acap a program of keystone human services and the pennsylvania department of public welfare bureau...
TRANSCRIPT
ACAP
A program of Keystone Human Services and the Pennsylvania Department of Public Welfare
Bureau of Autism Services
ANCOR Fall Leadership Summit
Robert J. Baker President/CEO, Keystone Autism Services
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ACAP is a fully integrated, comprehensive system of care for adults with Autism Spectrum Disorder (ASD). The program incorporates vocational, behavioral, social, health, recreational, transportation, therapeutic, educational, crisis, in-home support and independent living aspects of Participants’ lives.
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Three Unique Characteristics:
Pre-paid Capitation Payment Approach
Healthcare Services Fully Integrated into the Model
Outcome Measures Agreed Upon and Placed in the Contract
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PURPOSE: The purpose of the ACAP program is to help
adults with ASD to be valued and fully participating members of their society.
The program works to build competence, confidence and independence so people can, as much as possible, lead full and meaningful lives.
Over time, the program works to increase independent functioning and decrease the need for highly structured professional services.
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ACAP PRINCIPLES:
1. Every person living with an Autism Spectrum Disorder (ASD) can experience a meaningful and quality life.
2. Every person with ASD can grow and learn for the entirety of their life.
3. Services are comprehensive, highly individualized, flexible and continuously adapted to the persons needs and preferences.
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ACAP PRINCIPLES CON’T:4. Services are community based and make
maximum use of the capacity of the family, friends, neighbors and community at large.
5. Therapeutic strategies are evidence based and are carried out by a highly qualified clinical team.
6. The effectiveness of the program is continuously measured.
7. The program makes maximum use of innovation, creativity and technology to support successful functioning.
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ACAP ELIGIBILITY:
Be twenty-one (21) years old or older
Be eligible for Medical Assistance
Have a diagnosis of an Autism Spectrum Disorder (ASD)
Be able to live in a community setting (such as the person’s home or other family-members) safely without 16 hours or more per day of awake staffing and supervision
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ACAP SAMPLE SERVICES*:
Supported Employment
Physicians Services & Health Care
Dental Services
Behavioral Support Services
Service Planning & Supports Coordination
Respite
Recreation & Social
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ACAP SAMPLE SERVICES CON’T:
Crisis Intervention
Non-Medical Transportation
Family Counseling
Physical Therapy
Individual Counseling
In-home services
*We are not locked into service definitions; can provide any medically necessary service.
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Referrals or individual applications go to the Bureau of Autism Services (BAS)
BAS does preliminary eligibility determination
Referral to Keystone – We do comprehensive assessment and gathering of baseline data
Propose ISP to Individual. They decide whether to enroll.
ENROLLMENT PROCESS:
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PERSON-CENTERED PLANNING: Clinical assessments and the development of each
person’s Individual Service Plan (ISP) is provided by a highly qualified internal team.
ACAP services are dynamic, having the capacity to vary intensity and an individualized response dependent upon current and/or changing needs. Services can be deployed in “real time”.
Services are designed to include meaningful community inclusion and promote independence and self sufficiency.
The person’s dreams and choices are core considerations in ACAP person-centered planning.
The family is a central resource and partner in all planning and progress.
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ACAP meets the full range of defined needs when a person enrolls in the program.
Services are assessment and outcome driven. (SIB-R)
Authorizations are based upon medical necessity following a comprehensive clinical assessment and the development of individualized service plans.
Clinical assessments are conducted by a highly skilled team of Masters level clinicians working under supervision of a Licensed Psychologist.
ACAP is responsible for providing and/or arranging all services for Participants - doing so in a manner that assures effective service integration and continuity.
CLINICAL CAPACITY:
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Uses the federal Prepaid Inpatient Health Plan funding
model used currently by The Office of Long Term Living.
Funding consists of a single “per member per month”
payment for the full array of program services.
Rate determination is done yearly.
