shared across services (Web-based) and includes use of self-determination funds for non-traditional services and supports (like the Peer Mentor Program.) Arrange admission into desired or needed standard health services Coordinate mental health, chemical dependence, medical, legal, housing and needed support services Collect and report outcomes data
  9. Self-Directed Funds $1500 per individual/year Individual control over how dollars are spent related to goals as established in the ISP Expand the array of services/supports beyond those covered by Medicaid
  10. Self-Directed Funds Examples: Housing: Furnishings, household items, maintenance, temporary housing Education: Courses, computers, Medical care: Dental, medication Employment: Resume, clothing for interviews Other: gym membership, exercise equipment, yoga, music, books, personal care
  11. Peer Mentoring Program Option to select a recovery mentor Mentors participate in engagement & ISP development Serve as role models, partners with enrollee and the care coordinator Crisis prevention and intervention Not case managers
  12. Employment/Training 48 slots/3 years 1 week intensive program Assistance in locating employment
  13. Care Coordination Program Costs Per Year for 48 Enrollees
  14. Program Outcomes Medicaid Costs Days in State Hospital Days Incarcerated Visits to ER Homelessness Quality of Life Indicators Satisfaction with Program (staff/enrollee) Person-centeredness
  15. Baseline Data Average Costs Per Enrollee for the One Year Period Prior to Entering the Program (N=44)
  16. Results: Pre & Post-Enrollment Cost Data(N= 31)
  17. Cost Outcomes (N= 31)
  18. Average Days Homeless
  19. Chemical Dependency
  20. Other Outcomes Enrollees report feeling more in control of life. “Authority” Care Coordinators report job satisfaction levels are up vs. working in traditional ICM role (“This is why I went into the field.” “In many ways, my job is now significantly easier).” Trumpet; birthdays
  21. Partnering to Achieve GoalsNY Care Coordination Program (NYCCP)
  22. NY Care Coordination Program (NYCCP) Care Coordination Person-centered planning Managed care as a vehicle to achieve flexibility System transformation Existing working relationships with Beacon Health Strategies Pay for Performance
  23. Next Steps—Westchester’s Care Coordination Program Western New York—Care Coordination Program 7County Consortium Years of Experience Better Outcomes and Reduced Costs System reform Align funding and structures to improve outcomes and reduce health care costs Expand the “menu” of services—flexible spending Prepare for Health Care Reform- Regional BHO’s and Health Homes
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