1. Thinking in a New Way About Care Coordination
Staten Island Developmental Disability Council
JoAnn Lamphere, DrPH
June 16, 2017

2. Discussion Topics Rationale for Change
5/19/2017
Discussion Topics
Rationale for Change
Transition to Specialized Managed Care
Care Coordination / Management
CCO/HH Application Elements
Implementation Planning

3. Health Care & Transitions for People With Developmental Disabilities
Person-centered planning includes health concerns
Co-morbidities and co-occurring conditions
Over time, people’s health status & support needs change
Someone with I/DD is more than twice as likely to be admitted when they present in hospital emergency departments
People with I/DD in inpatient settings can be stable but not have long term supports and services identified or available to them

4. Underutilized Preventative Health Care Services
1/1/2019
Underutilized Preventative Health Care Services
Preventive screenings
Health promotion
Dental
Chronic care management
Prescription drug management
Maximize use of preventative services to maximize good health for optimum community life and independence

5. Transformation Panel & Managed Care
Transformation Panel Report
“Raising Expectations, Changing Lives”
Of 61 recommendations, ten related to care management and assessment
Report is available online on the OPWDD website
Goals of Recommendations:
Greater focus on outcomes and measurement
Ensure services are coordinated by experienced entities with expertise in providing services to people with developmental disabilities
Managed care model that reflects the unique needs of the people we serve

6. I/DD Specialized Managed Care
1/1/2019
I/DD Specialized Managed Care
In the FY Executive Budget, Governor Cuomo reaffirmed that the OPWDD system will transition to managed care
OPWDD is committed to developing a model of managed care designed around the unique needs of individuals with developmental disabilities
Performance measurement and value-based payments are tools to advance this vision
Collaboration with Health Department and OPWDD stakeholders to assure success

7. Building toward I/DD Specialized Managed Care
1/1/2019
Building toward I/DD Specialized Managed Care
Regional Care Coordination Organizations (CCO/Health Homes) will prepare for the move to a person-centered system of managed care for people with I/DD in NYS
CCO/HHs will be developed by existing developmental disability provider agencies with experience in coordinating services for people with developmental disabilities
Benefits of this approach include:
Providers have knowledge and experience serving individuals with disabilities and their families
Individuals and families have existing relationships with I/DD providers and confidence in their abilities

8. What is a CCO?
Care Coordination Organizations (CCO), a new organization to be approved by OPWDD
To provide enhanced care coordination services
Level of service tailored to individuals’ needs
Regionally based / community resources expertise
Personal choice
Build on traditional MSC role
IT enabled
Conflict free
Foster HCBS Rule attainment

9. Care Coordination Organizations (CCOs) are I/DD-Tailored Health Homes
1/1/2019
Care Coordination Organizations (CCOs) are I/DD-Tailored Health Homes
CCO/HHs will be designed as specialized Health Homes, with a focus on coordinating care for people with developmental disabilities
CCO/HHs will operate under the MRT 1115 Waiver
CCO/HHs may subcontract with existing I/DD MSC provider agencies for a period of time before being directly employed by the CCO
Those served currently by MSCs will transition to Health Home Care Management
This transition is the pathway to achieve a Conflict Free System per HCBS Final Rule – 42 CFR and transition to I/DD specialized managed care

10. Care Coordination is a Comprehensive Model
Care Coordination Functions
Linkage and Referral
Advocacy
Care Planning
Assess-ment
Monitoring
Record Keeping
Coordina-tion with providers
Cost Mgmt.
Eligibility & Benefits Maint.
Central Point of Contract

11. Comprehensive Care Management Includes
Use of care teams comprised of individuals receiving support and services and their representative/circle of support, developmental disability service providers, and medical, behavioral health providers, social workers, nurses and other care providers, as appropriate
Conflict-free care management services must be person-centered and person-driven
Comprehensive care coordination that addresses the individual’s needs holistically, including better access to physical, behavioral health services, and wellness
Support and care is detailed and monitored through the use of the OPWDD defined Life Plan that is integrated and electronic

12. Six Core Health Home Services
Comprehensive care management -- initial & ongoing assessment and care management services – to support individual outcomes & integration of habilitation, primary, behavioral and specialty health care and community support services, using a comprehensive person-centered care plan called a Life Plan
Care coordination and health promotion — implementation of the Life Plan and its continuous monitoring
Comprehensive transitional care from inpatient to other settings, including appropriate follow-up
Individual and family and caregivers support
Referral to community and social support services, to ensure that community resources are utilized, as individuals pursue meaningful activities consistent with their Life Plans and
The use of health information technology to link services, as feasible and appropriate

13. MSC Now And Future Focus
6/7/17
MSC Now And Future Focus -
New Paradigm Includes
MSC Current Approach
1. Coordinate and arrange provision of services
2. Support adherence to treatment recommendations
3. Monitor and evaluate individual’s needs
4. Identify community based resources
1. Use of Health Information Technology – to link services, and enhance communication between providers
2. Coordinate and provide access to wellness chronic disease support to individuals and families
3. Coordinate access to mental health and substance abuse services
4. Establish continuous quality improvement program – to collect and report on data that permits an evaluation of increased coordination of care
1. Strong emphasis on advocacy – actively supporting, encouraging, and/or negotiating on behalf of the individual
2. Required Professional Development Training/Courses – 10 to 15 hours of additional professional development training to enhance ability to service individuals with developmental disabilities

