Integrated Health Home

Integrated Health Homes For Iowa Plan Members Magellan Behavioral Care of Iowa August 2013

Format For Webinar • Olmstead Task Force and Magellan have partnered together to bring information to those interested, with a focus on delivering information to the consumer and family members who would like more information about the goals and design of the IHH program • Overview presentation of the integrated health home program including the Who, What When, Where and Why’s? - Kelley Pennington, Integrated Health Home Director (approx 30 minutes) • Q &A with assistance from Geoff Lauer, Olmstead Task Force (approx 30 minutes • Questions may be typed throughout the course of the presentation

What Is Magellan Behavioral Health of Iowa What is Magellan’s Role? • Magellan Behavioral Care of Iowa is a managed care organization charged with managing the Iowa Plan for Behavioral Health • The Iowa Plan is Iowa’s managed care program for certain publicly funded mental health and substance abuse services • Magellan has been the State’s contractor since 1995 • Significant expertise in behavioral health care • In partnership with the Iowa Department of Human Services , Magellan is providing the direction for the development and management of the Integrated Health Home Program

HOW is this program made possible? Affordable Care Act • Supports the development of health homes • Section 2703 • Allows for expansion of Medicaid services • 90 percent FMAP for health home-related services for first 8 quarters • Alternative payment models • Incentive grants Iowa Legislature Iowa Department of Human Services/Iowa Medicaid Enterprise

What

Is a “Health Home?”

A health home is a team-based health care delivery model that provides comprehensive, continuous care to people with the goal of obtaining maximized health outcomes Patient-centered medical homes (PCMH) have been developing in primary care world for decades

WHAT is an Integrated Health Home (IHH), Then?

The term Integrated Health Home is the name given for the health home program that is specifically designed for people with serious mental illnesses (SMI) and children/youth with serious emotional disturbances (SED)

Say It Again? Very simply stated, the integrated health home is a TEAM OF PEOPLE with unique skills, such as nurses, social workers and peer/family support specialists, solely positioned to provide much needed  care coordination  education

 direction for people with mental health challenges and their families The goal is BETTER HEALTH

IHH TEAM FOCUS

This team’s entire focus is to help people connect with information, services and other resources with the goal of improving all realms of one’s health – mental, physical, social….

WHO CAN ARGUE WITH THAT?

WHAT an integrated health home is NOT An integrated health home is NOT… • a house • a residential setting • a PMIC • a group care placement • a hospital • a building • A nursing home

NO, NO, NO, NO!!! Not even close….

Why call it HOME?

• The health home/medical home term has been around a long time • The Affordable Care Act refers to health homes • The term HOME is generally intended to have a positive connotation of somewhere where people know you, care for you, have your best interest in mind…You know the phrase…HOME SWEET HOME

Why develop integrated health homes? People with chronic mental illness die 25 to 30 years earlier than their peers who do not have a mental health condition, often due to unaddressed physical conditions. Much of this is preventable. 2006. National Association of State Mental Health Program Directors. “Morbidity and Mortality in People with Serious Mental Illness.” Alexandria, VA. http://www.nasmhpd.org/general_files/publications/med_directors_pubs/Technical%20Report%20on%20Morbidity%20and%20Mortaility% 20-%20Final%2011-06.pdf.

The drastically reduced lifespan for people with SMI and SMI/SUD is comparable with Sub-Saharan Africa

BUT WE ALREADY HAVE SERVICES, CASE MANGEMENT ETC…

PEOPLE ARE DYING. WE NEED TO DO MORE. WE CAN DO MORE.

