empire state plaza, albany

Empire State Plaza, Albany

NYAPRS EXECUTIVE SEMINARApril 28, 2011

Magellan Health Services, Inc. | 2

Magellan’s Medicaid Experience

Public sector focus - 60% of Magellan’s Revenue is Medicaid

Manage behavioral health care for 1.5 million Medicaid members for 8 health plans in 12 States through subcontracting agreements

Contract directly in 5 states representing 13 contracts (Arizona, Florida, Pennsylvania, Iowa, and Nebraska), for 1.9 million members

Pharmacy Benefits Administration Experience in 25 States and DC


All public sector programs are unique but leverage core competencies: Resources & Experience – Dedicated public sector teams

working locally in each State; national experts who provide implementation expertise and ongoing technical assistance/support.

Infrastructure – Specialized BH IT, claims and QI technologies customized for State and Health Plan customers. Focus on outcomes for members and families.

Flexibility- understanding of the unique needs of each State; customized clinical and provider initiatives that address service gaps.

Dynamic Service Array – Track record expanding and enhancing local service delivery systems to focus on community-based programs, peer support, wraparound services and services that promote recovery goals.

Partnership – Collaborative program design and oversight models that engage consumers, family members, providers and other stakeholders in the decision-making process.

Integration – Coordinated approach to physical and behavioral health, including holistic treatment planning and medication management.

Magellan: Medicaid Expertise


Experience working with persons with SMI; assisting individuals to manage their behavioral health symptomsExperience coordinating and managing the care of persons with a mental health or both mental health and substance abuse diagnosis; and physical health/medical diagnosisCo-location of behavioral health teams with health plans or MCOsData sharing within and across systems to create recipient profilesPartnering with State customers utilizing Section 2703 of the PPACA:

oA state may amend its Medicaid plan to provide for medical assistance to individuals with chronic health conditions who select a provider or health team as the individual's "health home" for the provision of home health services. oDuring the first two years that the State Medicaid Plan amendment is in effect, the federal medical assistance percentage or "FMAP" (the federal government's share of a State's expenditures for Medicaid) is 90%.

Experience with ACO-Like Models

Key elements in behavioral health approach to ACOs/Health Homes:


Maricopa County, Arizona: oGlobal payments to Provider Network Organizations (PNOs) who are accountable for individual and program outcomes:oPublicly-available on-line ‘dashboards’ promote PNO transparency and accountability

Florida: oSub-capitated payments for outpatient care provided to enrollees in the Prepaid Mental Health Plan (PMHP)

Examples of ACO-Like Models


Behavioral Health Approaches & Savings

Savings can be achieved through care management approacheso Magellan has achieved savings without reducing outpatient provider

rates by use of peer programs and community supports diverting members from emergency rooms and reducing inappropriate admissions to inpatient care

Savings can be achieved while meeting recovery and wellness objectives, and meeting quality improvement goals

Continuous care management efficiencies within mature Medicaid programso Field care management (6% savings on cost of care in a mature

program)o Targeted efforts in 2 mature programs (5-6% savings on cost of care)

• Reduce readmissions• Decrease inpatient lengths of stay• Decrease residential treatment utilization• Reduce admission to inpatient care


Collaborating with Providers to Improve Performance Provider Dashboard

o Increase provider accountability and performance o Measure key indicators designed to improve recipient outcomeso Data shared via Web – electronic provider benchmarking improves care

while incurring minimal costs

Performance-based Contracting (PA)o Reward for quality – varies by provider based on level of careo Reduce ALOS, improve outcomes while containing costs

Reward for Quality (IA)o Providers with demonstrated positive outcomes subject to less frequent

review/oversighto Reduces administrative burden on providers, while promoting and

leveraging provider best practices


Persons with SMI and co-morbid conditions are best served in a BH centered IHH due to unique capabilities and expertise required to treat persons with SMI

Creative and innovative uses of health information technologyo Integrated member service recordo Comprehensive view of member’s past and current medical, behavioral,

and pharmacy serviceso More efficient and streamlined coordination of health services

Superior anticipated outcomeso Improved clinical indicatorso Better experience of and satisfaction with careo Cost savings through reduced ER visits, hospitalizations, and re-

admissions to intensive levels of care

IHH: A Comprehensive Solution

Integrated health homes featuring behavioral health providers as the clinical lead for care