14. MSC Responsibilities Continue to Include:
Ensuring that the individual has determined who receives the whole plan or parts of the plan, based on the level of need of the individual, the scope of the services and supports being provided, and any applicable state and federal laws concerning privacy and confidentiality
Reviewing and revising the plan twice annually or when a change is needed, or when the individual requests one
Developing the ISP using a PCP Process
Writing the ISP
Following up to ensure that all needed attachments are received
Monitoring and implementing the ISP
Inviting the circle of support and providers to ISP review meetings and working with them when they cannot attend to ensure services are coordinated
Ensuring meetings occur when and where it is convenient to the individual;
Following up to ensure that the plan is being implemented as written
these two reviews are completed within 12 months prior to or by the end of the service month under review), when changes warrant a review, or when the individual or parties chosen by the individual request a review;
Attachments include: including habilitation plans, Individualized Plan of Protective Oversight (IPOPs), documentation to support rights modifications, such as behavior support plans, nursing plans, etc.;

15. Person-Centered Life Plan
1/1/2019
Person-Centered Life Plan
Supports and services are detailed and monitored through the use of OPWDD’s Life Plan, an integrated and person-centered electronic service plan
Care Coordination Organizations (CCO/HHs) will be responsible for the development & monitoring of the Life Plan
The Life Plan must include specific domain areas and be accessible electronically to all authorized members of the care team

16. Life Plan Domain Areas Description of the person
1/1/2019
Life Plan Domain Areas
Description of the person
Desired health, functional, and quality of life outcomes
Observable/measureable action steps to achieve outcomes that will be taken by the person, paid and unpaid service providers
Pertinent demographic information
Employment status
Services the individual will receive (waiver and non- waiver services)
Expectation of how goals and outcomes will be achieved
Safeguard description & supports to keep individual safe from harm
Back-up plan for situations where regularly scheduled HCBS waiver providers are unavailable or do not arrive
Information pertaining to behavioral support needed
Information regarding physical health conditions & treatment
Frequency of planned care manager contacts

17. 1/1/2019
Quality Measures
The State Plan and Health Home Core Sets of Quality Measures will be the basis for developing CCO/HH quality measures
Statewide Health Home Quality Measures PDF:
Additional, developmental disability focused quality measures will be developed by the State to track performance and help CCO/HHs, care managers and Managed Care Plans manage to quality outcomes
The list of quality measures will evolve over time

18. Initial DRAFT State HH Core Set of Quality Domains & Measures
Goal 1: Reduce utilization associated with avoidable (preventable) inpatient stays
Goal 2: Reduce utilization associated with avoidable (preventable) emergency room visits
Goal 3: Reduce utilization associated with short term Nursing Facility (NF) stays
Goal 4: Improve outcomes for persons with I/DD (health as well as personal/social):
Goal 5: Improve Disease-Related Care for Chronic Conditions
Goal 6: Improve Preventive Care
Goal 7: Improve Quality of Care Transitions

19. Impact on OPWDD’s Quality Improvement Efforts
DQI Certification and Surveillance activities will remain the same
DQI reviews involving current MSC providers will transition to CCO/HHs over time
Electronic systems will support information sharing among CCOs, the care team and OPWDD
Generate improvements in quality and care outcomes over time

20. Implementation Planning
OPWDD, DOH & CMS continue to finalize HH / CCO structure
Stakeholder communication – developing & ongoing
The HH State Plan Amendment expands the Health Home program to include Intellectual and Developmental Disabilities as a single qualifying chronic conditions eligible for health home services
Draft CCO / HH application will be released for public comment June-July 2017
Upon finalization of the CCO / HH application, a new phase of work will begin
Providers organize into CCO / HHs
Designation of organizations to be CCO / HHs
Readiness review & technical assistance
Launch in 2018

21. Learning From Emerging Experience
1/1/2019
Learning From Emerging Experience
Fully Integrated Duals Advantage program (FIDA-IDD)
One health plan that brings together Medicare, Medicaid and Waiver HCBS developmental disability services
Services are provided by a network of providers contracted with the health plan
Partners Health Plan (PHP) is the only plan selected by CMS to offer the FIDA-IDD program: PHP grew from downstate ARC consortium
Mainstream Managed Care enrolls 22,000 individuals with I/DD
DOH designated Health Home experience
DSRIP analysis and implementation, HARP, agency collaboration

22. What Can We Do Right Now?
The service relationships and expertise of the current MSC workforce will have an integral role in the transition to CCOs
Continue providing quality MSC services
Maintain current enrollment and caseload practices
Ensure that service coordinators understand and are following the Person-Centered Planning (PCP) regulation
Take opportunities to learn more about health and behavioral health systems and integration of care

23. 1/1/2019

24. Questions/Discussion
JoAnn Lamphere,