WHO is the Integrated Health Home Designed For? Iowa Plan* members (Medicaid) who have a Adults with serious and persistent mental illness (SPMI) Children/youth with serious emotional disturbances (SED) * Includes approximately 411,000 members; most all Medicaid members are eligible for the Iowa Plan

Diagnostic Criteria for IHH Membership The SMI diagnosis is defined by the following diagnosis categories:

Serious emotional disturbance (SED) means:

• Psychotic disorders

• A diagnosable mental, behavioral or emotional disorder of sufficient duration to meet DSM diagnostic criteria

• Schizophrenia • Schizoaffective disorder • Major depression • Bipolar disorder • Delusional disorder • Obsessive-compulsive disorder • Other MH diagnosis with significant functional impairment

• Results in functional impairment

Attributed Medicaid Member Population

• Identified through Magellan claims information –30,000 SPMI adults statewide –16,000 SED children and youth statewide

Can people on waivers be in IHH?

YES – Children on CMH waiver are included YES - Children and adults receiving Habilitation Services ___________________________________________________________

NO – ID waiver, PD waiver, HD waiver, BI waiver, Elderly waiver, HIV waiver

Is IHH Membership Optional? YES, this is an optional program. Members have choice and can always exercise the choice to opt in, opt out, move to different IHH provider in community Because it is available to offer additional help with care coordination, resources, education about health and wellness, peer support etc, the hope is that members do not opt out

But the choice is always with the member’s!

Do I have to change doctors, therapists etc?

NO!!! • Being assigned to IHH gives you an additional service of having access to the Care Coordination teams • You can keep seeing your providers – Primary care – Psychiatrist – Therapist – BHIS – Habilitation provider – Etc NONE OF YOUR PROVIDERS WILL CHANGE BECAUSE OF IHH UNLESS YOU WISH FOR A CHANGE

What You Need to Know About Opting Out of IHH CMH waiver – Currently requires case management as part of CMH waiver. The IHH will be provider for the case management service portion of the CMH waiver so if child is opted out of IHH, there is no case management service available and therefore the waiver services will be unable to be accessed.* Habilitation Services – Currently requires case management as part of Habilitation Services. The IHH will be provider for the case management service portion of Hab so if child/adult is opted out of IHH, there is no case management service available and therefore the waiver services will be unable to be accessed.* *Targeted Case Management will not be an available option for people who meet IHH criteria. The State has determined that IHH will provide the case management for those with SMI/SED.

WHO are the IHH providers?  Behavioral health providers that are the community experts for serving people with mental health needs

 Have willingness and support to think differently in terms of serving health care  Meet standards outlined  Not all willing and able will be IHH

IHH Provider Qualifications • Accredited/licensed mental health provider of good standing in the Iowa Plan • Capacity to serve a significant number of the targeted population • Demonstrated capacity to use HIT to measure outcomes • Commitment from highest levels of leadership to lead transformational change according to the IHH program principles • Demonstrated readiness to complete the change transformation curriculum in a year

• Demonstrated capacity to manage quality improvement processes • Ability to staff the program with the necessary teams to manage • Meet specific qualifications outlined in state plan amendment

HOW can I be a part of a IHH? • Meet criteria for membership

• Assigned membership will be automatically enrolled to health home in area – Should receive a letter informing you of enrollment – IHH provider will reach out to you • If you are not automatically assigned, – Call IHH provider directly to enroll – Call Magellan directly for local IHH

• Cannot be assigned to both physical health home and specialized integrated health home

IHH Is a Team Approach Magellan • Selects IHH providers • Provides care management support through  Claims-based reporting to identify gaps in care

 Risk analysis  Development of online tools

to support daily service delivery and population management needs

Community IHH Provider • Develops care teams to work with members

• Uses data and technology to oversee and intervene in the total care of the member • Works with community services and supports to address member/family needs • Develops whole-health approaches for care

IHH Community Provider Teams • Care coordination teams integrated within IHH sites

• Enhanced staffing for TCM members moving to IHH (50:1) • Ratio-based positions dependent on number of members – Nurse (RN) - 400:1 – Care Coordinator (BS/BA) 250:1 adults; 200:1 children – Peer or Family Support Specialist (certified) 250:1 adults; 200:1 children • Non-ratio-based positions – Program Director – Supervisor

WHAT can IHH do?

 Comprehensive care management  Care coordination  Health promotion  Comprehensive transitional care  Individual and family support services  Referral to community and social support services

GREAT things are done by a series of small things brought TOGETHER.