Barriers to Care Coordination

Primary Care

Behavioral Health

Substance Abuse

Specialists

Difficultykeeping primary

care and bh visits

Issues with transportation

Issues with literacy and

health literacy

Physician’s offices often not set up to care for individuals

with SMI

Anxiety from unaddressed

physical issues

ER/Urgent Care

Hospital Admission

More likely to die by suicide Likely to die 25

to 30 years younger 15% have

diabetes

40 – 60% of those with

schizophrenia are overweight

High prevalence of co-morbidities

Difficulties with

medication side effects

and adherenceINDIVIDUAL CHALLENGED

WITHMENTAL HEALTH AND/OR

SUBTANCE ABUSE

Very low Income / poverty

Surrounded by others with

similar issues

At least 75% smoke tobacco

78% Unemployed

Clinical gaps in care


Essential Elements of Integrated Health Home

Member engagement

, peer support,

and family support Use of

community resources

Increased access to

care, including

use of telemedicin

eProvision of

basic physical health

services

Outcomes and

accountability

Enhanced provider

coordination /

pharmacy managemen

t

Behavioral Health as Lead

Coordinator

1

2

45

6

3

SpecialtyCare

HospitalCare

Overview

Behavioral health is the gateway to improved health outcomes through this model, leveraging expertise in utilizing peer support, community resources and telemedicine.

Basic primary care functions are administered via the BH team, whether in a CMHC or other BH clinic setting.

The BH lead also coordinates more intensive medical care, including specialists and follow-up from hospital care.

Patient registry tools track outcomes and drive accountability.

1 2 3

4

5

6


PA HealthChoices/HealthConnections Case Study

“ Develop a best practice in which a behavioral health carve-out (Magellan) and a Medicaid physical health plan in southeastern PA partner together to improve the connection and coordination of care for adults with serious mental illness enrolled in the HealthChoices Medicaid program. “

Value Propositio

n

Serves Medicaid adults diagnosed with schizophrenia, mood disorder, or borderline personality disorder

Two-year pilot program established and monitored by the Pennsylvania Department of Public Welfare

Services include integrated member profile, including pharmacy data, for participants; multiple clinical touch points between physical and behavioral system; community-based ‘navigators’ who facilitate tx coordination

Program Summary

Decreased inpatient admissions and ER visits Member service profile and integrated health/wellness plan developed for each

member Timely notification to prescribers about medical refill gaps

Desired Outcomes

Improved coordination of care:100% of members connected with PCP100% of members connected with appropriate behavioral health services89% made or sustained progress meeting substance abuse recovery goals93% of participants connected to a medical specialist

Utilization changes:BH outpatient utilization increased,ER and inpatient utilization for physical health decreased

Preliminary Results


Magellan’s Peer Initiatives

Peer experience is valued and integrated at all levels of our Public Sector programs

o Peer specialists work in our care management centers and national team

o Peer-provided services and supports through our provider networko Partnerships with peer-operated organizations in communities we

serveo Promotion of mutual self-help and support groups as a vital resource

for recoveryPeer Support as an evidence-based practice is

implemented through approaches that worko Peer Crisis Navigators help link people to services to prevent ongoing

crisis involvement (AZ)o Peer Connections and other bridger-type programs help people

coming out of hospitals (PA and FL)o Peer specialists trained to provide crisis support (IA)o Peer Support Whole Health – rolling out across all Public Sector

programs. • Currently in place in Maricopa, Pennsylvania, and Iowa.


Peer Support Whole Health initiative promotes individual success in achieving personal health goals

o Participants set goals to address specific health/wellness issueso Targeted education sessions and activities (walking clubs, phone trees for

smoking reduction, relaxation and stress groups) to assist participants in meeting their goals

o Services billable to Medicaid as peer/family support, living skills, health promotion

Passport to Careo Educates recipients on importance of physical health care, preventiono Tools and techniques to assist recipients in talking with their PCP, sharing

critical BH information such as pharmacy and labs

Continuing commitment to implement across all Public Sector programs

o 250+ peer specialist trained in PSWH in partnership with Appalachian Consulting Group since 2009

o Peer Support Whole Health part of Integrated Health Home pilotso Expect an additional 150 peer specialists to be trained this year

Recovery, Resiliency & Wellness Initiatives Promote Improved Outcomes


Recovery, Resiliency & Wellness Initiatives Promote Improved Outcomes

Arizona Smokers’ Helpline (ASH)o Provides Medicaid recipients with free telephonic and on-line resources

to stop smoking, which in turn improves overall health outcomeso Includes “Personalized Quit Plan” to help participants meet their

smoking cessation goalso Resources available in Spanish and English

Peer Crisis Navigatorso Implemented in 2010 in Maricopa County – links individuals in crisis to

community outpatient treatmento Used as both step down and diversiono Peer navigators assist those in need, break cycle of repeat crisis

episodeso Contract with a peer organization to provide warm line service


Recovery, Resiliency & Wellness Initiatives

Youth in Transition - Magellan Youth Leaders Inspiring Future Empowerment (MY LIFE) – AZ, PAo Awardee at NMHCC National Convention 2011o Youth-led initiative in which young people develop their own service

