1. One Member at a Time  The Person-Centered Approach to Advancing Integrated Care and Population Health
Ellen Stoller, ATR-BC, LCAT, BH-HARP Training Specialist Jon Anderson, LMSW, HARP Supervisor, Albany

2. Brief tutorial on Managed Care A little history “The Triple Aim”
Agenda
Brief tutorial on Managed Care
A little history
“The Triple Aim”
Health and Recovery Plans (HARP) Principles & Fidelis staff training
The use of data
Strengths: a deeper dive
Closing 2

3. QUIZ: What is Managed Care?
Managed care companies…
Have accountants watching medical and pharmacy claims and their goal is to limit costs
Have nurses watching medical and pharmacy claims and denying requests for authorization
Have clinical social workers, psychiatrists, substance use experts, RNs & MDs talking to members about what they want/need to stay well and in recovery
New York State started working on the behavioral health transition to Managed Care…
In 2014
In 2011
In July 2015 3

4. QUIZ: What is Managed Care?
HARP is…
The name for the Medicaid carve-in Health and Recovery Plans
A multi-stringed instrument
One of the Marx Brothers
Carve-in refers to…
What you do to a turkey at Thanksgiving
Services previously paid on a fee for service basis by Medicaid being included in a Managed Care Plan
How you make a jack-o-lantern for Halloween 4

5. Improved health and behavioral health outcomes Reduced cost
The Triple Aim
Member satisfaction
Improved health and behavioral health outcomes
Reduced cost 5

6. Only health plan to offer HARP in every county
About Fidelis Care
Mission- focused
1.5 million members
Only health plan to offer HARP in every county 6

7. Managed Care vs. Fee For Service7

8. One Member at a Time… 8

9. Care Managers: ‘Mission Control’ for MCOs
Help members get to their desired health goal or destination
Make sure members don’t go off course
Are able to assess and coordinate all systems that need to be involved 9

10. HARP Principles 10

11. HARP Principles
Person-Centered Care 11

12. Group Exercise: Agree, Disagree, or Unsure?
HARP Principles
Group Exercise: Agree, Disagree, or Unsure?
Group Discussion: The impact of words 12

13. Use “person-first” language to improve services.
HARP Principles
WORDS MATTER.
Use “person-first” language to improve services.
Avoid buzz words and jargon, and instead put those words in to behaviors, actions, activities, outcomes members can understand. 13

14. HARP Principles
Recovery-Oriented: Services should be provided based on the principle that all individuals have the capacity to recover from mental illness and/or substance use disorders. 14

15. HARP Principles
Integrated: Services should address both physical and behavioral health needs of individuals. Care coordination activities should be the foundation for care plans, along with efforts to foster individual responsibility for health awareness. 15

16. HARP Principles
Data-Driven: Providers should use data to define outcomes, monitor performance, and promote health and well-being. 16

17. HARP Principles
Evidence-Based: Services should utilize evidence-based practices where appropriate. 17

18. HARP Principles
Trauma-Informed: Trauma-informed services are based on an understanding of the vulnerabilities or triggers experienced by trauma survivors that may be exacerbated through traditional service delivery approaches. 18

19. HARP Principles
Peer-supported: Peers will play an integral role in the delivery of services and the promotion of recovery principles. 19

20. HARP Principles
Culturally Competent: Address bias and blind spots, be open, and never make assumptions. Always ASK. 20

21. HARP Principles
Flexible and Mobile: Services should adapt to the specific and changing needs of each individual. 21

22. Family Matters 22

23. Strength-Based Approach
In The Strengths Perspective: Putting Possibility and Hope to Work in Our Practice, Dennis Saleebey relates a strengths approach in social work practice to CPR, or cardiopulmonary resuscitation: breathing for someone until they can breathe for themselves. 
This translates to believing in someone until they can believe in themselves. He uses CPR to encourage practitioners to explore clients as follows:
C- Capacities, competencies, courage, character P- Promise, positive expectations, purpose, potential R- Resources, resilience, relationships, resolve, reserves 23

24. Strength-Based Approach
Strength-based practice is a social work practice theory that emphasizes people's self-determination and strengths. It is client-led, with a focus on future outcomes and strengths that people bring to a problem or crisis.
“What’s strong rather than what’s wrong.” 24

25. Strength-Based Approach
Group Activity: At My Best! 25

26. Strength-Based Approach
“Risk assessment” or “strength-based” approach?
Develop approaches that look at the whole picture of a person’s life. As Graybeal (2001) explains:
“The identification of strengths is not the antithesis of the identification of problems. Instead, it is a large part of the solution.” 26

27. Takeaways
We hope you have learned more about managed care and also that…
At Fidelis we train staff to:
Take one member at a time, one day at a time
Maintain an asking stance
Make no judgments
Take a deeper dive to find strengths
Look at the value of personal data 27

28. People will forget what you said People will forget what you did
But people will never forget how you made them feel.
Maya Angelou 28