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NEW MEXICO’S INTERAGENCY BEHAVIORAL HEALTH PURCHASING

COLLABORATIVE: TRANSFORMING THE SYSTEM

“Transforming Children’s Mental Health: States on the Cutting Edge”

National Alliance for the Mentally Ill

Austin, Texas

June 20, 2005

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BACKGROUND

September 2003-Governor Richardson announced the Behavioral Health Purchasing Collaborative– Better services– Better access– Better use of taxpayer dollars

HB 271–A bipartisan effort, effective May 19, 2004

Goal is single behavioral health delivery system across multiple state agencies and multiple funding sources for all publicly funded populations

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PROBLEMS TO BE SOLVEDLack of common agreement about goals and outcomes“Fragmentation” (per President’s New Freedom Commission Report), i.e., multiple approaches, plans, service definitions, billing processes, reporting requirements for similar or related servicesDuplication of effort and infrastructures at state and local levelsHigher administrative costs for providers due to multiple state approaches and multiple contracting entitiesInsufficient oversight of providers and servicesConfusion for families and consumersInsufficient services; inappropriate servicesNot always maximizing resources across funding streamsMultiple disconnected advisory groups and processes working toward a different, sometimes disconnected goals

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Interagency Behavioral Health Purchasing Collaborative

Children, Youth and Families DepartmentDepartment of HealthHuman Services Department (Medicaid State Agency)Department of CorrectionsAging and Long Term Services DepartmentPublic Education DepartmentDepartment of Finance and AdministrationDepartment of TransportationDepartment of Labor

Division of Vocational RehabilitationAdministrative Office of the CourtsMortgage Finance AuthorityIndian Affairs DepartmentHealth Policy CommissionDevelopmental Disabilities Planning CouncilGovernor’s Commission on DisabilityGovernor’s Health Policy Coordinator

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STATUTORY PURPOSE

– “To develop a statewide system of behavioral health care that promotes behavioral health and well-being of children, individuals and families; encourages a seamless system of care that is accessible and continuously available; and emphasizes prevention and early intervention, resiliency, recovery and rehabilitation”

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STATUTORY DUTIES

Identify behavioral health needs statewideGive special attention to regional differences, including cultural, rural, frontier, urban and border issuesInventory all expenditures for mental health and substance abuse servicesPlan, design and direct a statewide behavioral health systemContract for operation of one or more behavioral health entities to ensure availability of services throughout the stateDevelop a comprehensive statewide behavioral health planSeek and consider suggestions of Native Americans

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VISION

A single behavioral health delivery system in New Mexico in which available funds are managed effectively and efficiently; the support of recovery and development of resiliency are expected; mental health is promoted; the adverse effects of substance abuse and mental illness are prevented or reduced; and behavioral health customers are assisted in participating fully in the life of their communities

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PRINCIPLES AND VALUES

Commitment to recovery and resilience– Consumer/family directed– Result is quality of life

Commitment to high quality services with system performance and consumer/family outcomesCommitment to diversity and cultural responsivenessCommitment to integrated, community-based services, respecting community differences

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DESIRED RESULTS“Braided” flexible fundingSingle billing process and consistent data collection and managementCommon age-appropriate assessment process used in all service settingsSmooth transition from current systems to single systemLocal Collaboratives are active participatory local voice; attention to rural and frontier areasAttention to persons with unique service or access needs

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DESIRED RESULTS

Uniform program standards, including common:– service definitions and requirements– utilization management requirements/criteria– system performance measures– consumer/family outcomes expectations– credentialing of providers

Sufficient number and distribution of providersA comprehensive and coordinated benefit package, within available fundingEmphasis on evidence-based, best practices and practice based evidence

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Players

Interagency Behavioral Health Purchasing Collaborative (Purchasing Collaborative)

Statewide Entity-ValueOptions

Local Collaboratives

Behavioral Health Planning Council (BHPC)

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Interagency Behavioral Health Purchasing Collaborative

– All involved state agencies operating as one, and retaining responsibility for agency specific funds, reporting, planning, etc.

– Memorandum of Understanding signed by all state agencies to establish process for decision-making

– First formal meeting held June 11, 2004– BH Design Work Group (BHDWG) for day-to-day staff work– Cross Agency Coordinating Teams with specific

tasks/responsibilities (e.g., Oversight Team, Local Collaboratives Team, Administrative Support Services Team, Policy and Planning Team and Workforce, Program Development and Research Team)

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FUNCTIONS IN ADDITION TO STATUTORY DUTIES

“Keeper of the values and philosophy”

Collective oversight of statewide entity

Address system and individual problems that cannot be resolved at the local level

Assure consumer and family voice in governance, planning, implementation and evaluation

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Statewide Entity

Not just a vendor – a partner – to help the Purchasing Collaborative implement the law and achieve its purpose and vision

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RESPONSIBILITIES

Contracting with and paying providers or provider groups

Helping to “braid” “blend” or “coordinate” multiple funding streams – increasing flexibility and maximizing resources

Credentialing and quality oversight of providers

Utilization review (UR) and management (UM)

Assuring care coordination

Assisting with development and nurturing of Local Collaboratives

Consumer/family/youth relations

Collecting, managing and reporting data

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PROCUREMENT PROCESS

Single RFP to select the statewide entityOpen competitive procurement process pursuant to state procurement lawDraft RFP (Concept Paper) for stakeholder inputConsumer/family involvement in drafting of RFP and review of proposalsJoint selection and negotiation by Purchasing Collaborative agenciesSingle contract with multiple agencies