solutionso Improves the systems of care for youth in transition

www.magellanofaz.com website – extensive tools and resourceso Recovery and Resiliency learning center – 10 webinars on diverse

recovery/resiliency topics; four webinars on Peer Supporto Outcomes dashboard showing program performance in key areas

http://www.magellanofaz.com/


Recovery, Resiliency & Wellness Initiatives Self Directed Care

o Persons with SMI (Iowa) Person-centered planning, life coaching, individual budgeting, financial

management, expanded provider networks and services Participants work within a “budget” to “purchase” both traditional Medicaid

services and other, non-traditional goods and services that support their recovery and resiliency plans

o Families with Children with Autism (Pennsylvania) Children with a diagnosis along the autism spectrum and their families

received funds to purchase products and services not otherwise covered by insurance

Funds used for activities to encourage interaction with family members/peers. Other families purchased computers and other media to increase their child’s communication skills

Families empowered to take leadership role in their own treatment process Children’s System of Care

o Goal: Maintain at-risk children with families/caregivers, in their communities

o Care coordinated by dedicated clinicians with expertise in children’s issues

o Access to a range of specialized child/family resourceso Joint treatment planning with schools, medical providers, families,

caregivers


Participation in Maricopa County Continuum of Care on Homelessness Committee:o Multi-agency committee that includes Government representation, agency

members, formerly homeless individuals and advocateso Committee develops strategies to access Federal and local HUD fundso Magellan provides dollar-for-dollar match in the form of case management,

wraparound services to support housing initiativeso Also provides technical assistance in development and submission of

renewal/new grant applications Housing and Urban Development (HUS) Point-in-Time Homeless Count:

o Federally-mandated point-in-time survey to gather data on numbers, characteristics of homeless individuals

o Magellan staff volunteer time to participate in annual surveyo Survey data used to justify additional funding requests, prioritize housing

developmento Includes sub-survey that profiles homeless and chronically homeless veterans

Project Homeless Connect:o Monthly ‘one-stop shop’ that provides immediate access to an array of social

and support services to homeless/chronically homeless individualso Behavioral health assessment and crisis evaluations with clinical professionalso Provided in partnership with local provider agencies that specialize in services

to homeless individuals

Homeless/Housing InitiativesSince 2007, Magellan has facilitated addition of 3,911 new units of subsidized and transitional housing in Maricopa County, AZ – an increase of 15% in total units available


Project for Assistance in Transition from Homelessness (PATH):o Partnership with AZ Department of Health Services and Southwest Behavioral Health

Serviceso Outreach for homeless individuals not currently engaged in BH services to help them

find treatment and housingo Quarterly meetings to identify barriers, find solutions to increase housing availability o SAMHSA’s national PATH consultant has provided presentations and program

assessment support

Bridge Subsidy Program (BSP):o Collaboration between Magellan, Public Housing Authorities (PHAs) and non-profit

organizationso Provides linkages and housing for persons with serious mental illness using a

Housing Choice Voucher (HCV) systemo Features the Permanent Supportive Housing (PSH) model (a national best practice)

that provides permanent housing, typically rentals, for members.o The BSP provides transitional funding to help eligible recipients until they can apply

for HUD’s Section 8 HCV.o It also applies for additional Section 8 vouchers when they become available

Corporation for Supported Housing, Tempe AZo Multi-agency collaborative that includes Magellan – Federal stimulus funds used for

rent/utilitieso Created, funded and implemented 35 units of permanent supported scattered site

housing for chronically homeless individualso Magellan provides ‘supportive services teams’ to individuals to ensure their ongoing

stability

Homeless/Housing Initiatives


Preparing to Become a SNP Provider

PCP/Specialty Health Provider Coordinationo Majority of SNP eligible individuals will have complex care needs, both

medical and behavioralo Foster collaborative relationships with PCPs, other specialty systemso Co-sponsor meetings with primary care system to establish common

understanding of challenges and potential solutions

We look to NYAPRS and its member providers to provide input, partnership and guidance during the transition to an SNP system. Areas for consideration include:


Preparing to Become a SNP Provider

Clinical Documentationo Review existing clinical documentation (initial assessment, treatment

plan, discharge planning documentation) to ensure inclusion of:• Coordination with PCP• Medication management• Recovery and resiliency focus

Technology Competencyo Develop Readiness for Electronic Medical Record requirementso Ensure system has functionality for comprehensive connectivity, data

sharing


Questions

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Documents

health plans

behavioral health care

behavioral health teams

modelsmagellan health

dcmagellan health services

health plan customers

individuals health home

chronic health conditions