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THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS PRESENTED AT The Rehabilitation Summit, NYSRA Saratoga Springs, NY Monday September 16 th , 2013 1 Jonas Waizer, PhD, Chief for Healthcare Policy FEGS Health and Human Services

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Page 1: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

THE CHANGING HEALTHCARE ENVIRONMENT:POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS

PRESENTED ATThe Rehabilitation Summit, NYSRA Saratoga Springs, NYMonday September 16th, 2013

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Jonas Waizer, PhD, Chief for Healthcare PolicyFEGS Health and Human Services

Page 2: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

Change Is Constant: Who Moved My Cheese

• Personal Journey

• State Medicaid Redesign

Provider Actions

• Challenges

• Models

• Actions

Next Steps

TODAY’S THEMES

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Page 3: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

1968 –Autism: Parental Upbringing vs. Neurobiology

1980’s – Deinstitutionalization vs. Trans-

institutionalization

1990’s – Programs vs. Consumer Centered

Today – F-F-S vs. Managed Care, Service Integration,

Risk Sharing

CHANGE IS CONSTANT: A PERSONAL JOURNEY

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Page 4: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

$25.9 Billion

Total ComplexN=976,356

$2,338 PMPM32% Dual

51% MMC

NYSDOH: SPECIAL PLANS FOR HIGH-NEED MEDICAID POPULATIONS

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Page 5: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

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Strategic Factor Old World New World (Federal ACA, MRT)

Change NYS Fiscal Environment

Fee-for-Service (FFS) – Session, DayRates Set by Each State Agency

Managed Care (MCOs)PMPM, Case Rates; Capitation

Consolidate and Shift Public Funding Mechanisms

Medicaid, Medicare, State/City ContractsLegislative Member Items

Medicaid/Medicare, FIDA

Consolidate Government Authority - Medicaid/Medicare

NYS OMH, OPWDD, OASAS DOH NYC DOHMH NCDMH SCDMH

Medicaid Redesign NYSDOH as Lead Agency

Redesign Public Health Service Structures

General Healthcare Clinic (A-28)Behavioral Health Clinic (A-31)Substance Abuse Clinic (A-22)Developmental Disabilities Clinic (A-16)Specialized Residences – Similarly Specialized

Under MCOsIntegrated Health Care: Co-locationCare Coordination: Health Homes

Affordable & Mixed Use Housing

Service Sector Success Measures

Hospitals – Fewer DaysOutpatient - Day Hab & Clinics - SessionsResidences – Stability and TenureWork Centers – Subsidized Employment

Hospital – Reduced ReadmissionsAftercare - 100% of DischargesResidences – Upward MobilityEmployment – Mainstream FT or PT Report Cards (Across Agencies)

Technology Billing, Client RegistrySpecialized EHRs (DD, MI, Psychiatry)Paper Medical/Clinical Charts

Full EHR – Clinical Record and BillingStatewide Connectivity (Local RHIOs)Customer Access to Personal Health Record

Provider Strategy Diversification, GrowthMedicaid Revenue Maximization

Partnerships, Networks, IPAsRisk-sharing w/MCOs Technology for Client Tracking w/in and w/RHIOs

STRATEGIC CHANGES IN NYS HEALTH CARE

Page 6: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

Maintain Services to Disability Groups - Shifting from FFS

to MC

Partnerships and Networks - Forming New Business

Models

Risk-Sharing Arrangements – Contracting with MCOs

New Models of Care Coordination - DISCO, HARP, FIDA

Integrating Services - Health, Behavioral Health, SA,

Habilitation, etc.

Focus on Outcomes – e.g. Recidivism, Employment, Housing

Stability

Focus on Measures - Performance, Health and Quality

Metrics

Upgrade EHR - Tracking, Reporting, RHIOs , Customer

Centered Services

SOME PROVIDER CHALLENGES

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Page 7: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

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The Best Way To Predict the

Future Is to Invent It

Abraham Lincoln Peter DruckerSteve Jobs

Page 8: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

One of the Nation’s Largest and Most Diversified Nonprofit Health and Human Services Organizations.

FEGS by the numbers: 100,000+ New Yorkers Served Annually$300 Million Annual Budget5,000 Staff3,000 Interns, Volunteers and Consultants 350 program locations across New York City, Long Island and Westchester County14 Subsidiaries1.6 Million Square Feet

FEGS HEALTH & HUMAN SERVICES

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Mission:

To help each person served achieve greater success, independence and dignity at work, at school, at home and in the community.

FEGS HEALTH & HUMAN SERVICES PRESENTATION TO: HEALTHPLUS AMERIGROUP

Operating Areas:

Health Disabilities Homecare Housing Employment Education Youth and Families

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Page 9: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

NYS Medicaid MRT Program

(NYS DOH)

IPAs

Service Provider

Payment for Care Management Services

Service Provider

Service Provider

Service Provider

Service Provider

Medical Payment Risk Arrangements

Continue as Service Providers

MANAGED SPECIAL NEEDS (SIMPLIFIED VIEW)

HEALTH HOMES

(LIBA and CBCPartnership)

DD- DISCO (ACA

Partnership)

MLTC(SinglePoint

Care Network w/SelfHelp)

Managed Care Organizations

FEGS - NEW HEALTHCARE PARTNERSHIPS

Behavioral Health

Developmental Disabilities

Homecare

9FEGS HEALTH & HUMAN

SERVICES

Risk Sharing PartnershipsUnder MRT

Page 10: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

Advance Care Alliance, LLC

EmblemHealth (MCO)

StateAlliance

Care Network,

LLC

Advance of Greater NY,

LLC

LI Alliance, LLC

ACA Structure

Providers

ACA IPA

owners

Care management contract

$

Contract for risk sharing, claims payment, IT, back office services

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Page 11: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

PROVIDER ACTIONS FOR THE 21st CENTURY

Focus on Engagement, Outreach, Adherence (esp. Rx)

Care Coordination for Complex Cases – Keep People at

Home

Prepare for Variable Payment Systems: FFS, Case

Rates, PMPM

Pilot Innovative Services - e.g. Health Coordination,

Employment Support, Residential and Crisis Beds,

Self-Directed, etc.)

Partnerships*

IT Upgrades*

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Page 12: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

PARTNERSHIPS AND NETWORK DEVELOPMENT

Acute Care Partners: Local Hospitals , Urgi-centers

Primary Care Community Partners: FQHCs, Medical

IPAs

Specialized IPA: With Other Licensed Providers

Families and Consumers: Promote Governance and

Choice

Managed Care Companies for Shared Savings, Shared

Risk

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Page 13: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

IT REQUIREMENTS

Track/Monitor Consumers Inside and Outside the

Agency

Import & Export Data (Network Providers, Hospitals,

RHIOs)

Link to MCOs for Referral Stream

Collect and Process Standardized Measures, Metrics

Process Data Analytics, Report Cards 13

Page 14: THE CHANGING HEALTHCARE ENVIRONMENT: POSITIONING COMMUNITY REHABILITATION AGENCIES FOR SUCCESS P RESENTED A T The Rehabilitation Summit, NYSRA Saratoga

NEXT STEPS: FOR PROVIDERS (& GOVERNMENT)

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