Behavioral Health Integration and Beyond The Pathway to Fully Integrated Managed Care Presentation for The 11th Annual Provider Conference Joe Valentine, North Sound Behavioral Health Organization “Empowering Individuals and Families to Improve Their Health and Well-Being”

QUESTIONS TO BE ADDRESSED What has changed in the public funding of behavioral health services What is a Behavioral Health Organization? What is the Behavioral Health System of Care? What is the future for the North Sound Behavioral Health System of Care? What is the pathway to fully integrated managed care?

WHAT WOULD SUCCESSFUL INTEGRATION OF BEHAVIORAL HEALTH AND PRIMARY CARE LOOK LIKE FOR OUR CUSTOMERS? What would it look like for Joe? Joe is a 50 year old homeless man, chronic alcoholic, diabetes and frequent visitor to Emergency Departments

What Has Changed in the Public Funding of Behavioral Health Services? 1989 – Legislature allows counties to form “Regional Support Networks” for mental health services 1991 – formation of the North Sound Regional Support Network 1994 – Establishment of a formal “Interlocal Agreement” 2006 – transition to managed care for RSNs 2014 – SB 6312 directs the integration of mental health and chemical dependency services 2016 – North Sound Behavioral Health Organization LLC

Behavioral Health Organizations SB 6312 integrated financing for SUD services into the former RSN- mental health managed care system. The state provides “capitated” payments for all medically necessary MH and SUD services for Medicaid enrollees. These rates are based on an actuary process factoring in # Medicaid enrollees, projected utilization, and cost of services BHOs must provide a full “network” of integrated mental health and substance use disorder services

The North Sound BHO MENTAL HEALTH SERVICES EXPANDED – SUD AND INTEGRATED SERVICES Crisis Services Integrated Crisis Services Involuntary Commitment CD “Involuntary Commitment” Evaluation & Treatment Facilities Acute Detox - Everett Triage Centers – mental health Whatcom and Skagit Triage: sub-acute detox Psychiatric Hospitalization Psychiatric Residential Treatment SUD Residential Treatment

The North Sound BHO MENTAL HEALTH SERVICES EXPANDED SUD AND INTEGRATED SERVICES Outpatient Services SUD Individual and Group OP Intensive Outpatient Services SUD Intensive OP Medication Management Medication Assisted Treatment PACT Teams Children’s Wrap-Around - WISe SUD services for Pregnant and Parenting Women Jail Transition Unfunded

The Behavioral Health System of Care The BHO is only one part of the “Behavioral Health System of Care”. Behavioral Health Agencies – Outpatient and Residential County Human Service and Public Health Departments Crisis Line DMHPs and Mobile Crisis Teams Triage Facilities Detox

The Behavioral Health System of Care The BHO is only one part of the “Behavioral Health System of Care”. Hospitals Primary Care Clinics – Apple Health Mental Health services Law Enforcement – “911” Courts - Therapeutic and ITA Tribal Behavioral Health Programs School based behavioral health services Community prevention programs

The Future for the North Sound Behavioral Health System of Care Continue to expand access to mental health and SUD services Add new SUD providers to serve “niche” populations Expand Medication Assisted Treatment Improve access to services in geographically challenged areas Integrate screening and treatment of mental health and SUD services

The Future for the North Sound Behavioral Health System of Care Expand training for the workforce Improve electronic health record systems and health information exchange Support expansion of “collaborative care” and care coordination between behavioral health agencies and primary care

The Behavioral Health Facilities and “Recovery System of Care” Vision Develop new, smaller, community based mental health and SUD treatment facilities in the North Sound- coming on line in 2017: Lynwood- Evergreen Recovery 16 Bed Acute Detox Mount Vernon Evergreen Recovery 24 Bed SUD Intensive Inpatient Bellingham- Lake Whatcom Residential and Treatment Center 16 Bed SUD Intensive Inpatient