CAPITATION APPROACH:
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OUTCOME MEASURES: Improvement in behavioral stability of the Participants as measured by:
1. Fewer Episodes of:a. Law Enforcement involvement
b. Psychiatric Emergency Room care
c. Psychiatric Inpatient Hospitalization
d. Crisis Intervention Plan use
e. Mental Health crisis interventions
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OUTCOME MEASURES CON’T:
Improvement in behavioral stability of the Participants as measured by:
2. Increases in:a. Percentage of Participants with jobs or engaging
in volunteer work
b. Number of hours Participants work or are engaged in volunteer work
c. Participants’ independence and social skills
d. Parental satisfaction and quality of life indicators
e. Participant’s quality of life
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OUTCOME MEASURES CON’T: Improvement in behavioral stability of the Participants as measured by:
3. Improvement in access to medical services including:a. Initial visit with a PCP within three weeks of
enrollment
b. Annual dental exams
c. Improved diabetes management
d. Annual gynecological exams
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PRELIMINARY OUTCOME RESULTS:
Decrease in frequency of incidents
Increase in work and volunteer participation
Increase in SIB-R scores- Independence and Social
Skills
Increases in Participant’s Quality of Life Scores
Minor increases in Parental Satisfaction and
Quality of Life scores
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FINANCIAL RESULTS:
Grant provided start-up support
Month 9 of the program was the first profitable month
Every month since has been profitable
Program reached Life to Date Profitability in month 13
Start-up line of credit reached $747,578
Positive cash position is now over $1,000,000
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SAFEGUARDS:
Extensive and valid measurements of outcomes
Family advocates on governing board
Family advocates on Plan Advisory committee
Bureau of Autism Services clinical team reviews all ISPs
Comprehensive reporting of all incidents
Easy external appeal to BAS
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SAFEGUARDS CON’T:
Extensive quality system
Highly credentialed clinical team
Extensive family communication
Family advocate
Annual cost report and review of rate
Right to transfer to Adult Autism Waiver
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UNIQUENESS OF THE MODEL: One Agency Responsible-One Agency Accountable
Comprehensive services
Full Coordination and Integration of Services
Inclusion of Health Care Services
Person Centered
Dis-intermediated
Fully integrates risk and service delivery
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BROAD APPLICABILITY:
The ACAP model is fully approved by CMS and has broad applicability to autism, intellectual disabilities, behavioral health, aging, children and youth and criminal justice services
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FEE FOR SERVICE PARADIGM:
Fee for service (focus on human service widgets)
Compliance focus on unit of service, claims & process
Highly defined service codes (commodities)
Individual need must accommodate authorized services
Utilization driven incentives
Highly structured service models
Exclusion of natural capacity of community and family
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FEE FOR SERVICE PARADIGM CON’T:
Exclusion of technology and innovation
Complex systems, regulation and licensing demands
Very expensive infrastructure
Rigid structures and processes
External case management and authorizations
Minimal integration across service models and need
Authorized service may have no relevance to need
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EMERGENT HUMAN SERVICE PARADIGM: Focus on the person, not human service widgets
Capitated funding – aligning risk and authority to manage service resources
Comprehensive services and supports
Flexible and responsive
Highly Individualized
Compliance focus on outcomes not claims
No service codes
Highly credentialed clinical staff & effective clinical models
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EMERGENT HUMAN SERVICE PARADIGM CON’T:
Focus on growth and capacity building vs. utilization
Dynamic deployment of resources as people’s needs change
Extensive range of service models
Extensive use of natural capacity of community and family
Extensive use of technology and continuous innovation
Moderate infrastructure cost
Highly integrated across service systems and needs
Cost reporting and limit on profits
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PUBLIC POLICY BENEFITS (ACAP): The Department of Public Welfare knows its exact
financial liability at the beginning of the fiscal year.
The Provider is responsible for all changes in need during
the year.
The model makes effective use of public resources.
The ACAP model provides relevant, valid and reliable
outcome data on performance.
The ACAP model has the potential for extensive costs
savings.
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PUBLIC POLICY BENEFITS CON’T: The model caps (retention) profits at a level
appropriate to public policy interests.
The model supports innovation and use of technology.
The model incurs no intermediary (middleman) administrative costs and intermediary profits.
The model has high accountability and transparency.
The model is applicable to a wide range of services to include intellectual disabilities, behavioral health, aging and criminal justice.