Patient-Centered Focus New Attitude • Patient-centered – Focus is on mobilizing services and supports based solely on the individual’s health and wellness needs • Integration of physical, behavioral, and other social supports • Proactive, preventative efforts to improve/maintain health • Access to services available • Information and guidance

• Plants and lamps campaign – creating warm, inviting places for health care delivery • It is a privilege to serve this population

Old Attitude • Practice-centered - Patient needs to fit into available service array • Silo approach to care, lack of integrative efforts • Reactive efforts to manage crisis, illness • Waiting lists, poor access, missed appointments • Confusion within system, no designed guidance • Sterile, low focus on environmental setting • Population should feel privileged to be served

Using Data to Manage Member Population • A move from thinking of health care as a series of isolated, reactive, crisistype encounters, to a big-picture approach that anticipates needs and improves outcomes • A process of scanning large groups of patients and asking, “What are the pressing health needs of this population, and how can we best satisfy or even pre-empt those?” • A “population” is a group of people with a shared condition, such as diabetes, schizophrenia or asthma

• Use data, such as claims or encounters, to inform areas of intervention needed to improve or maintain health status • Example: Diabetic patients may need annual eye exam, foot exam, HbA1c testing, medication management, etc.

Using Information Technology • Allows for immediate health information access • Electronic Medical Records (EMRs) – Allow for improved internal information-sharing – Allow critical patient medical information to move to outside providers quickly • Continuity of Care Document (CCD) - electronic document exchange standard for sharing patient summary information • Create tools to inform next steps within practice: – Look across practice patient population – Sort and group patients by common traits – Make informed choices about where dollars and energy are best spent – Measure progress in real time

Let’s Talk About Wellness for a Change…

Health promotion includes use of • self-management tools • fitness • nutrition • health education • other innovative approaches

IHH Sites: Practice Transformation Coaching • Practice transformation coaches will be routinely onsite to instruct and assist practices with quality improvement efforts to transform site to patient-centered practice • Ongoing technical assistance for 2 years • Tools to assess readiness and transformation progress • Learning Collaboratives to learn from others, share best practices • Adult IHH – HealthTeamWorks will be providing coaching expertise • Child IHH – University of Iowa will be providing coaching expertise

IHH Sites: Quality Outcomes Expectation

• Demonstrated effectiveness is critical • Quality measures will be monitored related to health status, improvement in function, etc. • Financial incentives available to sites for meeting health measures

IHH Sites: Flexible Payment Methodology • Health homes services paid on a per member per month (PMPM) basis

• Blended rate of high-need to low-need member costs of care • Allows for flexibility in delivery of care • Concentration of efforts can be given where needed with less cost concern

• Fee-for-service remains in place for traditional services available (e.g., therapies, medication management, BHIS, etc.) • Large primary care sites will be paid lower PMPM to participate in care coordination, communication for common members

IHH Sites: Systems of Care Approach for Child IHH Child sites will function using Systems of Care model

• Child- and family-centered • Strengths-based approach • Family team meetings

• Wraparound process • Community engagement • Use of natural supports

Habilitation Services and IHH • Medicaid members who receive Hab services are attributed to IHH sites (currently phase 1 only) • Anyone starting Hab will also be attributed to an IHH site when IHH is available • IHH is required for anyone on Hab (as long as IHH is available) • Exception: Members who are on waivers other than CMH waiver will not be attributed to IHH (i.e. Elderly, ID, HIV, PD, HD, BI)

Phased Statewide Roll-Out

PHASE 1: July 2013 Dubuque (pediatric only); Linn, Polk, Warren and Woodbury counties

PHASE 2: April 2014

PHASE 3: July 2014

30 counties

64 counties

For More Information:

www.MagellanofIowa.com Kelley Pennington, IHH Director [email protected] Cheryl Holt, Assoc. Director, IHH Adult Program [email protected] Dave Klinkenborg, Assoc. Director, IHH Child Director [email protected]