The Behavioral Health Facilities and “Recovery System of Care” Vision Develop new, smaller, community based mental health and SUD treatment facilities in the North Sound- for FY 17-19: Skagit “Stabilization Campus” North Sound E&T replacement for Sedro Wooley Acute Detox Possible future re-location of Skagit Triage Everett Denny Youth Center (2) 16 Bed SUD and/or Co-Occuring Treatment facilities Bellingham 16 Bed Mental Health Triage 16 Bed Detox West Skagit County “Tri-County” Triage/Sub-acute TBD 16 Bed “Long Term Care” SUD replacement beds for Pioneer North

The Behavioral Health Facilities and “Recovery System of Care” Vision Develop new, smaller, community based mental health and SUD treatment facilities in the North Sound- for FY 19-21: All Counties Recovery Houses Skagit “Recovery Campus” : recovery and long term housing, health, employment, and social services TBD 16 bed SUD and “Co-Occurring” Treatment Facilities

The Behavioral Health Facilities and “Recovery System of Care” Vision RECOVERY SUPPORTS FOR JOE: Ongoing engagement in treatment – and “check-ins” “Recovery Coach” Access to Housing Access to employment and other social services Access to Health Care!

The Pathway to “Fully Integrated Managed Care” SB 6312 also directed that by January, 2020, the “community behavioral health program must be fully integrated in a managed care health system, that provides mental health services, chemical dependency services, and medical care services to Medicaid clients” A model for financial integration of Medicaid services with Apple Health “Managed Care Organizations” is being piloted in the Southwest and North Central Regions.

The Pathway to “Fully Integrated Managed Care” Counties have requested of the Governor’s Office and the Legislature a role in the decision making for the design and implementation of the model in each region within state established parameters. This request would establish “Interlocal Leadership Structures” within each region jointly administered by “County Authorities”, the state Health Care Authority and the Apple Health MCOs

The Pathway to “Fully Integrated Managed Care” The Interlocal Leadership Structure must also fully engage: Primary Care Providers Behavioral Health Providers Tribes Other Stakeholders, including the “Accountable Community of Health”

The Pathway to “Fully Integrated Managed Care” The Interlocal Leadership Structure is responsible to design and implement a fully integrated managed care model for each region that: Assures clients are at the center of care delivery and: Supports integrated delivery of physical and behavioral health care at the provider level

The Pathway to “Fully Integrated Managed Care” Key Tasks for the Interlocal Leadership Structure: Align contracting and administrative functions to minimize the administrative burden for providers Monitor implementation including development of an “early warning system” Develop regional coordination processes for capital infrastructure requests and local capacity building Develop and build on data measures to maintain accountability for delivery system performance

The Pathway to “Fully Integrated Managed Care” Key Tasks for the Interlocal Leadership Structure: Discuss whether managed health care systems awarded the contract by the authority for a region should sub-contract with county-based administrative service organization or other local organizations, which may include and determine, in partnership with that organization, which value-add services will best support a “bi- directional” system of care

The Pathway to Fully Integrated Managed Care and the Accountable Communities of Health The Accountable Communities of Health [ACHs] are charged with the responsibility to design and implement projects to support the State’s Health Care Transformation Goals The ACHs will be receiving “Medicaid Waiver” funds to support this work Includes development of a strategy to support “bi-directional” integration of care between primary care clinics and behavioral health agencies ACHs are also to suggest a model for moving towards fully integrated managed care

The Pathway to Fully Integrated Managed Care and the Accountable Communities of Health In the North Sound, the BHO will work with the NSACH to engage providers and other stakeholders in the design of what the ideal system for the North Sound should look like. The vision for an ideal system should improve access to behavioral and physical health care for persons with serious mental illness and addictions.

The Pathway to Fully Integrated Managed Care and the Accountable Communities of Health The ideal system for fully integrated managed care should improve access to behavioral and physical health care for Joe!

Questions? For more information: Joe Valentine, Executive Director North Sound Behavioral Health Organization http://northsoundbho.org Joe_valentine@northsoundbho.org Empowering Individuals and Families To Improve Their Health and Well-Being