from the balcony and on the ground the louisiana balcony view march 4, 2014

From the Balcony and On the GroundThe Louisiana Balcony View

March 4, 2014

Coordinated System of Care (CSoC)

• 1915c/b(3) Waiver• Implemented in five of state’s 9 regions (1200

youth)• Wraparound Agencies• Family Support Organization• State Plan services + specialized services• Statewide expansion (2400 youth) planned for

this FY

2Louisiana Department of Health and Hospitals – Office of Behavioral Health

Louisiana CSoC Regions

Louisiana Department of Health and Hospitals 3

IMPLEMENTATIONEssential Community/System Supports

Essential Community/System Supports

• Community partnership• Collaborative action• Fiscal policies & sustainability• Access to needed services & supports• Human resource development & support• Accountability

Bruns, E. J. & Walker, J. S. (2010). The wraparound process: An overview of implementation essentials. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative.

Louisiana Department of Health and Hospitals – Office of Behavioral Health 5

Community Partnership

Strengths• Cabinet level state leadership engaged in

development• Broad-based inclusive planning processChallenges• Family/youth engagement• Geography

6Louisiana Department of Health and Hospitals – Office of Behavioral Health

Collaborative Action

Louisiana Department of Health and Hospitals 7

Strengths• Policy development led by national experts• Lead agency identified with expectation for

collaboration (Executive Order)Challenges• Concurrent move to statewide managed

behavioral healthcare• Lack of knowledge base and experience

Fiscal Policies & Sustainability

Louisiana Department of Health and Hospitals 8

Strengths• 1915b/c waivers• Braided fundingChallenges• Lack of flexibility of leveraged dollars• Family Support organization model

Access to Needed Services & Supports

Louisiana Department of Health and Hospitals 9

Strengths• Regionally based Wraparound Agencies (WAA)

in all implementing areas• Waivers and State Plan Amendments with

expanded/enhanced allowable servicesChallenges• Limited children’s service capacity in state• Provider understanding/buy-in

Human Resource Development & Support

Louisiana Department of Health and Hospitals 10

Strengths• Consistent workforce development approach• Reimbursement for Child & Family Team

participationChallenges• Role of Family Support Organization in the

wraparound process• Information sharing

Accountability

Louisiana Department of Health and Hospitals – Office of Behavioral Health 11

Strengths• Goals established in Executive Order• Performance measures within WaiversChallenges• Undeveloped data collection methodology• Lack of CQI focus

Contact Information

Jody Levison-JohnsonDeputy Assistant SecretaryOffice of Behavioral HealthJody.Levison@la.gov225.342.9532

Louisiana Department of Health and Hospitals 12

From the Balcony and On the GroundThe Louisiana Ground View

March 4, 2014

Choices Care Management

• Indiana Choices – Since 1997

• Maryland Choices – Since 2005

• DC Choices – Since 2008• Louisiana Choices – 2012• Illinois Choices – Since 2014

Choices Care Management

• More than 240 employees• $60 million annual budget• More than 1600 youth

served daily• Working across ALL child

serving systems – 60% child welfare

Coordinated System of Care

Choices Operating System

• Systems of Care Principles (clinical)– Family Centered Involvement– Wraparound Process– Multi-system Coordinated Care

• Care Management technologies (fiscal)– Capitated or Case Rates– Outcome Based – Flexible Funding

• Technology blending clinical & fiscal– Real Time Data – Data driven decision making

Wraparound Facilitation

PLAN

Case ManagerSchool

FamilyJuv Probation

Child Welfare Mental Health/Substance Abuse

WraparoundFacilitator Flex FundsProvider Network

Community Partnership

• Strengths– Choices previous experience building relationships– State vision, support, and engagement

• Challenges– Newness of wraparound concepts in community– Lack of understanding/buy-in at the local level

Collaborative Action

• Strengths– Focus on quality improvement– Ongoing dialogue and conference calls

• Challenges– Frequent operational changes from SMO– Decisions made without WAA input

Fiscal Policies & Sustainability

• Strengths– Start-up funding provided by state– Braided funding

• Challenges– Lack of control and passed on risk– Limited flex funds

Access to Needed Services & Supports

• Strengths– Expanded service array for waiver enrollees– Establishment of local natural supports

• Challenges– Need more service providers– Adequate availability of FSO in all areas

Human Resource Development & Support

• Strengths– Training provided by Institute for Innovation &

Implementation– Phased roll out and hiring

• Challenges– Turnover– Lack of familiarity with SOC & Wraparound in

workforce

Accountability

• Strengths– Information management system– Real-time data analysis

• Challenges– Labor intensive data collection process– Making changes retroactive

Contact InformationShannon Van DemanChief Financial OfficerChoices, Inc.SVanDeman@ChoicesTeam.org

317.205.8311