1. State Models of Medicaid/Behavioral Health Collaboration New Jersey Stakeholder Group Meeting January 20, 2012 Allison Hamblin, CHCS

2. Behavioral Health System Reform: Why Such a Hotbed of Activity? It’s all in the numbers… ► Top 5% drives 50% of Medicaid spending ► Half of beneficiaries with disabilities have BH comorbidity ► Addition of mental illness and substance use disorder to chronic medical population is associated with 3-4x increase in costs ► 25 years of lost life expectancy associated with serious mental illness, primarily due to physical health issues Yet, most of these individuals receive services through fragmented, uncoordinated systems 22 *Sources: RG Kronick et al., “The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions.” Center for Health Care Strategies, October 2009; C. Boyd, et al. “Clarifying Multimorbidity for Medicaid Programs to Improve Targeting and Delivery of Clinical Services.” Center for Health Care Strategies, December 2010.

3. Impact of Mental Illness & Substance Use Disorders on Cost and Hospitalization for People with Diabetes 3 SOURCE: C. Boyd et al. Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services. Center for Health Care Strategies, December 2010.

4. The National Landscape General trend away from fee-for-service toward managed systems of care Efforts to promote integration at both the system level and at the point of care ► Aligned incentives ► Information exchange ► Accountable care homes Significant variation in approach 4

5. A Range of Approaches to Reform StateSystem Design TennesseeIntegrated MCOs Pennsylvania Financial alignment across MCOs/BHOs ArizonaIntegrated BHO linked to BH Home New YorkASO to BHO/Integrated BHO 5

6. Pennsylvania’s Approach Separate capitated systems: MCOs and BHOs Regional pilots to promote integration for individuals with SMI Created Shared Incentive Pool tied to Performance Measures ► Process: Integrated health profiles, real-time hospital notification ► Outcomes: ED visit and hospital admission rates Designated accountable care home 6

7. New York’s Approach Separate approaches based on level of BH need ► Mild to moderate: MCO continues to include BH services ► Higher acuity: movement from FFS to managed care Phased implementation ► ASO in 2011 ► Capitated managed care in 2013 Geographic variation ► NYC: Integrated BHO/SNP ► Elsewhere: BHO Linkage to health home 7

8. Common Elements to Promote Integrated Care Aligned financial incentives (e.g., to coordinate, reduce hospitalizations, etc) Information exchange Clear policy guidance on privacy issues Accountable care homes Multidisciplinary care teams Competent provider networks Mechanisms for assessing and rewarding high- quality care 8