Longer-Term Strategies To Prepare For Changes In Behavioral Health & Child Welfare Systems Making It Through to the Future Arizona Council of Human Service Providers Membership Retreat August 12, 2010, Prescott Resort Monica E. Oss, Chief Executive Officer, OPEN MIND

Planning & Management in Economic Recession Has Three Simultaneous Elements Short-Term Cash Management Short-Term Revenue Stabilization Plan for Recessionary Period Preparing for the Post- Recession Marketplace Opportunities OPEN MINDS © 2009 All rights reserved. 2

Key Environmental Factors Driving Behavioral Health & Social Service Market 1. State and local budget issues dominate the current market 2. Parity goes live and health care reform is pending 3. New science reinventing best practice in service models 4. Comparative effectiveness as emerging criteria for health system management 5. Federal tech mandates 6. E-health and the virtual consumer – reinventing service delivery and consumerism 3

Four Major Strategic Implications Of The Two Legislative Initiatives 1. Most behavioral health dollars will flow through health plans 2. Technology and financing will increase the specialty behavioral health services provided via primary care – leaving complex/chronic cases to be provided through disease management models with risk-based financing 3. Health plan-based financing will draw clear lines between health services and social services 4. Comparative effectiveness initiatives will increase private pay market – new tech, services not preferred 4

Key Environmental Factors Driving Behavioral Health & Social Service Market 1. State and local budget issues dominate the current market 2. Parity goes live and health care reform is pending 3. New science reinventing best practice in service models 4. Comparative effectiveness as emerging criteria for health system management 5. Federal tech mandates 6. E-health and the virtual consumer – reinventing service delivery and consumerism 5

Drivers of Service System Evolution 6 1. Change in Service: Neurotech, biomedical tools, cognitive retraining tools, and emerging evidence-based practices 2. Change in Service Location: Facilitation of remote service delivery and emergence of smart home technologies 3. Change in Control of Service: Increasing consumer self-service and consumer evaluation of services with increasing power of and information availability through bioconnectivity

OPEN MINDS Child Welfare Delivery System Emerging Market Model Facilitated by PHR, RHIO, or specialty primary care practice Tech-Enabled Medical Home For Children On-line and in-home services and supports for foster families and kinship arrangements On-line and in-home services and supports for biological families to support family reunification Mobile supports for case workers Tech-Enabled Supports To Foster Family, Biological Family, & Kinship Arrangements Increased kinship care and family preservation Foster care increasingly intensive Reduced use of residential and group home services Shift in Residential Arrangements For Children OPEN MINDS © All rights reserved. 7

OPEN MINDS Model Of Emerging Roles for Specialty Health Provider Organizations 8 Location-Based Services Destination Specialty Services One-Stop Health Service Shopping Location-Independent Services Mobile, Home- Based, & Community Care Services E-Health & Remote Services

OPEN MINDS Emerging Market Model for Support for Consumers with Disabilities 9 Facilitated by PHR, RHIO, HIE, medical home, and/or specialty primary care practice Tech-Enabled Medical Home For Consumers On-line (smart home) and in-home services and supports for consumer and their families On-line in-home services and supports for community living arrangements Mobile supports for case workers Tech-Enabled Supports Expand Community-Based Delivery Systems More consumers at home with emerging use of community living arrangements. supported housing, and assisted living models Decreased use of group homes, nursing homes, and residential services Shift in Residential Arrangements

Strategic Implications of the New Paradigm 1. Substitution of new technologies for traditional services 2. New competitive marketplace with pronounced shifts in competitive forces 3. Competition for consumers across the health care system 4. Economies of scale critical for on-going competitive success 5. New competition drives need for capital 10

Best Practice Management System Requirements 1. Improve cost management 2. Improve consumer preference 3. Support continuous innovation 4. Compete through effective marketing strategy and infrastructure 5. Assure organizational viability 11 Aune D. Best practice management. Presented at the Best Management Practices Institute; January, 2009, Georgia, AL.

Attributes of Organizational Success in Emerging Mental Health Market Models 12 Tech-Enabled Community-Based Consumer- Centric Integrated In Local Market Model Risk-Based or Performance-Based Compensation Model Oss ME. Emerging market models for behavioral health & human services. Presented at Marketing & Innovation Institute: Preparing Executives for the Next Generation of Behavioral Health & Social Services; March, 2010, Orlando, FL

Executive Team Competencies for New Environment OPEN MINDS Management Pillar OPEN MINDS Executive Competencies Leadership & Governance Board composition and board performance management Board meeting and governance management Executive team composition, performance management, and succession planning Financial Management Budgeting and financial management Financial risk management Long-term financing and capital planning Marketing & Innovation Government, regulatory, and legislative relations Communications, public relations, and media management Marketing planning, strategic alliances, and community collaborations Service line development Technology & Information Management Organizational performance metrics management Information management infrastructure Strategic Management Strategic planning and leadership of organizational evolution Service line management and corporate compliance Talent management 13 Oss ME. Emerging market models for behavioral health & human services. Presented at Marketing & Innovation Institute: Preparing Executives for the Next Generation of Behavioral Health & Social Services; March, 2010, Orlando, FL

Role of Mergers & Acquisition in Post-Recession Market How big is big enough? Big versus virtually big? Collaboration as an alternative what is the strategic purpose for collaboration? Merger/acquisition The zebra model The survival model The strategic model 14

Bringing the Management of Behavioral Health & Social Services Into Focus York Street, Gettysburg, Pennsylvania