So You Want to Keep Doing the Good Work of Saving Lives: So You Want to Keep Doing the Good Work of Saving Lives: What it will take in the New Era of Healthcare Reform Presented by: Suzanne Rabideau, MA, LPC, MBA National Association of Crisis organization Directors Annual Conference Phoenix, AZ October 21, 2016

Today’s Conversation – Funding and Sustainability 1. National Perspective HealthCare– for context purposes Trends in payment sources Forces Driving Change Solutions coming about to solve problems with the healthcare system Business Capabilities needed by providers of crisis services in order to operate in new world of healthcare What does this mean for your organization My hopes for our conversation- You have 1-2 actionable take-aways Have some fun

Some info about the presenter Suzanne Rabideau, MA, LPC, MBA 25 + years of working in healthcare systems Clinician All populations, all treatment/community settings Executive Leadership in State Government Behavioral health managed care contracts (early 2000’s about 1 Billion in contracts / year) Redesign of Medicaid system Executive Leadership Crisis Services Consulting firm Supporting managed care, provider agencies, peer/family run Process enhancement Strategic positioning Most recent endeavor launching Nov 2016 Invested in and launching a commercial financing firm National Business Funding Solutions, LLC

Slide presentation available www.rabideauconsulting.com - under Resource tab

Before we get to far into this ….. In the big scheme of things, where are we with implementation of healthcare reform? Does this topic pertain to your organization? Middle Beginning End

Starting Point for Our Conversation What are the sources of revenue for behavioral health services funding?

Starting Point for Our Conversation What are the sources of revenue for behavioral health services funding? Foundation and Donations Private Grants Other non-government community resources County Funding State Funding Medicaid Funding Medicare Marketplace Certified Community Behavioral Health Clinic (CCBHC)

Starting Point for Our Conversation What do we know about the current trend in these funding? Foundation and Donations Private Grants Other non-government community resources County Funding State Funding Medicaid Funding Medicare Marketplace Certified Community Behavioral Health Clinic (CCBHC)

Payors are not buyer the old business paradigm We do good work We are passionate about what we do Payers (States / Managed Care Organizations) contract with providers with passion but it is so much more than that! What does the new paradigm look like

Forces Driving Change in the US Healthcare System The United States healthcare delivery system is undergoing the most significant changes since 1965 when Medicaid was enacted. “Generational Change” Let’s see why

US Healthcare System in Numbers

30% Waste

Diligent study of the data Government is focusing efforts to understand the cost data Cost of co-morbid conditions https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- Office/Downloads/Dual_Condition_Prevalence_Comorbidity_2014.pdf

Does any of this have anything to do with providing crisis services?

Solutions Coming About to Solve Problems – An Overview Triple Aim Integration of Care (doing away with the silos) Government Working to Spur Innovations (CMS Innovations) Payment Modernization Other key ideas ….. Crisis providers must become experts in all these topics …..

Triple Aim Institute of HealthCare Improvement (IHI) http://www.ihi.org/Engage/Initiatives/TripleAim/pages /default.aspx Improving health outcomes Reducing the per capita costs of health care Improving the consumer’s healthcare experience Think of these as the goals to strive towards – The how (operationally) is what the industry is trying to figure out – this is where the innovation and creativity is happening

Integration of Care Changes in payment models – less BH carve outs for Medicaid managed care Changes in delivery systems Co-location BH provider at PCP offices PCPs at BH provider offices Virtual integration – services in multiple places with cohesion through technology Resources SAMHSA – HRSA Center for Integrated Health Care http://www.integration.samhsa.gov/about-us Levels of Integrated Care http://www.integration.samhsa.gov/integrate d-care- models/A_Standard_Framework_for_Levels_o f_Integrated_Healthcare.pdf

Government Working to Spur Innovations (CMS Innovations) CMS is testing various models for payment and delivery systems to help improve access, improve outcomes and reduce costs. CMS has an Innovation Center established under Section 1115A of the Social Security Act to develop new payment and delivery models.

CMS Categories of innovation Accountable Care designed to incentivize health care providers to become accountable for a patient population; and, in turn, to invest in infrastructure and redesigned care processes that provide coordinated, high quality and efficiently delivered services. Bundled Payments for Care Improvement Initiatives to Speed the Adoption of Best Practices Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models https://innovation.cms.gov/

New payment models Also use of sanctions Historically, medical reimbursement was on a fee-for-service model – deliver care and submit a claim to be reimbursed – incentivized volume Move from volume to value Some new approaches Bundled Payments Pay for Performance Capitation Also use of sanctions Medicare – hospital readmission penalty

A few more concepts to cover National trends – Mergers and Acquisitions Consolidation to: Maximize infrastructure Acquire competencies Expand into new markets Open Minds Conference – Centerstone CEO $400-500 million annual revenue is the magic # for the future (11 mergers) Unfamiliar competitors in the behavioral Health services market Managed care companies purchasing provider organizations Social service organizations entering market

A few more buzz words to cover Medical Homes or Health Homes - A comprehensive system of care coordination for individuals with chronic conditions. Health home providers will integrate and coordinate all primary, acute, behavioral health and long term services and supports to treat the “whole-person” across the lifespan. Population Health Management – managing the health of a targeted population Populations health determinants – how individual behavioral, social environments, physical environments impacts health Hot spotting – data mining for individuals who have high cost, poor outcomes (5% population uses 50% of the resources, aggressively engaging these individuals in treatment Business Intelligence, Predicative or Suggestive analytics Tech solutions Excellence in Mental Health Services Act – creating CCBHCs – Certified Community Based Health Centers – 2 year state planning grants to change delivery system, following there will be 8 (maybe 24) states selected to participate in demonstration grants National Council resources http://www.thenationalcouncil.org/topics/certified-community-behavioral-health-clinics/

Recap National Healthcare Perspective What is driving need for change in the US healthcare system? What are some solutions that are coming about to support the change? What might all this have to do with crisis services

So….. Question 1 - What are you and/or your organization currently doing to make a difference in solving these national healthcare issues?

So….. Question 1 - What are you and/or your organization currently doing to make a difference in solving these national healthcare issues? Questions 2 - What are you and/or your organization currently doing that continues to contribute to the national healthcare issues?

Business Capabilities needed by providers of crisis services in order to operate in new world of healthcare Understanding and navigating local care delivery systems and reimbursement systems Use of electronic systems and demonstrating outcomes Developing sustainable budgets Negotiating contracts Mission and values considerations Adapting to sustainable business structures - Silos be gone

Write down one or more action(s) you will take in the next five days to enhance your organization’s sustainability.

Thank you and Onward!!!!!! suzanne@rabideauconsulting.com 602-501-3838 www.rabideauconsulting.com