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LOCAL COLLABORATIVES

Local community groups developed in areas consistent with each of the State’s 13 judicial districts and grouped into 5 geographic regions and 1 non-geographic Native American Region for the 22 Tribes and Urban Indian populationsBased on Children’s Systems of Care Model and Principles, they consist of consumers, families, youth, providers, advocates, and other system representatives, such as courts, schools, churches, child welfare, juvenile/criminal justice, health improvement councils, tribes, vocational/ employment providers, housing authorities, area agencies on aging, local DWI councils, civic organizations, primary care providers, local government officials, and other interested individuals or groups

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RESPONSIBILITIES

Identifying gaps and needs

Recommending service array

Capacity building and program development

Proposals to funding bodies

Evaluation of local providers and services

Agreeing on common protocols for referrals and follow-up of persons in need of multiple services

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BEHAVIORAL HEALTH PLANNING COUNCIL

Single statewide behavioral health advisory group appointed by the Governor with 51% or more consumer/family/youth membership and having the following standing subcommittees:– Adults, Children/Adolescents, Substance Abuse

(including DWI), Medicaid, Native Americans, Criminal/Juvenile Justice, Employment, Housing, Neurobehavioral issues

Replaced all previously existing behavioral health advisory councils and structures that were set up by statute or as part of grant requirements

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STATUTORY DUTIES

Advocate for children, adolescents and adults with behavioral health needsReport annually to the Governor and LegislatureEncourage development of a comprehensive, integrated, community-based behavioral health systemAdvise the Collaborative agencies & statewide entityReview and make recommendations for the comprehensive mental health plan, mental health and substance abuse block grant applications, Medicaid state plan, and all other by plans and applications

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PROCESS

The Behavioral Health Planning Council and Local Collaboratives will be active partners with the Purchasing Collaborative and the statewide entity in evaluating services, monitoring trends and making recommendations for improvement

Contracts with the statewide entity and with providers will include performance and outcome requirements, with enforceable consequences for not meeting requirements and/or incentives for exceeding requirements

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ROLES OF CONSUMERS, FAMILIES AND ADVOCATES

The Behavioral Health Planning Council which reports to the Collaborative and the Governor is the formal voice of consumers, families and advocates who make up a majority of the Council membershipMembers in turn represent constituencies in their local communitiesConsumers and families have had and will continue to have meaningful roles that will make a difference in governance, design, implementation and evaluation of services

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TRIBAL ISSUES

Service dollars currently dedicated to tribal populations and communities will continue to be so dedicatedIHS and tribal providers will be considered essential providers with whom the statewide entity has to contract, if they meet criteriaUse of culturally appropriate and traditional healing services will be encouragedOn-going tribal input – as Advisors, on BH Planning Council, in tribal input meetings, during statewide planning process

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CHILD SERVING SYSTEMSEight months prior to the formation of the Collaborative, the child serving systems were involved in planning a re-design of the children’s behavioral health system which transitioned into the Collaborative processChildren’s behavioral health, child welfare, juvenile justice (all within the Children, Youth and Families Department) and education have all been active contributors to the design and implementation of the new system through the CollaborativeProviders/advocates of children’s services have been actively involved in Local Collaborative development, work groups and public meetings

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TRANSFORMATION PROCESS

Extremely inclusive process from the beginning through public involvement in work groups, local and regional stakeholder meetings and BHP Council meetings, that included consumers/ families/youth, advocates, providers, state agency staff, legislators and othersDouble duty of State agency staff during past yearNo new money or resourcesRe-training/re-tooling of existing State agency staff to assume new roles and job duties

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KEYS TO A CULTURAL TRANSFORMATION

LeadershipPolitical willInclusivenessStakeholder buy-inA strong values baseDedicated resourcesTiming

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CHALLENGES

Time Anxiety/fear about changeCulture shift - letting go of turf, fear of: losing control over services/money/methods of accessing services or funds/livelihoods Managing expectations-satisfying everyone all the time

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ADDITIONAL INFORMATION

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SERVICE DEFINITIONS

Exhaustive process of collapsing all pre-existing service definitions and codes from all State agencies into one definition and code for each service

Common HIPAA compliant definitions and service requirements for all services funded through or coordinated with the statewide entity using CPT and HCPCS Codes was a 3 year process that preceded the Collaborative but is ready for implementation July 1, 2005

Will relieve significant burden from providers who have had to deal with multiple funding streams, management information systems and billing mechanisms in the past

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SERVICE REQUIREMENTS – for each covered service

Definition

Billing code

Target population

Service exclusions

Program requirements

Staffing requirements

Documentation requirements

Admission requirementsContinuing service criteriaDischarge criteriaService authorization periodsService authorization unitsBenefit limits

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TARGET DATES

September 2003 – March 2004 – Organizing, Planning and Concept Paper DevelopmentSpring/Summer 2004 – Public Stakeholder Meetings (including tribal meetings)July, 2004 – Draft Request for Proposals out for review and commentNovember, 2004 – Request for Proposals ReleasedSpring 2005 – Vendor SelectionSpring 2005 – Transition and ContractingJuly 1, 2005 – New System Begins Operating

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PHASES

Pre-planning and transition: September 2003 – July 1, 2005

– Designing– Planning– Massive Public input– Federal approvals sought– Local Collaboratives criteria determined and

development begun– Releasing RFP and selecting partner– Transition

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PHASES

July 1, 2005 to June 30, 2006– Services provided; providers paid– Transition continued– Expectations refined– Data systems refined– Identification of ways to maximize funding– Local Collaboratives developed further– Implement statewide behavioral health plan– Goals for Phase Two set

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PHASES

July 1, 2006 to June 30, 2008– more blending and flexibility of funding– additional funding streams added– Local Collaboratives refined– development of additional evidence-based, best

and promising practices, practice based evidence– additional consumer/family operated services– performance expectations and consumer/family

outcomes refined, measured and reported– additional resources sought (e.g., grants)