1 NH Division of Community Based Care Services Bureau of Behavioral Health Payment and System Reform Project June 10, 2011

2 Current System

3 NHs Community Mental Health System 10 Community Mental Health Centers 8 Peer Support Agencies 1 Family Mutual Support Agency – NAMI NH

4 CMHCs Responsible for providing a comprehensive array of services to individuals residing in a region who meet the criteria for a severe mental disability as defined in state law and administrative rule. The primary safety net system in NH that provides services to Adults with Severe Mental Illness and Children with Serious Emotional Disturbance. 95% of BBH Medicaid Funding is targeted to this population.

5 CMHCs Services are comprehensive and provide the most effective treatment for individuals with a Severe Mental Disability Emergency Services Therapy Services Medication Services Residential Supports and Supported Housing Case Management Individualized Resiliency and Recovery Oriented Services Illness Management and Recovery Supported Employment

6 What are we trying to address through this project?

7 Challenges = Need for Change Rate of growth and demand for services is unpredictable, and with the past few years experience is unsustainable. Challenges with a fee-for-service model of reimbursement –Does not promote or create incentives for an efficient service delivery system –Reimbursement based on volume and number of people served, not outcomes

8 Challenges, continued –Unsustainable growth in expenses, inevitably lead to the need for cost containment measures, which can further erode the community mental health system –The system and the state are continually in a position of trying to do more, with less funding –Need for new strategies to support NHs 10-year Plan –BBHs federal mandate to ensure an efficient and effective service delivery system

9 Beginnings of the project…

10 Project Partners NH Endowment for Health NH Community Behavioral Health Association NH Department of Health and Human Services NH Bureau of Behavioral Health Optumas Health Strategy University of New Hampshire- Institute on Disability National Association of State Mental Health Program Directors (NASMHPD) Substance Abuse and Mental Health Services Administration (SAMHSA) Centers for Medicare and Medicaid Services (CMS) Consumers, Families, and community organizations that partner with NHs Community Mental Health services system to support individuals and families

11 Approach to System Reform Review of NHs Community Mental Health System in July 2009 Request for Technical Assistance from NASHMPD- Fall 2009 Development of Underlying Goals and Principles to guide the work of the project Developed a comprehensive project plan Stakeholder Meeting with CMHCs, Peer Support Agencies, CMHC and PSA Boards- December 2009 Reviewed multiple national models for managed care

12 Approach to System Reform, continued Through the support of the Endowment for Health, retained a Project Manager through UNH Retain an Actuarial Firm- Optumas, to assist with the program design, and rate setting work- Fall 2009 Solicited the input of stakeholders Finalized recommendations for a managed care approach that best meets the needs of our population Established a Rate Advisory Committee Developed a comprehensive concept paper

13 Approach to System Reform, continued Awarded SAMHSA grant to implement outcomes measures and tools on a statewide basis- the CANS and the ANSA, as well as implement a web based reporting and tracking database Development of quality and outcomes measures Ongoing consultation with the CMS in the development of a 1915(b) managed care waiver application Budget presentations incorporated the model and the goals and principles of the project

14 Goals and principles…

15 Underlying Goals and Principles Establish the road map and the benchmarks to guide the project, and ultimately measure its success Revised on an ongoing basis using stakeholder feedback and our work with the project team

16 Goals and Principles Inclusive of Active Participation Restructure the funding of community mental health services Develop a plan to more effectively address the needs of the uninsured Focus on collecting outcomes data, and supporting improved outcomes through performance based contracting

17 Goals and Principles, continued Establish a Timely, Flexible and Responsive System of Care Ensure Transparency to Consumers, the Public, and Stakeholders Locally Driven Care Risk is initially shared with the State, and as the system matures, is transferred more to the provider in specific areas

18 New Proposed Service System CURRENTNEW Services paid for on a fee for service.Services paid for on a capitated payment model. No performance based contracts or accountabilityOutcomes driven system for improved outcomes.with Performance contracts for providers. 10 CMHCs responsible exclusively for communityEstablishing 10 mental health services.Prepaid Health Plans, move to a network based model which integrates care on a local level with other service systems (ex. Substance abuse, other mental health providers, inpatient, primary care)

19 New Proposed Service System CURRENTNEW No Risk to providers- paid for every serviceBegin with a shared risk providedmodel utilizing risk corridors through contract, as the system matures, and appropriate tools are put into place, move to full risk model. Services are not integrated on a local levelIntegrated service model of leveraging Health Homes provision within the Affordable Care Act.

20 Next steps….

21 Next Steps Finalize rates to budget Submit waiver application to CMS for review Develop new contracts for prepaid health plans Implementation- January/February 2012

22 To learn more…and keep informed

23 Project Website

24 Contact Information Erik G. Greg