NYAPRS 7th Annual Executive Seminar on Systems Transformation Integration Strategies for Behavioral Health:Managing Care, Outcomes, and CostsWhile Preserving our Recovery Vision Turning Health Homes Into Recovery Homes James Schuster, MD, MBA Chief Medical OfficerCommunity Care Behavioral Health Organization Albany, NY April 27, 2011
About Community Care Behavioral health managed care company founded in 1996; part of the University of Pittsburgh Medical Center Federally tax exempt non-profit 501(c)(3). Major focus is publicly-funded behavioral health care services; currently doing business in PA and NY. Licensed as a Risk-Assuming PPO in PA; NCQA Accredited Quality and Disease Management Programs. Serving over 1.3 million individuals in 36 Pennsylvania counties through a statewide network of over 1,800 providers.
Susquehanna Warren Warren McKean McKean Tioga Tioga Bradford Bradford Potter Potter Wayne Wayne Wyoming Forest Forest Cameron Cameron Lackawanna Elk Elk Sullivan Sullivan Pike Jefferson Clarion Luzerne Columbia Columbia Monroe Montour Montour Clearfield Clearfield Centre Union Union Centre Carbon Northum- berland Northum- berland Snyder Snyder Mifflin Schuylkill Juniata Allegheny Allegheny Berks Berks Huntingdon Huntingdon Chester Chester York York Adams Adams Community Care Counties Erie Susquehanna Crawford Wyoming Venango Lackawanna Pike Lycoming Mercer Clinton Clarion Luzerne Jefferson Monroe Lawrence Butler Carbon Armstrong Northampton Beaver Schuylkill Indiana Mifflin Lehigh Juniata Blair Cambria Lebanon Berks Perry Bucks Dauphin Westmoreland Washington Cumberland Montgomery Lancaster Chester Bedford Somerset Franklin Fayette Fulton York Adams Greene Philadelphia Delaware Community Care Contract Community Care Office
Recovery Initiatives Multi-year plan to change the clinical approach and culture of clinical systems Annual Recovery Institute for consumers and providers. Shared decision-making focus. Learning Collaborative model. Steps of Hope: Focus on wellness. Statewide Member Advisory Board.
Models for IntegratingPhysical and Behavioral Health Co-location of physical health and behavioral health providers. Integrated system. Coordination among disparate providers.
Connected Care™ Initiative to improve the connection and coordination of care for those with Serious Mental Illness among health plans, PCPs, and behavioral health providers in outpatient, inpatient, and ED care settings. Based on Patient Centered Medical Home model with integrated care team and care plan to address all medical, behavioral, and social needs. Partnership between: Center for Health Care Strategies (CHCS) Department of Public Welfare (DPW) UPMC for You Community Care Behavioral Health Allegheny County Departmentof Human Services
Connected Care™ Data sharing: care plan viewable by staff from both health plans. Team meetings for integrated care. Resulted in reduced medical and BH admissions and reduced use of ER. Improvement opportunities include more structured provider health home and more consistent function of health navigators.
Toward Integrated/Well-Coordinated Care: Next Steps Expand Steps of Hope to include smoking cessation and weight management. Train peers and case managers to support members as “system navigators.” Build health homes for consumers with serious mental illness or substance dependency that can functionally integrate care.
Recovery Homes Basedin Behavioral Health Agencies Provide a person-centered system of care. Develop a “virtual team” for each individual. Enhance physical health competencies in the behavioral health team. Develop person-centered plans with individuals. Coordinate physical, behavioral, and supportive services. Manage integrated reporting. Integrate health focused activities into existing recovery initiatives to create true health homes.
Like Politics, “All Health Care is Local” The challenge: Create local and regional models of Physical Health/Behavioral Health recovery homes. Participants include: Counties/local governments. Behavioral health and physical health provider systems. Consumers. Advocacy organizations. Behavioral health managed care/payers. Physical health managed care/providers. Content experts.
James Schuster, MD, MBAChief Medical Officer Community Care Behavioral Health Organization One Chatham Center, Suite 700 112 Washington Place Pittsburgh, PA 15219 412-454-2120; www.ccbh.com Schusterjm@ccbh.com Contact Information